Atrial septal defect, ventricular septal defect, and patent ductus arteriosus are common congenital heart diseases, and the traditional treatment methods include open-chest direct vision surgery as well as transcatheter peripheral vascular interventional occlusion. Open-chest surgery is the earliest method, which is suitable for all patients and has saved the lives of a large number of patients, but has the disadvantages of splitting the sternum or intercostal muscles, long surgical incision, need for blood transfusion, need for extracorporeal circulation, and long postoperative recovery time, which are very traumatic to patients both psychologically and physically. In order to overcome these disadvantages, transperipheral vascular interventional occlusion has emerged, which has the advantages of less trauma and faster postoperative recovery, but requires a catheter to be delivered into the heart from the root of the thigh, which has the risk of vascular rupture, retroperitoneal hematoma, cardiac perforation, etc., and can seriously endanger the patient’s life; moreover, radiation must be used to irradiate the patient during the operation, which has radiation damage and can affect the function of the bone marrow, genitalia and thyroid gland, etc., and increase the risk of the patient’s future childbirth. The risk of congenital diseases in the child’s future birth is increased, and even the risk of cancer in the child’s future is increased. The radiation hazard is so great that national legislation requires all doctors to wear protective clothing to protect themselves during surgery; there is a risk of allergy and kidney failure with the contrast agent used during surgery; if the blocker is unsuccessful, another queue is required for hospitalization in surgery and another anesthetic followed by open-chest direct vision surgery. In case of life-threatening complications such as dislodgement of the blocker, heart perforation, or pericardial tamponade, the child will need to be urgently transferred to the surgical unit for open-heart resuscitation, which will result in death if the transfer is not timely. Pan Xiangbin, Department of Pediatric Cardiac Surgery, Fu Wai Hospital, Beijing
To overcome these disadvantages, a third method has emerged: ultrasound-guided transthoracic occlusion. This technique involves the surgeon plugging the defect with an ultrasound-guided transthoracic blocker, avoiding complications such as damage to blood vessels and retroperitoneal hematoma; the surgical incision is about 2 cm, much smaller than the 10 cm incision for open-chest direct vision surgery, but slightly larger than the 1 cm incision for transcatheter intervention; the technique is not limited by the patient’s age and weight, enabling early detection and treatment; there is no radiation; no need to use The technique is not limited by the patient’s age and weight; there is no radiation; no contrast agent is required; the heart can beat normally during the procedure, avoiding extracorporeal circulation and blood transfusion; and shortens the patient’s hospital stay. More importantly, if the blocker is difficult to be inserted or dislodged during the operation, the surgeon can immediately perform open-chest surgery, avoiding re-anesthesia and eliminating the need for transport, thus gaining valuable rescue time and maximizing the safety of the patient. As long as the blocker is not placed in the body, no blocker fee is charged, truly allowing the patient to be cured with only one hospital stay, only one operating room, and only one cost.
Characteristics of various treatment methods
Consultation method
Outpatient Surgery
Interventional Clinic
Surgical Interventional Clinic
Surgical procedures
Open-heart surgery
Transperipheral vascular interventional occlusion
Transthoracic occlusion
Indications for surgery
Suitable for all types of patients
Suitable location and size of the defect
Suitable location and size of the defect
Surgical incision
Approx. 10 cm
Approx. 1 cm
Approx. 2 cm
Weight limit
No
Yes
None
Contrast agent
No
Yes
No
Radiation
No
Yes
None
In vitro circulation
Yes
None
No
Blood transfusion
Yes
No
No
Hospitalization time
7 days after surgery
3 days after surgery
3 days after surgery
Hospitalization cost
About 30,000
About 30,000
About 30,000
Major risks
Risk of extracorporeal circulation, third degree atrioventricular block, residual shunt
Failure of blocker insertion and readmission to open-heart surgery, third-degree AV block, blocker dislodgement, femoral arteriovenous fistula, retroperitoneal hematoma, contrast allergy, radiation injury
Immediate conversion to open-chest surgery for failed blocker placement, third-degree AV block, blocker dislodgement
Each of these three treatment methods has its own advantages and disadvantages, and they complement each other and are suitable for different patients. The modern medical system fully respects the patient’s right to know and the right to choose. We have the responsibility to introduce the advantages and disadvantages of various methods to you, and to develop individualized treatment plans according to the characteristics of the patient’s condition for the patient and his family to choose, so that the patient can receive safer and more effective treatment. Please consult the Surgical Interventional Clinic to find out if your child can enjoy the best treatment.
“Surgical Interventional Clinic hours: Monday morning, Tuesday morning, Wednesday morning, Thursday morning, Friday morning.
Contact: 010-88396666.