Objective:To explore the characteristics and prognoses of perimembranous and high ventricular septal defects (VSD) closure via a ultra-minimal trans-intercostal incision (i.e.left parasternal intercostal ultra-minimal incision≤1 cm) in children guided by transesophageal echocardiography (TEE) and provide references for such mini-invasive surgery.Methods:From January 2015 to December 2021, 344 cases of VSD closure via a left parasternal ultra-minimal trans-intercostal incision in children guided by TEE.According to the location of VSD, they were divided into two groups of perimembranous VSD (239/344, 69.5%) and high VSD (outflow tract & high membrane)(105/344, 30.5%). Operative procedures, operative duration, postoperative complications, prognoses and other relevant data of two groups were compared.Results:Among them, 229 cases (229/239, 95.8%) of perimembranous VSD and 100 cases (100/105, 95.2%) of high VSD were successfully occluded.No significant difference existed in success rate ( P>0.05). However, operative duration of perimembranous VSD was longer than that of high VSD ( P<0.05). In both groups, diameter of VSD was correlated positively with diameter of occluder, but not with operative duration.Among 239 cases of perimembranous VSD and 105 cases of high VSD, 12 cases (12/239, 5.0%) and 5 cases (5/105, 4.8%) were successfully re-occluded after adjusting or replacing occluder.No significant inter-group difference existed in success rate of re-occlusion ( P>0.05). A total of 10 children in perimembranous VSD group failed to occlude, including 7 cases (7/239, 2.9%) in which guide wire could not pass through VSD, 2 cases (2/239, 0.8%) in which occluder slipped off and 1 case of ventricular fibrillation.There were 5 cases of occlusion failure in high VSD group, including 1 case in which guide wire could not pass through VSD during operation (1/105, 1.0%), 1 case with occluder displacement during operation and 1 case post-operation (2/105, 1.9%), 1 case with aggravation of aortic regurgitation and 1 case with marked decrease in blood pressure.There was no significant inter-group difference in failure rate when guide wire could not pass through VSD and occluder slipped off or shifted( P>0.05). During a follow-up period of (1-4) days in perimembranous VSD group, there were 1 case of mild mitral regurgitation and 4 cases of mild-to-moderate tricuspid regurgitation.No change occurred during 6-month follow-ups.During a follow-up period of (1-4) days in high VSD group, one case developed right ventricular outflow tract obstruction and flow velocity declined during 6-month follow-ups.There were residual slight shunt ( n=19), pericardial effusion ( n=19) and pleural effusion ( n=4) in two groups.They were self-cured during 6-month follow-ups. Conclusion:Through a ultra-minimal trans-intercostal incision guided by TEE, perimembranous and high VSD closure offers a high success rate and an excellent postoperative recovery in children.Although operative duration of high VSD is shorter, diameter of VSD is not a sole influencing factor of operative duration.

Objective:To summarize and evaluate the therapeutic effect of total anomalous pulmonary venous drainage with obstruction.Methods:The clinical data of 189 children treated with TAPVC surgery in Children's Hospital Affiliated to Zhejiang University School of Medicine from January 2010 to December 2019 were retrospectively analyzed, including 36 cases in the obstruction group and 153 cases in the non-obstruction group.The obstruction group contained 20 males and 16 females with age 1~140 (29.1±28.7) d and body weight at the time of operation 2.4~6.5 (3.6±0.9) kg.According to the postoperative death, the patients were further divided into the obstruction death group (5 cases) and the obstruction survival group (31 cases). Compare two groups of preoperative lactic acid levels, preoperative left ventricular end-diastolic volume index, extracorporeal circulation time, postoperative mechanical ventilation time, postoperative Extracorporeal Membrane Oxygenation (ECMO) support cases, delayed chest closure cases, multifunctional organ failure cases, peritoneal dialysis cases, arrhythmia cases, postoperative pulmonary hypertension crisis cases and pulmonary venous obstruction cases.35 cases were done with the vertical veins ligation and establishment of the connection between pulmonary vein and left atrium, without sutureless technique of pericardium in situ.Results:Comparing the obstruction group and the non-obstruction group, ages were (29.1±28.7) vs.(98.3±121.6) days, body weight (3.6±0.9) vs.(5.1±3.4) kg, neonatal cases 21 (58.3%) vs.32 (20.9%), pulmonary venous velocity (1.4±0.5) vs.(1.1±0.4) m/s, delayed chest closure cases 15(41.6%) vs.10(6.5%), death cases 5(13.9%) vs. 10(6.5%). There were statistically significant differences in age, body weight, neonatal proportion, pulmonary venous velocity, delayed chest closure and death between the two groups ( P<0.05). Comparing the obstruction death group and the obstruction survival group, lactic acid levels were (6.7±3.8) vs.(2.5±1.2) mmol/L, left ventricular end-diastolic volume indices (27.1±19.5) vs.(29.2±16.8) mL/m 2, extracorporeal circulation time (216.3±64.3) vs.(159.3±73.4) mins, postoperative mechanical ventilation time (17.5±13.5) vs.(4.8±5.2) d, ECMO support cases 3 (60%) vs.1 (3.2%), delayed chest closure cases 4(80%) vs.11(35.5%), multifunctional organ failure cases 3 (60%) vs.0, peritoneal dialysis cases 4(80%) vs.16(51.6%), arrhythmia 2(40%) vs.3(9.7%), pulmonary hypertension crisis cases 3(60%) vs.1(3.2%), pulmonary venous obstruction cases 2(40%) vs.4(12.9%) respectively.There were statistically significant differences in preoperative lactic acid, extracorporeal circulation time, postoperative mechanical ventilation time, ECMO support cases, multifunctional organ failure cases and postoperative pulmonary hypertension crisis cases between the two groups ( P<0.05). No pulmonary vein obstruction was found in the surviving children after 6 months of follow-up. Conclusion:The operative mortality of children with complete pulmonary vein obstruction was high.Various techniques were used to expand the anastomosis during the operation.The early death was related to multiple organ failure and the perioperative application of ECMO, delayed chest closure and peritoneal dialysis can reduce the mortality.Pulmonary vein obstruction induced to the medium and long-term death.

To summarize the perioperative nursing experience of a child with congenital left ventricular aneurysm.Key points of preoperative nursing include controlling blood pressure strictly to prevent cardiac rupture,monitoring heart rate and rhythm closely to prevent heart failure,early identifying and treating thromboembolic symptoms. Main points of postoperative nursing include strengthening the management of early sedation and analgesia,strictly controlling the intake and output volume to maintain left ventricular function,maintaining the stability of internal environment to prevent arrhythmia,enhancing home care guidance. After careful treatment and nursing care,the child was discharged smoothly. A month after discharge,the outpatient follow-up showed that the cardiac function of the child was stable while the growth and development was normal.

Objectives To build a fluid-structure interaction model of pulmonary veins with total anomalous pulmonary venous connection, which can be used to predict the result of surgical treatment and at the same time to estimate the elastic properties of pulmonary veins based on patient-specific data and clinic postoperative results. Methods The fluid-structure interaction (FSI) model was used to simulate the anastomosis on pulmonary veins based on computed tomography angiography data collected from three children with total anomalous pulmonary venous connection (TAPVC), supra-cardiac type. The deformation and the stress of anastomosis, and also the velocity of blood flow were calculated in fluid-structure coupling algorithm. During the simulation the variable boundary conditions were applied, including the thickness of vessel wall and the vessel elasticity for which was selected a range of values. The calculation results were finally compared to postoperative results of same patients and discussed. The corresponding outcomes are given in the conclusions section. Results The blood flow velocity through the outlet will vary depending on the properties of vessels, including physical properties and thickness of vessel wall. The stress on vessel is lower for smaller values of Young’s modulus. The calculated blood flow velocity correlates well with the postoperative results for the Young's modulus of vessels ranging from 0.5 to 1.0 MPa. Conclusions The FSI model has high potential to predict the result of surgery for TAPVC and to estimate the physical properties of pulmonary vein. This model also has potential to guide the strategy for surgical treatment.

Objective:To explore the efficacy and safety of patent ductus arteriosus (PDA) ligation in extremely premature infants.Methods:Clinical data were retrospectively reviewed for 49 extremely preterm PDA infants admitted into Neonatal Intensive Care Unit of Children's Hospital, Zhejiang University School of Medicine. They underwent surgical intervention at Department of Cardiac Surgery from January 2015 to December 2019. There were 27 boys and 22 girls with a gestational age < 28 weeks, an average gestational age of 26 +5 weeks and a gestational age range of 24 +5 to 27 +6 weeks; multiple pregnancies accounted for 38.8% (19/49) ; birth weight was (930±148) g; diameter of PDA assessed by preoperative ultrasound was (4.0±0.8) mm; there were approximately 1.6 courses of drug treatment. Basic clinical data, early surgical prognosis, inhospital mortality and operation-related complications were recorded. Durations of ventilator support and oxygen therapy before and after operation were compared. And clinical characteristics and therapeutic effect of PDA ligation were summarized. Results:Operative duration was (52±16) min, average operative age 42.4 days, average operative weight 1.68 kg, median diameter of PDA 3.8 mm, average corrected age at discharge 42 +6 weeks and average weight at discharge 3.47 kg. Without mortality, none had residual fistula postoperatively and achieved immediate closure. Two children had left vocal cord paralysis preoperatively. No new case of nerve injury occurred postoperatively. Postoperative pneumothorax accounted for 10.2% (5/49) . Four pre-discharge deaths were not related with surgery and there was an in-hospital mortality rate of 8.2 % (4/49 ) . Preoperative invasive mechanical ventilation support accounted for 85.7% (42/49) and non-invasive positive pressure ventilation support 14.3% (7/49) . Total mechanical ventilation time during hospitalization was (42±37) days and total ventilator support time of invasive mechanical ventilation and non-invasive positive pressure ventilation was (73±34) days. The differences between pre and post-operation of invasive mechanical ventilation time and total ventilator support time were (12.4±26.5) and (32.2±35.0) days ( P=0.003, P<0.001) and the differences were statistically significant. Survival analysis revealed that infants with multiple pregnancies, operative weight ≥1.5 kg and PDA diameter < 3.8 mm could be weaned off ventilator treatment and oxygen therapy earlier postoperatively. Conclusions:Surgical ligation is both safe and effective for PDA in extremely premature infants.

Aims To investigate the value of transesophageal echocardiography (TEE) in perimembranous ventricular septal defect (PmVSD) closure via a left parasternal ultra-minimal trans intercostal incision in children. Methods From January 2015 to December 2020, 212 children with PmVSDs underwent device occlusion via an ultra-minimal trans intercostal incision. TEE was used throughout the perioperative period, including TEE assessment, TEE-guided localization of the puncture site, and TEE guidance. All patients were followed up using transthoracic echocardiography for more than 6 months. Results A total of 207 cases were successfully occluded, and the success rate was 97.64%. One hundred forty-five patients had a single orifice, and 62 patients had multiple orifices in the aneurysm of the membranous septum (AMS). During the operation, the surgeon readjusted the device or replaced it with a larger device in 17 cases. After the operation, 19 cases of a slight residual shunt, 13 cases of pericardial effusion, and 4 cases of pleural effusion were noted. All patients returned to normal during the 4-month follow-up period. Mild mitral regurgitation was present in one patient and remained the same during the follow-up period. No other complications were found. Conclusions Under TEE guidance, PmVSDs were closed successfully using a concentric occluder via an ultra-minimal trans intercostal incision. TEE, which was used to assess defects and postoperative effect, effectively guide PmVSDs closure, is of great value.

室间隔完整型肺动脉闭锁(pulmonary atresia with intact ventricular septum,PA/IVS)是一种少见的复杂紫绀型先天性心脏病,约占先天性心脏病的1％～3％[1].PA/IVS的病理解剖包括肺动脉瓣的完全梗阻、右心室及三尖瓣不同程度的发育不良、伴或不伴冠状动脉畸形.如果早期没有进行外科干预, PA/IVS的病死率极高,患儿出生后2周内病死率为50％,6个月内病死率约为85％.PA/IVS多数需分期手术,但由于其病理解剖的多样性和复杂性,初期治疗方法各异.初期手术依据患儿右心室发育程度以及有无右心室依赖性冠状动脉循环(right ventricle dependent coronary circulation,RVDCC)等,采用右心室减压术和/或体肺分流术如改良Blalock-Taussig分流术或动脉导管支架置入术[2].浙江大学医学院附属儿童医院采用经皮球囊肺动脉瓣打孔扩张术对6例PA/IVS患儿进行右心室减压,并根据患儿循环状态同期处理动脉导管,治疗效果满意,现报道如下.

Objective:To summarize the experience of diagnosis and surgical treatment for congenital pulmonary vein stenosis (CPVS) plus congenital heart disease (CHD).Methods:Retrospective analysis was performed for 58 surgical children with CPVS plus CHD admitted into Beijing Fuwai Hospital and Children's Hospital of Zhejiang University School of Medicine from May 2007 to August 2019. There were 24 boys and 34 girls with a median age of 9.3(1-180) months and a median body weight of 6.5(3-48) kg. CHD was simple (n=43) or complex (n=15). And PVS was single branch (n=27), multiple branch (n=31) and bilateral (n=13). The treatments included resection of membrane incision (n=26), expanded patch (n=23), sutureless technique (n=6) and blunt expansion (n=3). Excluded 1 case with blunt expansion from the postoperative follow-up patients, the other 53 cases were divided into endometrial resection group (n=26), patch expansion group (n=21) and sutureless technique (n=6). Chi-square analysis was performed for comparing mortality and restenotic rate among three groups. After excluding 13 cases of complicated CHD, three groups were compared again.Results:Preoperative mean PVS severity score was (4.5±2.7)(2-11.5). Two cases (3.4%, 2/58) of early death occurred due to pulmonary infection. During a follow-up period of (49.8±40.0)(2-145) months, two children were lost and 17 cases developed restenosis. Eleven children died and none was reoperated. The mortality rate of endometrial resection group was 19.2%(5/26) and restenotic rate 26.9%(7/26); the mortality of patch expansion group was 23.8% (5/21) and restenotic rate 38.1%(8/21); the mortality of sutureless technique was 16.7%(1/6) and restenotic rate 16.7%(1/6). No statistically significant differences existed in mortaliy and restenotic rate among three groups ( P=0.22 & 0.97). Excluding 13 case of combined complex CHD during follow-ups, the mortality of endometrial resection, patch expansion and sutureless technique groups were 5.3%(1/19), 25%(4/16) and 16.7% (1/6); restenotic rates 15.8%(3/19), 37.5% (6/16) and 16.7%(1/6) respectively. No statistically significant inter-group differences existed in mortality or restenotic rate ( P=0.33 & 0.17). Conclusion:Sutureless technique is not superior to conventional technique in the treatment of pulmonary venous stenosis plus CHD.

总结1例体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)辅助非体外循环下患儿行冠状动脉去顶手术的护理配合经验.护理要点如下:术前病情讨论、手术间准备、ECMO下患儿的院内转运,术中护理配合和应急预案制订以及术后管理.该例患儿成功完成心脏手术,术后继续ECMO支持,14 d后顺利脱机,术后27 d出院.

Objective:Combined with the actual clinical situation, to introduce the application of invasive trans super minimal intercostal device closure in doubly committed ventricular septal defect(DCVSD).Methods:Between January 2017 and July 2020, 82 DCVSD children were recruited. Relevant data such as operation time, length of hospital stay, postoperative complications, etc. were analyzed, and the follow-up of the postoperative period was used to evaluate the effect of the operation.Results:Among them, 2 children’s puncture points were bleeding. Chest closure time was obviously extended. The total operation time of the remaining children was 24-72(47.54±12.06)min, among which the umbrella release time was 5-37(16.16±8.01)min, and the chest opening and closing time was 14-59(31.56±9.58) min. Pericardial effusion occurred in 2 patients after operation, and the discharge time was more than 2 weeks. The remaining children were hospitalized for 3-9(5.79±1.45)days after surgery.Conclusion:Closing DCVSDs through a super minimal intercostal incision under TEE guidance was safe, effective and less trauma.

Object: To compare the clinical data of sternotomy and left intercostals incision, combined with the literature, to provide the best surgical incision for committed subarterial ventricular septal defect（DCS-VSD）. Methods: From July 2016 to July 2020, a total of 117 cases of occlusion surgeries for DCSVSD, which guided by transoesophagel echocardiography(TEE) were completed, including 34 cases with sternotomy incision and 83 cases with left intercostal incision. Statistics and analysis of the operation and follow-up. Results: 115 cases successfully occluded, the successful rate was 98.29%, and 1 case failed in each group. Pericardial effusion occurred in 5 children after the drainage device was removed, and the pericardial effusion disappeared after diuretic treatment. There was no statistical difference between the two groups in operation time, occlusion time, thoracotomy time and postoperative hospital stay. All the children recovered and were discharged from the hospital, and were followed up for 2-30 months after operation. Conclusion: TEE-guided intercostal DCS-VSD occlusion is safe and effective. There is no statistical difference between two approach with the operation time, chest opening and closing time, occluder placing time, and postoperative hospital staying. At the same time, the surgical incision by intercostal incisionis smaller and the operation invasion is less, it is a surgical approach which worth to develop.

Background Extracorporeal membrane oxygenation (ECMO) support on D-transposition of the great arteries (D-TGA) carries formidable challenges. Methods A retrospective study was performed on pediatric patients with D-TGA supported by ECMO from July 2007 to December 2019. This study summarized the clinical experience of ECMO support in pediatric patients with D-TGA preoperative, intraoperative, and postoperative. Results Overall, 16 children with D-TGA received ECMO support during this period. Two (2 of 16) were supported before cardiac surgery, 3 (3 of 16) were supported postoperatively in the intensive care unit, and 11 (11 of 16) failed to wean off cardiopulmonary bypass. Two cases of preoperative ECMO support for patients with D-TGA with an intact ventricular septum and restrictive atrial septum due to severe hypoxemia died. In this study, D-TGA with coronary artery malformation and other complicated deformities died (8 of 14), whereas uncomplicated D-TGA without coronary artery malformation all survived (6 of 14). The wean-off rate of ECMO patients supported in D-TGA was 62.5% (10 of 16), while the 30-day survival rate was 44% (7 of 16). Conclusion Although a promising ECMO weaning rate was obtained, 30-day survival of this population was frustrating, mainly attributed to the original anatomy of coronary arteries and the concomitant deformities.

AIMS:This study aimed to investigate the safety, feasibility and, availability of perimembranous ventricular septal defect (PmVSD) closure via a left parasternal ultra-minimal trans intercostal incision in children.METHODS AND RESULTS:From January 2015 to January 2019, 131 children with restrictive PmVSDs were enrolled in this study and successfully done in 126 patients (96.18%). PmVSDs were occluded via an ultra-minimal trans intercostal incision (≤1 cm), and the entire occlusive process was guided and monitored by TEE. A pericardium hanging technique was employed without sternal incision. PmVSDs were closed through a short delivery sheath assembled using a concentric occluder device. All patients were followed up for a period ranging from18 months to 24 months. Thirteen patients with PmVSD had aneurysm of membranous septum (AMS). Multistream (≥2) PmVSDs with AMS were found in 11 cases. After the operation, mild residual shunt beside the amplatzer occluder in one patient was found and had self-healing result during the 5-month follow-up period. Five patients transferred to ventricular septal defect repair operation under direct visualization with a cardiopulmonary bypass. One reason was ventricular fibrillation when guidewire passed the PmVSD, another was device dislocation, and others were the guidewire cannot pass through the PmVSD.CONCLUSIONS:PmVSDs closure using a concentric occluder via a left parasternal ultra-minimal trans intercostal incision under TEE guidance is feasible, safe, and effective in children. This approach can be considered as an alternative treatment to open-heart surgery for restrictive PmVSDs.

肺动脉吊带( pulmonay artry sling,PAS)是一种罕见的婴幼儿期先天性心血管疾病,解剖特征为异常左肺动脉走形于食管气管之间压迫气管造成气管狭窄,半数以上患者气管软骨呈全环"O"型环样改变( complete trachtal rings,CTR) [1,2].PAS患者常存在反复呼吸道感染、气道梗阻,预后不佳,故一经确诊,无论有无肺部感染,都需及时行手术治疗[3-5].

目的 回顾性分析先天性肺静脉狭窄(CPVS)合并先天性心脏病(CHD)外科手术后死亡和再狭窄的危险因素.方法 2007年5月至2019年8月,北京阜外医院和浙江大学儿童医院手术治疗58例房室连接正常合并CHD的CPVS患者,其中男24例、女34例,年龄(17.2±26.3)个月,体重(8.8±8.2)kg.以死亡和再狭窄作为终点事件,分析其危险因素.结果 术前肺静脉狭窄严重性评分(PVSSS)为(4.5±2.7)分.每例患儿平均累及肺静脉支数(1.9±1.0)支.早期死亡2例,死亡率3.4％.随访2～145 (49.8±40.0)个月.1年、2年、3年及5年生存率分别为86.7％、81.3％、78.5％和73.6％,免除再狭窄率分别为79.6％、68.5％、68.5％和68.5％.早产是随访死亡的独立危险因素.出院时肺静脉峰值流速≥1.2 m/s是出院后随访死亡和再狭窄的独立危险因素.结论 CPVS仍然是预后不良的疾病,术后残余狭窄是出院后随访死亡和再狭窄的独立危险因素.

目的 增加对胎儿大动脉转位(TGA)的认识,加强各时期的管理,同时了解TGA的手术时机及预后,为围生期合理处置胎儿TGA提供临床依据.方法 选取2006年至2018年在浙江大学医学院附属妇产科医院诊断为胎儿TGA的孕妇168例,收集孕妇年龄、诊断孕周、影像学检查结果 、胎儿染色体检查结果 、分娩方式、分娩孕周、胎儿出生体重、新生儿娩出后一般情况、处理措施、手术时机、预后等资料,对相关数据进行归纳整理和分析.结果 85.2％(75/88)的TGA在孕20～26周行胎儿超声检查时发现.72.6％(122/168)合并1个或多个心脏或其他部位畸形.46例孕妇随访至胎儿娩出,分娩孕周为(37.63±2.45)周,分娩方式:顺产23例,剖宫产21例,产钳助产2例.胎儿出生体重(3 082.1±674.9)g,多数在同孕周出生胎儿体重的第10到第90百分位数之间.新生儿产后会出现不同程度的低氧血症并接受相应的处理.在接受手术治疗的31例患儿中,出生距手术的时间为出生当天～1个月不等,室间隔完整型和室间隔缺损型患儿分别为7(6,10)和8(4,26)d,但两者比较差异无统计学意义(P=0.215).在访的患儿中,22例目前恢复良好.结论 TGA胎儿若未合并其他复杂心脏畸形或其他部位异常,孕妇可考虑继续妊娠.若无阴道分娩禁忌可尝试阴道分娩,且无需提前催产.胎儿娩出后的处理以及手术时机应遵循个体化原则,手术治疗大多预后良好.

Objective To explore the value of transesophageal echocardiography ( T EE ) in high ventricular septal defect ( VSD) occlusion via a left parasternal ultra‐minimal intercostal incision ( ≤1 cm ) with eccentric occluder in children . Methods Forty‐eight children with high VSD underwent device occlusion via ultraminimal intercostal incision with eccentric occluder . T he w hole operation , including preoperative evaluation ,intraoperative localization and guidance and postoperation evaluation were performed under the guidance of T EE . Results Forty‐six children with high VSD underwent successfully device closure in all 48 cases and the operation success rate was 95 .8% . T he average size of high VSD was 2 .2－6 .0 ( 3 .70 ± 0 .90) mm and the average size of eccentric occluder was 4－8 ( 5 .48 ± 1 .12) mm . T he average operation duration was 18－98 ( 49 .80 ± 16 .71) min . T here were 2 cases of peri‐membranous high VSD and 44 cases of outlet‐typle VSD ,of w hich 10 cases of mild aortic valve prolapses ( AVOP) ,including 5 cases of aortic valve regurgitation ( AR ) . In addition ,there was 1 case of replacement of device ,1 case of having septum below the margin of the defect and 1 case of using a dilator for a small defect . T he 46 cases were followed up for 6 to 42 months ,and the pericardial effusion occured in 3 cases and disappeared during follow‐up . No other abnormal conditions were found . Conclusions During the surgery of high VSD device occlusion via ultraminimal intercostal incision with eccentric occluder ,T EE has an important value in defect assessment ,intraoperative localization and guidance ,and immediate evaluation of efficacy ,and can effectively guide the device occlusion of high VSD .

This study sought to investigate the feasibility, safety and effectiveness of transcatheter closure of atrial septal defects (ASDs) under the guidance of transesophageal echocardiography (TEE) in children.

OBJECTIVE:To compare the efficacy of percutaneous atrial septal defect (ASD) closure guided by transesophageal echocardiography (TEE) or guided by fluoroscopy in pediatric patients. METHODS:Medical records of patients who underwent percutaneous ASD closure in the Children's Hospital, Zhejiang University School of Medicine from January 2017 to March 2018 were reviewed. There were 120 patients whose procedures were guided by TEE (TEE group), and 125 patients who had their procedures guided by fluoroscopy (fluoroscopy group). The performance of surgery, efficacy and postoperative complications were compared between two groups. RESULTS:Percutaneous ASD closure was successful in all patients. The operation time was shorter in the TEE group than that in fluoroscopy group[(20±14) min vs. (29±11) min, t=-7.939, P<0.05]. The size of the defect was larger in the TEE group than that of fluoroscopy group[(11±4) mm vs. (9±4) mm, t=2.512, P<0.05], but there was no significant difference in the sizes of occluder and occluder sheath between two groups (all P>0.05). No residual shunt, occluder shedding or displacement, severe arrhythmia or pericardial effusion were observed in either group. The incidence rates of fever, cough and diarrhea were not statistically different between two groups (all P>0.05). CONCLUSIONS:There was no significant difference in the outcome of percutaneous ASD closure guided by TEE or by fluoroscopy, but the procedure guided by TEE may reduce the operation time and can evaluate the size of ASD more accurately without involving radiation exposure, contrast agents use and large digital subtraction equipment.