Introduction
ASD is one of the most common congenital heart diseases, accounting for about 10-20% of all congenital heart diseases(1). Traditional treatments—surgical extracorporeal circulation operation and transcatheter intervention therapy—have advantages and disadvantages. Transcatheter interventional therapy causes minor trauma and provides rapid recovery, but the use of radiation can damage the function of bone marrow, genitals, thyroid and other organs, and the use of contrast medium has a risk of an allergic reaction or renal insufficiency (2,3). The surgical extracorporeal circulation operation method is mature and has more indications, but it needs extracorporeal circulation, causes major trauma and unsightly incision. In recent years, echocardiography guided transcutaneous closure of ASD has gradually been applied. At present, the most common approach for transcutaneous ASD occlusion under the guidance of echocardiography is through femoral vein (4-9). However, this approach requires a relatively long operation path and the patient requires a long period of bedrest after femoral vein puncture. The femoral vein is slender in young patients, which limits the application of this technique. An alternative is to use the larger dimeter jugular vein, increasing the suitability in younger children(10-12). This approach also has shorter operation path and so requires shorter delivery system (11). Recent reports have highlighted the safe and effective use of trans-jugular ultrasound-guided closure of ASD (10-12). The use of an adjustable curved sheath for transcutaneous occlusion by this approach means the head of the sheath can be bent 0-900 , easing entry to left atrium through ASD under the guidance of transesophageal echocardiography (TEE). Though trans-jugular transcutaneous closure of ASD with an adjustable curved sheath under echocardiography guidance is few reports. Since 2016, the Heart Center of Henan Province People’s Hospital has started to use an adjustable bent sheath to close ASD under echocardiography guidance. The patients have been followed-up regularly, and the procedure has achieved good results.
We report the safety and effectiveness of this method to provide more information on this approach for clinicians interested in adopting the method in suitable patients.