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Percutaneous Device Closure of ASD under Transesophageal Echocardiography with a Newly Designed Adjustable Sheath Through Right Internal Jugular Vein off Fluroscopy
silin pan, Quansheng Xing, Benzhen Wang, Zhen Bing, Yueyi Ren.
Qingdao Women and Children's Hospital, Qingdao, China.

OBJECTIVE: Transcatheter intervention from femoral veins under fluroscopy, has been the gold standard for selected secundum atrial septal defects(ASD) with good results in the past 20 years. However, potential radiological injury and induced psychological worry has been a big problem. Futhermore, for small infants this method is limited for the improper femoral vein. Diameter of internal jugular veins in young children is bigger than that of their femoral veins. We, therefore, tried percutaneous device closure of ASD under transesophageal echocardiography (TEE) through right internal jugular vein off fluroscopy.
METHODS: Between June 2015 and September 2015, nine selected patients with secundum atrial septal defects were recruited . Their age ranged from 9 to 26 months and their bodyweight from 7 to 13.5 kg. The right internal jugular vein was punctured by a trocar of 20G. A guide-wire and then delivery sheath was introduced into the right atrium(RA) under real-time guidance of TEE. The sheath was curved into the left atrium by rotating the button at the end of the sheath. A proper device was selected according to the ASD size from transesophageal echocardiography (TEE) and then the device was released under real-time monitoring of TEE if no residual shunt, abnormal atrioventricular valvular motion appeared.
RESULTS: Eight of the nine children were successfully device closed through right internal jugular veins without fluroscopy. The other one was converted to conventional open heart repair due to abnormal occluder shape. There was no operative or late mortality or major morbidity. All of them were followed up 1 to 4 months. No residual shunt, increased aortic prolapse or regurgitation or serious AVB was recorded until the most recent follow-up.
CONCLUSIONS: Selected secundum ASD can be safely closed with a proper occluder through right internal jugular veins off fluroscopy with satisfactory results.

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