There is still no clear standard for the choice of occluders. The occluder size selected with reference to the congenital heart disease should be equal to or larger than the actual size of the atrial septal occluder by 1-2 mm.
Choosing a too large atrial septal occluder can easily cause compression of the surrounding tissues, which will affect the surrounding circulation and tissue blood supply, causing new damage, even tissue necrosis, and enlargement of the fistula. Choosing too small may cause the displacement and falling off of the occluder.
The method is similar to the closure process of congenital heart disease: under local anesthesia, sedation or general anesthesia, routine bronchial examination is performed to determine the location of the fistula. Put the guide wires from the working channel of the bronchus into the thoracic cavity through the fistula, fix the guide wires, and exit the bronchoscope.
Enter the bronchoscope again to enter the target site, feed the delivery sheath along the guide wire, select the appropriate atrial septal occluder and deliver it to the thoracic cavity through the delivery sheath, exit the guide wire, and open the thoracic end umbrella of the occluder first under the direct view of the bronchoscope, withdraw the long sheath so that the pleural umbrella is attached to the fistula. Make sure that the position is good, the occluder is fixed, open the occluder, and withdraw the sheath to release the bronchial tube of the occluder. You can repeatedly push and pull the delivery sheath with a little force. When the occluder is fixed, you can operate the rotating handle to release the occluder. Then withdraw the sheath.