Patient: description of the disease (onset time, main symptoms, hospital, etc.): patient, male, 41 years old, slightly fat, physical fitness in the past, blood lipids, blood pressure and blood glucose is normal, red blood cells, hemoglobin is slightly higher than the high limit of the normal value. Two months ago, he suffered a cerebral infarction and was thrombolized, and then suffered a cerebral hemorrhage 16 hours later, and now he is recovering well. In the hospital cardiac ultrasound examination: ejection fraction 76%, the internal diameter of each atrial cavity in the range of normal values, ventricular wall and septum thickness, amplitude of movement did not see any abnormality. In the multisection view, there was an echogenic interruption of about 6 mm in the middle and lower part of the atrial septum, and the broken end was not clear. The morphology, echogenicity, and activity of the valves were not abnormal. The doppler: left-to-right septal flow was detected at the atrial level, and the spectrum showed a maximum flow velocity of 0.9 m/s; trace regurgitation was detected during systole in the tricuspid valve region. When would this patient be suitable for surgery if he were to undergo foramen ovale occlusion at your hospital? What other special investigations are needed before surgery? Is transesophageal ultrasound performed? Should transesophageal ultrasound be used for intraoperative intervention? Is it more risky to operate on a patient with an unclear stump? Because the patient had a cerebral infarction and hemorrhage 2 months ago, and we need to apply anticoagulant drugs during the surgery and take oral aspirin for 6 months after the surgery, so from the safety point of view, it is better to operate 3-6 months after the infarction or hemorrhage, after all, safety comes first. Because the location of the patent foramen ovale is in the lower middle part of the body, the stump is not clear (it may also be related to fatness and lack of ultrasound penetration), so we need to review the cardiac ultrasound, and if necessary, do a transesophageal ultrasound. If there is no stump in the inferior vena cava of the atrial septum, interventional occlusion is not possible. However, in patients with patent foramen ovale, the margins are usually fine and, based on experience, the likelihood of successful closure is very high. During the procedure, transesophageal cardiac ultrasound is usually not needed, only transthoracic ultrasound. Try to minimize the discomfort. Patient: Thank you very much for your detailed reply! Will I be able to see you directly in four or five months? Will you be able to do the surgery yourself? After all, he is the breadwinner of the family, and even a small operation has risks, so I don’t know what to expect. Yes, I can. Call me if you need anything. I will make a detailed judgment and formulate the best treatment plan. As a relative, I understand your feelings. Patient: Dr. Ku, I would like to ask you about a 10 year old girl, 28kg, who has had umbrella surgery for an atrial defect of about 5.5mm, is the dose of aspirin 0.1 too high? What else do I need to pay attention to in terms of exercise? Thank you! Generally speaking, after atrial septal defect blockage surgery, oral aspirin enteric-coated tablets 3-5mg/kg, 28kg, the minimum oral dose is close to 90mg, while Bay Aspirin is imported from Bayer, which has a more stable efficacy (than domestic aspirin enteric-coated tablets), and relatively fewer side-effects, with one tablet of 100mg. Therefore, in combination with your situation, oral Bay Aspirin 100mg once a day, no problem, half a year’s worth of dose. No problem, half a year’s worth. Of course, the biggest side effect of oral aspirin is bleeding. For example, gastrointestinal bleeding (dark stools), oral bleeding, nosebleeds and so on. Just keep an eye on it. Patient: You must be a very patient doctor! Thank you very much for your reply! You’re welcome, and I wish you good health!