Surgical treatment of complications after atrial septal defect sealing has a history of more than 30 years, and interventional treatment of atrial septal defects (ASD) has been favored by physicians and patients because of its relatively simple operation, minimal trauma, and rapid postoperative recovery. However, physicians who perform interventions must clearly understand that although interventions are safe, there are various complications. Some complications can interpret ~ a simple congenital heart disease into a more complex surgical situation and affect the long-term survival quality of the patient, and some complications are even fatal and require emergency surgical treatment. From March 2005 to December 2008, the authors treated 12 cases of surgical complications after atrial septal defect sealing in different hospitals (mostly patients referred after sealing in other hospitals), which are reported below. 1. Data and methods There were 12 cases in this group, including 5 male and 7 female cases. All cases were diagnosed as secondary foramen ovale septal defect and underwent percutaneous atrial septal defect occlusion. In four cases, the blocker was dislodged intraoperatively, and the blocker was removed and the atrial septal defect was repaired under emergency extracorporeal circulation. Intraoperatively, the blockers were located in the tricuspid orifice in 2 cases and in the right ventricular outflow tract in 2 cases. Three months after percutaneous septal defect sealing, one case of acute pericardial tamponade developed, and an emergency open-heart exploration was performed. The hematoma was removed under extracorporeal circulation, the blocker was removed, and atrial septal defect repair and repair of the hematoma near the right upper pulmonary vein in the atrial sulcus was performed. One case of persistent cough, coughing sputum, and inability to lie down at night after atrial septal defect blocking, with echocardiography indicating massive mitral regurgitation. After 2 weeks of drug treatment for left heart insufficiency, intracardiac exploration was performed under extracorporeal circulation. Intraoperatively, the blocker was seen to be holding the left atrial lateral disc against part of the anterior leaflet of the mitral valve, resulting in massive mitral regurgitation. Intraoperatively, the blocker was removed, and the root of the anterior leaflet of the mitral valve was indented and the annulus was significantly enlarged.j Mitral annuloplasty was performed. The residual shunt of the atrial septal defect was closed in 6 cases, with a shunt diameter of 6-8 cm. The blocker was removed 3-6 months after closure. The atrial septal defect was repaired. Two cases of residual shunt due to unsatisfactory position of the blocker, one case of multiple ASD, and three cases of ASD edge avulsion due to weakness were seen intraoperatively. 2. Results All cases were cured by surgical treatment without any special complications. In those with mitral valvuloplasty, mitral valve hemodynamics were normal. 3, Discussion Complications after ASD occlusion include atrial arrhythmias, transient conduction block, air embolism, thromboembolism, and migraine. In addition, they include ASD residual shunt, blocker dislodgement, and blocker abrasion of surrounding tissues. 3.1 Residual shunt after occlusion: The diameter and location of ASD, the softness and hardness of ASD edge and its relationship with the surrounding structures were accurately measured intraoperatively so that a suitable size of blocker could be selected to reduce the occurrence of residual shunt. In this group, there were 6 cases of residual shunts from ASD occlusion with a shunt diameter of 6-8 rtlnA. 2 cases of residual shunts due to unsatisfactory position of the occluder, 1 case of multiple ASDs and 3 cases of ASD edge avulsion due to weakness were seen intraoperatively. It is generally believed that defects with shunt diameter <5 mm can be left untreated, and surgical procedures can be considered for those ≥5 mm. In order to prevent the occurrence of residual shunts in ASD, it is also undesirable to choose the method of oversized blockers during the blocking operation. Firstly, oversized blockers are likely to cause damage to the surrounding tissues, and secondly, if the blocker is too large, the thrombus will fill the blocker, which will cause the blocker to be too heavy. Therefore, the authors also believe that blocking is not an option for ASDs that are too large. 3.2 Blocker dislodgement: Blocker dislodgement can occur intraoperatively or postoperatively. Common reasons include poor connection between the push rod and the blocker, small blocker selection, short or irregular ASD margin, and improper operation. Once it occurs, the patient is placed in a flat position and given sedation and heparin anticoagulation. The blocker should be removed under emergency extracorporeal circulation. The blocker is usually retained in the tricuspid orifice or right ventricular outflow tract. Retention in the mitral valve orifice has also been reported. After removing the blocker, attention should be paid to the presence of thrombus at the site of retention. In our group, four cases of blocker dislodgement occurred intraoperatively, including two cases of blocker retention in the tricuspid orifice and two cases in the right ventricular outflow tract. 3.3 Abrasion of the surrounding tissue by the blocker: Abrasion of the surrounding tissue by the blocker can lead to rupture of the aortic sinus, resulting in right or left atrial fistula. In addition, it can also wear the free wall of the atrium and perforate it, resulting in cardiac compression. Rupture due to wear of the surrounding tissue by the blocker can occur several years after blocker implantation. In our case, 3 months after the blocking of the atrial septal defect, an acute cardiac tamponade appeared on review, and an emergency open-heart exploration was performed. The intraoperative findings were due to wear of the right atrial free wall by the occluder. Therefore, long-term monitoring should be performed after ASD occlusion, especially if a large size blocker is used. 3.4 Mitral valve insufficiency: This complication has not been reported in the literature, and mitral valve insufficiency should be highly considered after ASD occlusion when patients present with symptoms of left heart insufficiency such as coughing, coughing up foamy sputum, and inability to lie down at night. Echocardiography may clarify the diagnosis. In this patient, the left atrial side of the blocker was seen to be on top of the anterior leaflet of the mitral valve, causing the leaflet to fail to close when the mitral valve was closed, resulting in a large amount of mitral regurgitation. After intraoperative removal of the blocker, traces of pressure on the root of the anterior leaflet of the mitral valve were seen, and the annulus was significantly enlarged. The enlargement of the annulus may be due to the enlargement of the heart caused by long-term mitral valve insufficiency. Because of the clear etiology, satisfactory results can be achieved after mitral valvuloplasty. Related literature 1. Efficacy of transcatheter interventional occlusion for congenital atrial septal defect and management of its complications. Chinese Journal of Health Care Medicine 2010,12(4) 2. Analysis of arrhythmias after catheter occlusion of atrial septal defect [Journal Article] - Clinical Auxiliary 2007,22(23) 3. Prevention and care of complications of interventional occlusion of atrial septal defect [Journal Article] - Journal of the Fourth Military Medical University 2005,26(10) 4. Rescue and care of acute pericardial tamponade complicated by atrial septal defect occlusion [Interventional treatment of residual shunts after surgical suturing of unclosed arterial catheters [Journal paper]-Medical Clinical Research 2008,25(12) 6. Prevention and treatment of vasovagal reflexes caused by interventional treatment of coronary heart disease [Journal paper]-Chinese Traditional Chinese Medicine Emergency 2009,18(9) 7. Analysis of the causes of complications and nursing countermeasures in 50 cases of postoperative pediatric VSD occlusion [Journal Article] - Lingnan Journal of Cardiovascular Disease 2004,10(6) 8. Analysis of the efficacy of 175 cases after transcatheter interventional occlusion for arteriovenous ductus arteriosus [Journal Article] - Journal of Nanjing Medical University (Natural Science Edition) 2007,27(6) 9. Analysis of complications and causes [Journal Article] - Chinese Ultrasound