To study the application value of transeaophageal echocardiography (TEE) combinated transthoracic echocardiography (TTE) in preoperative screening,intraooperative guidance and postoperative follow-up of minimally invasive isolated secundum atrial septal defect (ASD) closure.

Totally 130 cases of isolated secundum atrial defects were treated by minimal invasive surgical device closure in The First Affiliated Hospital of Zhengzhou University from January 2013 to December 2014. Before the surgery, transthoracic echocardiaography was applied for screening; during the surgery we reassessed the sizes of the defects and their remaining margins, designated the suitable occluders, and guided the placement of the occludes, real-time dynamic evaluation of the effect by TEE. After 3 d, 3 months, 6 months, 1 year, the patients were postoperatively followed up at regular intervals by TTE which was employed to assess the therapeutic efficacy. Included the cardiac structure and function, synchronous detection, electrocardiogram, blood and urine routine.

Among the 130 cases of isolated atrial septal defect, 119 cases were successfully closed, the success rate is 91.5% (119/130). Among the 120 successful cases, 33 were cases (26.0%, 34/130) with short residue margin in opposite side of aortic posterior wall of ASD, all 27 cases (20.6%, 27/130) with short atrioventricular valve side margin of ASD were successfully closed, all 12 cases (9.1%, 12/130) with short posterior-tope of atrial margin of ASD were successfully closed, 6 cases were successfully closed among the 14 cases (10.8%, 14/130) with short posterior-inferior margin of ASD, 4 cases were successfully closed among the 6 cases (4.6%, 6/130) with mesh-type or double ASD, the remaining 37 cases (28.5%, 37/130) were successfully closed, which residul rims around the ASD were ≥ 5 mm. Eleven cases were repaired by intracardiac repairing under direct vision with the assistance of extracorporeal circulation, included 8 cases with short posterior-inferior margin of ASD, 1 case with short residue margin in opposite side of aortic posterior wall of ASD, 1 case of mesh-type ASD and 1 case of double ASD, the distance between two adjacent holes is >8 mm. With 1 year′s follow up, 119 successfully closed cases showed the firmly occlusion, there were no notable residual shunt, atrioventricular block, valve damaged, occluder-loss or valve regurgitation.

Echocardiography plays vital and reliable role in minimal-invasive surgical device closure of secundum atrial septal defects, especially in those with special and difficultly-occluded defects.