[Note: Because of the search for information, it is incidental to summarize the problems related to interventional occlusion of atrial septal defect. First of all, the following content is from the network, and each question is answered by a well-known expert in the field, my review is only from the perspective of a third party, only for the reference of patients, after all, the medical knowledge of patients is limited. Please also peers correction, do not teeth laugh].
Consultation title: Patient with precordial disease, atrial defect closure, headache and chest tightness after half a month postoperatively.
Q: Half a month after the interventional blocking of the precordial atrial defect. In oral medication. If the headache and chest tightness do not improve, can the blocker be removed and the atrial defect be repaired?
A: Why do I need to remove the blocker? If there is no abnormality, it is not necessary to take it out. Although technically it is easy to remove the blocker and repair the defect, it is not necessary to do so.
Q: The patient felt fine after the blocking surgery, but within a few days, he had several severe headaches with nausea, and then increased the dose of aspirin (from 400 mg to 600 mg) for a week without an attack, but after reducing the dose, he had another attack, and is now taking 600 mg. Since two days ago, I have been experiencing chest tightness and suffocating in my chest again. I am worried that it is the reason for putting in the blocker, and I am afraid that other adverse symptoms will occur in the future, which will affect my health and life. Therefore, if the risk is not too great, I would like to remove the blocker and surgically repair the atrial defect. I wonder if the child’s headache and chest tightness are normal reactions after blocking surgery? Will they gradually get better over time.
A: Headache after atrial septal defect blocking is a rare or even uncommon condition. The exact mechanism of occurrence is not fully understood, and it usually resolves on its own, but it lasts for an average of 2 years. At present, there is nothing too good except symptomatic pain relief treatment. The method you described is too extreme, undesirable and too traumatic. If conditions permit, you can go to an outpatient clinic for in-person counseling, which really relies heavily on explaining the condition to the patient and providing psychological relief. Everything will pass.
Medications can be tried with some of the newer anticoagulants that have been reported in the literature to significantly reduce the percentage of headache attacks and the duration of the illness. You can call me if you need.
Q: Hello! My child had a sudden headache this morning with blurred vision that lasted for half an hour and then gradually improved. In addition, the number of chest tightness has increased over the past two days and he feels some pain in his chest. What should I do? You said yesterday that changing the medicine can reduce the symptoms, I wonder what is the name of the medicine? How should I take it? I need a reply urgently!
(My comment: It may be necessary to remove the blocker and repair the defect surgically.)
Consultation title: Chest tightness after atrial defect surgery, vomiting blood in the morning
Q: I was admitted to the hospital in September last year for atrial defect, and you performed the atrial defect blocking surgery, and I was discharged 2 weeks later. Since then, I have been very busy at work and often feel very tired and have chest tightness. When I brush my teeth in the morning, I vomit blood with bright red blood and vague chest pain.
A: Is it bleeding from teeth or other parts of the body? You can review the heart ultrasound to check for pulmonary hypertension. Outpatient clinic every Monday.
Q: I have been paying attention for a long time and it does not look like bleeding gums because it is vomited and the blood is sticky red. I will visit you next Monday, thank you!
Q: Professor, I’ve been particularly busy at work lately, traveling all the time, feeling especially strained, feeling as if my back is so sore, and my face doesn’t look too good. Is this due to my lack of exercise, or is it due to atrial deficiency? Could it be pulmonary hypertension? I always feel that the area of my body where the lungs and heart are in contact is particularly prone to strain. Director, please don’t mind if I say something amateurish!
(My comment: You should be admitted to the hospital as soon as possible for examination to identify the cause. (Depending on the cause, different strategies should be adopted.)
Consultation title: I had sinus rhythm after blocking surgery when I was five or six years old for congenital atrial defect; now I am nine years old and I often suffer from lymphitis, chest tightness and chest pain recently.
Q: I had blocking surgery in 2007, and recently I had chest tightness and chest pain, frequent lymphatic inflammation, (right lower abdomen, parotid gland) ECG showed 1st degree atrioventricular block and sinus arrhythmia, and the results of the review after blocking surgery in 2007 were basically normal. Is it normal to have such symptoms now and do I need any tests?
A: Hello, this situation should be a complication of interventional blocking, it is recommended to review the cardiac ultrasound, and individuals may not rule out the possibility of removing the blocker. In developed countries, interventional blocking is limited to myocardial ventricular septal defect and arterial catheterization. In the past, interventional blocking of atrial septal defects was done in developed countries, but this method was eliminated due to many problems. I hope the above reply will be helpful to you.
(My comment: close observation, regular follow-up ultrasound, if the symptoms of chest tightness and chest pain worsen, then you should really consider removing the blocker. In addition, atrial defect accounts for the first place in Chinese precordial interventions, and the amount of Chinese precordial interventions is the first in the world. A lot of practice proves that interventional blocking of atrial and ventricular defects is feasible, but the indications must be chosen well.)
Consultation title: 21-year-old female, who had atrial defect closure three years ago and now has mild tricuspid regurgitation
Q: Patient female, 21 years old, you helped me to have atrial defect blocking surgery three years ago, I have been feeling good after the surgery, recently I have been having panic attacks and sometimes shortness of breath. This time the condition.
1. myocardial ischemia, ECG sinus rhythm with T-wave changes.
2. No residual shunt at atrial level and mild tricuspid regurgitation. 2. No residual shunt at the atrial level and mild tricuspid regurgitation. What is the treatment?
A: Mild tricuspid regurgitation is meaningless if there is no residual shunt! Recent discomfort is not necessarily cardiac related. Seek medical attention if necessary!
Q: Thank you very much, I would also like to ask if the risk of complications from atrial defect sealing is with the whole life? I am now very worried about this …… Thank you again!
A: Complications from atrial defect closure usually only occur within a short period of time after surgery, and if there are no complications at that time, they usually do not occur again afterwards!
Q: Hello, I would like to ask you a question. Since I had my atrial defect blocked, sometimes I have trouble seeing, I get white in front of my eyes, and then I get a headache, but I usually get better after I sleep. Last time, the doctor gave me seven days of Trigonelline Hydrochloride, but in the past two days, I’ve been getting some white in front of my eyes again, and I have a slight pain in my head, and sleeping doesn’t help. What is going on here? How should I treat this?
A: If necessary, perform an ambulatory electrocardiogram. If there is no significant abnormality in this test, it is not related to the heart. If there is no significant abnormality, it is not related to the heart.
(My comment: Complications after atrial defect closure may occur several years later. Continue close observation and regular follow-up ultrasound.)
Consultation title: Female, had atrial defect blocking surgery 8 months ago, now the pulmonary artery is widened, further
Q: She had atrial defect blocking surgery 8 months ago, and now she has had cardiac ultrasound results: widened pulmonary artery, right ventricle, normal left heart, left ventricle wall is not thick, normal motion, right ventricle wall motion amplitude is normal, atrial septal continuation is intact, patch echo can be detected, septal continuation is intact, each valve morphology structure opening and closing is generally normal pericardial cavity (not) detects liquid dark area bilateral chest cavity (not) detects liquid dark area. This is the result of the examination in the hospital. Do I need further examination?
A: Hello, Melan! According to your examination results, there should be no problem. The widening of the pulmonary artery is due to the original disease and will not affect you in any way. Please rest assured!
(My comment: Continue to observe and follow up with ultrasound and ECG regularly.)
Consultation title: Atrial defect 8 mm. Interventional closure, will there be sequelae
Q: Congenital atrial defect, 8 mm in diameter, usually without obvious symptoms, was seen at Shenyang Army General Hospital. There is no treatment yet. What kind of help do I want to get: What will happen after interventional blocking?
A: No complications clearly related to the treatment of atrial defect have been found.
(My comment: Interventional occlusion has complications and is life-threatening in severe cases.)
Consultation title: I have a congenital atrial septal defect of 3.5 cm in size, which is a large atrial defect
Q: I have a congenital atrial septal defect of 3.5 cm, which is a large atrial defect, but I had a famous professor in China do the blocking operation at the age of 20, and the umbrella is 4.0 cm, the largest. It has been two and a half years since I had the surgery, and I have had three ultrasounds, all of which were normal. Can I get pregnant? Is it dangerous? What should I pay attention to? Thank you!
A: Hello, according to your condition, it is impossible to get pregnant. But everything is normal after your surgery is it? We suggest you to consult with your local maternal and child health station.
(My comment: If multiple ultrasounds and ECG are normal, there is still a chance of pregnancy, and a woman should not be deprived of her rights.)
Title: I heard from a patient in the same hospital that I had to give a red packet to the attending doctor, surgeon and anesthesiologist before the operation. How much should I give?
Q: I heard from a patient in the same hospital that I had to give a red packet to the attending doctor, surgeon, and anesthesiologist before the operation. How much do I have to give? I heard from the patient that if they don’t give the red packet, they will use the non-medical stuff, including the long time in ICU! How much should I give normally?
A: Hello, congenital heart disease, atrial septal defect, surgical treatment is recommended, rather than intervention. Based on the following: “atrial septal defect repair” the total cost of hospitalization is about 18,000 to 20,000, which may vary from region to region and from hospital to hospital. You can look at “open heart” in Baidu. It is possible that you will have a new understanding of intervention. The success rate of “atrial septal defect repair” is basically 100% in large cardiovascular surgery centers with mature technology. After treatment, you will be as normal as a normal person. It does not affect your work and life. If surgery is performed, it is recommended to go to a hospital that performs a small right axillary cosmetic incision for atrial septal defect repair. Small right axillary cosmetic incision (as shown in the picture) The postoperative period is the same as normal. There are no after-effects. Interventional occlusion is limited to muscular ventricular septal defects (very rare) and arteriovenous catheterization. Interventional occlusion is very risky compared to more mature cardiovascular surgery, so it is now strictly limited in developed countries. Only a few surgical procedures that are more risky, such as myocardial septal defect and arteriovenous insufficiency, are used for interventional treatment. Do not ignore the greater risks of interventions (including the dangers of radiation) for fear of larger skin incisions. For more information on the risks of interventional management you can look at the references. I hope the above reply will be helpful to you and wish the patient good health.
(My comments: Hospitals are not allowed to accept red packets from patients, and recently the Ministry of Health also requires hospitals: all patients who are hospitalized should sign an agreement to refuse red packets on the first day of hospitalization. As for whether atrial and ventricular defects are suitable for interventional blocking, it depends on the specific situation. At present, China has the highest number of interventional occlusion cases in the world. (Facts speak louder than words.)
Consultation title: 41-year-old female, atrial septal defect (central type) occlusion surgery
Q: In May 2011, she had an ultrasound examination at Xijing Hospital because she felt tightness in her chest for a long time, and the ultrasound suggested congenital heart disease: atrial septal defect (central type). After the examination at Xijing Hospital, I went to Jiaotong University Second Hospital and asked a friend to help me. Currently untreated. What kind of help do you want: I saw Dr. Li’s introduction online, he is good at seeing congenital heart disease, do you need surgery for the above case? Is it risky to have surgery and can it be cured after surgery? Is it long-term medication, how long does hospitalization and recovery take?
A: Interventional atrial defect blocking can be done. It is a radical surgery. The surgery is relatively safe. The cost is about 25,000 yuan. Hospitalization is 4~5 days.
(My comment: It is possible to do interventional occlusion. Of course, it should be explained to the patient that there is an open-chest surgery. Let the patient choose whether to have an open or interventional procedure. Don’t let the patient think that there is only one method of interventional occlusion)
Consultation title: Atrial defect occlusion
Q: 1. 11-hole atrial defect “left-to-right shunt” 2. mild pulmonary hypertension with mild to moderate tricuspid regurgitation.
How are you, doctor? Is it okay to take medication without surgery? I am afraid that there may be sequelae or life threatening effects.
A: Nowadays, atrial defect surgery is very safe and there are very few serious complications, so you don’t need to worry too much about surgery. What you need to consider is to choose the type of surgery.
1, atrial defect blocking, less traumatic, but limited to the atrial defect itself, if combined with moderate to severe tricuspid regurgitation or open surgery is more reasonable. In addition, if the circumference of atrial defect is thin or narrow, the blocker for blocking will be easily dislodged, and after dislodging, the blocker will need to be removed in emergency surgery, which is risky.
2.Thoracoscopic atrial defect repair and tricuspid valvuloplasty are more suitable for your case, with small trauma and fast recovery, using a cosmetic incision, which basically leaves no scar after surgery.
3. Traditional open surgery is very mature and safe, but it is slightly more traumatic and leaves a longer scar after surgery.
On the whole, I recommend you to choose thoracoscopic atrial defect repair + tricuspid valvuloplasty.
Patient: Thank you, doctor. Is there a difference between thoracoscopic atrial defect repair, tricuspid valvuloplasty, and atrial defect occlusion? Is there a difference between atrial defect repair and tricuspid valvuloplasty? I am afraid that there will be sequelae after the surgery. What medicine can I take to control it?
A: Theoretically, an atrial defect larger than 1 cm needs to be operated. The timing of surgery is generally the earlier the better. You already have tricuspid valve closure insufficiency, the pulmonary artery pressure is getting higher and higher, and the symptoms will only get worse. The risk of surgery will gradually increase over time, so I recommend that you have surgery sooner if you have the conditions. Atrial defect blocking can only solve the problem of your atrial defect, tricuspid valve insufficiency still needs surgery. It is recommended that you undergo surgery early, which can be thoracoscopic atrial defect repair + tricuspid valvuloplasty for less trauma and faster recovery. If thoracoscopic surgery is difficult, undergo traditional open surgery.
Patient: Doctor, I have been on the special electrocardiogram, thank you in the busy time to give me a look, not to do surgery, or how is the treatment, I can now move significantly, because I am a dancer, now as a coach, often dance rehearsal, I thank you very much, look forward to your answer!
A: The ultrasound results have been read. From the ultrasound results, there is a 1.6cm atrial septal defect, which currently has a small effect on the size and function of your heart. With the passage of time, the size and function of your heart and the lesions of the pulmonary vascular system will gradually worsen, and there are no drugs that can reverse or treat these changes, and surgery should still be done early. According to the nature of your work and requirements, atrial defect closure is the treatment option of choice. If closure is reluctant, thoracoscopic atrial defect repair is not the best treatment option.
(My comment: All methods have risks, it is just a matter of which method has relatively less risk and is suitable for this patient.)
Consultation title: Is it necessary to try interventional closure of atrial defect in this patient?
Q: The edge of atrial defect (secondary foramen type) is 0.2 cm from the posterior wall of the main A. No significant symptoms at present. Not treated either. What kind of help do I want to get? One hospital said to try atrial defect interventional occlusion. Is it necessary to do so? Laboratory and examination results: Cardiac ultrasound (transthoracic and esophageal) large-vessel short-axis view of the atrial defect is about 1.3 cm in caliber, and the edge of the notch is about 0.2 cm from the posterior aortic wall. In the apical four-chamber view, the continuous interrupted notch in the upper middle of the atrial septum is about 1.5 cm, the upper edge is 0.5 cm from the top of the atrium, and the lower edge is 2.3 cm from the mitral annulus (of which 1.8 cm is the soft edge).
A: It can be blocked and treated. Interventional treatment should be performed for defects larger than 0.5 cm. Your atrial defect hole is large and should be treated early.
Patient: Thank you, director, for replying to me in your busy schedule. This patient’s atrial notch is large, mainly the edge of the notch is only 0.2 cm from the posterior wall of the aorta, and I see that the edge has to be more than 4 mm to be done, is that right?
A: It can be successfully blocked.
(My comment: All methods have risks, just which method has relatively less risk and is suitable for this patient. The echocardiographic short-axis view shows that the defect is close to the aorta, so we can try to seal it, but we should also be prepared for failure. In addition, according to the long-term follow-up observation, a few patients after atrial defect intervention have experienced heart perforation due to blocker abrasion, which may be related to insufficient aortic side stump. About this point, it must be clearly explained to the patient. If the patient has doubts, then open-heart surgery is recommended for repair. (In short, in a word: any intervention regarding precordial disease should not be forced, otherwise, it will not look good for everyone if there are unexpected complications.)
Consultation title: Atrial septal defect blocking consultation
Q: Congenital atrial septal defect of 10 mm. 30 years old before this year with no obvious symptoms, ultrasound was done at the time of delivery and the diagnosis was: secondary foramen ovale, slightly increased pulmonary artery pressure, tricuspid valve closure insufficiency (moderate). Ultrasound findings three months after delivery: right atrium, right ventricular enlargement, secondary foramen ovale (central type), tricuspid regurgitation (moderate amount), and no abnormalities in left ventricular function. What kind of help do I need: Is there a doctor in Shanxi who is skilled in interventional blocking? What is the best doctor to call? What is the total cost of the interventional blocking procedure? How long does it usually take from the time of consultation to the time of discharge? (I want to know if there are working class people who can do this.)
A: I don’t know much about the situation in Shanxi. There are several specialists in the hospital who can do this procedure. The cost of the interventional blocking procedure in the hospital is about 25,000 yuan (domestic blocker) to 45,000 yuan (imported blocker), and the general hospital stay is 2 to 3 days.
(My comment: Now interventional blocking therapy has been carried out in many places, and the technology is gradually mature. But relatively speaking, Guangzhou, Shanghai and Beijing are still the three major cities with the most advanced medicine in China)
Consultation title: Can atrial defect blocking be done?
Q: Atrial defect of precordial disease. 17-year-old female with atrial septal defect [secondary foramen ovale, 13mm wide], enlarged right heart, pulmonary artery internal diameter, widened right ventricular outflow tract, tricuspid regurgitation [mild], and reduced cardiac function measurements. How do you want to be helped?
1.Whether interventional treatment can be done.
2.Can we do thoracoscopic minimally invasive occlusion?
3.How long does it take for cost and recovery time?
A: You can choose interventional blocking and surgical blocking treatment, the cost is about 25,000, and the hospital stay is about 1 week.
(My comment: Whether the atrial defect can be blocked by intervention depends not only on the diameter, but also on the relationship between the defect and the surrounding tissues, if the defect is <5mm from one of the surrounding structures, it is difficult to perform interventional blocking. (Therefore, the interventionalist should first be familiar with ultrasound himself, and it is better to operate ultrasound himself.)
Consultation title: 6 weeks old boy with atrial septal defect secondary to a central foramen of about 3.7mm, should I intervene?
Q: Atrial septal defect. 6 weeks old boy, atrial defect secondary foramen central type about 4.1mm was found in hospital two years ago, and about 3.7mm was rechecked this year.
Previous treatment and results: No treatment. How would like to be helped.
1.Does the data indicate that the atrial defect is decreasing?
2.Do I need to do interventional treatment? When is it appropriate?
A: At least it has not grown. At present, because the atrial defect is not large, interventional surgery can be done or not, parents decide, the technology is quite simple.
(My comment: The diameter of atrial defect is not the same twice, so it may not be the same person who did the ultrasound. But it can be considered as a small defect. The technique is simple, but any surgery is risky and parents should understand that)
Consultation title: Is surgery necessary for pediatric secondary foramen ovale heart defect 8.7mm and when and when to do it
Q: Pediatric secondary foramen ovale heart defect 8.7mm. patient age: 1.5 years old gender: male. Ultrasound examination (October 30, 2008)
Image description: Normal aortic valve structure, root internal diameter 15.8mm pulsatile artery valve structure normal, root internal diameter 11.7mm. left atrium anteroposterior diameter 13.0mm, right atrium large 27.3*26.6mm, interrupted atrial septum. Left ventricle: end-diastolic anteroposterior diameter 26.5mm, end-systolic anteroposterior diameter 15.2mm, posterior wall thickness 4.9mm.
Right ventricle: anteroposterior diameter 11.7 mm, anterior wall thickness 2.5 mm, right ventricular outflow tract 14.4 mm. septal thickness 3.5 mm with left ventricular posterior wall motion in reverse continuity intact. The left ventricular end-diastolic volume was 25.8 ml. end-systolic volume was 6.2 ml. ejection fraction was 75.7% and shortening fraction was 42.7%.
The right atrioventricular cavity was enlarged. The left ventricular cavity was found to have a strong echogenic cord-like echo.
The ventricular wall is not thick and the motion pattern is normal.
An 8.7 mm echogenic defect was found in the middle of the interatrial septum, and a left-to-right red shunt signal was detected at the atrial level on CDFI. The ventricular septum was intact, and no shunt signal was detected on CDFI.
The CDFI detected an orchid regurgitant signal at the tricuspid orifice, Vp2.49m/sPg24.8mmHg.
5.The position structure and internal diameter of large vessels were normal.
Ultrasound: congenital heart disease: atrial septal defect (secondary foramen) left ventricular tendon abnormality tricuspid valve insufficiency with mild regurgitation left heart systolic function is normal.
Is my child’s condition serious? Is surgery necessary, or does he need surgery right away? Is there any hope for automatic closure? If surgery is necessary, at what age is it appropriate? What should I pay attention to in my daily life before surgery? Is intervention suitable for treatment? What is the approximate cost?
A: From my experience, surgery is needed, he is already 1.5 years old to close by himself may not be great, in adults this defect is not large, but for such a small child is already larger, surgery can now do, slightly older to do can also, the cost is about 20-30,000, interventional surgery is too young is not easy to operate, can wait 2-3 years and then see, the cost of 50,000. The cost is about 50,000. Pre-existing heart disease mainly leads to heart failure, prone to infection, avoid physical load and infection. If there are still questions, you can consult the surgery.
(My comment: This atrial defect is unlikely to close naturally, treatment is sooner or later, but later, you can choose interventional blocking surgery)
Consultation title: Can people who have undergone heart surgery and “atrial defect blocking” exercise? There is a blocker inside, what is the best exercise to do. I hope the experts will give me advice Q: I have atrial defect with precordial disease, and I have undergone atrial defect blocking. Is it possible to do physical exercise? What is the best exercise to do?
Answer.
1. Direct heart surgery under extracorporeal circulation. At present, the main treatment method for atrial septal defect is direct cardiac surgery under extracorporeal circulation to perform atrial defect suture or repair. However, the surgery is very traumatic, and the length of the surgical incision can reach tens of centimeters. The recovery period after surgery is also longer. The patient’s pain is greater.
2.Interventional blocking method. Interventional blocking method, which has emerged in recent years, is to close the defect by placing the atrial defect blocker into the atrial septum through a catheter via percutaneous puncture. This treatment method is less invasive and has a faster recovery after surgery. However, the indications for the procedure are narrow and limited to simple central atrial defects. Moreover, due to the longitudinal stress between the blocker and the catheter, the success rate of the procedure is low, and there is a high possibility of blocker dislodgement after surgery. In addition, because the blocker is soft, its transverse projection is large, which has an effect on blood flow and is more destructive to blood cells. Also, the high cost of this treatment method is not affordable to the general public. The success rate is 98.1%. The incidence of serious complications is 0.9% (including 0.5% of blocker dislodgement and 0.4% of pericardial blockage), and the mortality rate is only 0.2%.
3.Minimally invasive atrial defect blocking under non-extracorporeal circulation. No extracorporeal circulation is needed, and the surgical incision is only 2-3 cm. A small incision is made through the third or fourth intercostal incision on the right side to enter the thoracic cavity, and the pericardium is incised. Under the guidance of B-ultrasound, the surgical blocker is inserted into the atrial septal defect. The operation is relatively simple and takes only half an hour to complete. The incision is small, no extracorporeal circulation is required, and the patient suffers little pain. Patients can move freely on the ground the day after surgery and can be discharged from the hospital three days after surgery, and the cost of surgery is similar to that of traditional treatment. The indications for surgery are broad and can be applied to all secondary atrial defects. Because of the direct operation, the texture of the blocker is stronger and it is not easy to fall off after the operation, and the success rate of the operation is 100%.
(My comment: The movement is possible. There are more than 1 million patients who have minimally invasive interventions in the United States every year, and they live their lives with the same exercise. (However, less direct confrontational sports such as rugby are recommended to avoid impacting the chest.)