Transcatheter Closure Of Perimembranous Ventricular Septal Defects With The Amplatzer Asymmetric Ventricular Septal Defect Occluder: Immediate Results And Long-term Follow-up

Objective: To evaluate the long-term therapeutic effect of transcatheter closure of perimembranous ventricular septal defect (PMVSD) using Amplatzer asymmetris ventricular septal defect occluder(AAVSDO). Methods : 25 patients with PMVSD were treated using AAVSDO through the percutaneous procedure under fluoroscopy, angiography and Transthoracic echocardiography(TTE). The mean age of patients was 22.26 ± 13.25 years(ranging from 2.5 to 47 yeas) and the mean weight was 49.20 ± 19.86Kg (ranging from 13 to 78Kg). All PMVSDs were diagnosed by TTE before interventions. The mean diameter of PMVSDs assessed by angiography was 6.56 ± 2.83mm (ranging from 3 to 16mm). Follow-up evaluation was performed with TTE, Electrocardiogram (ECG) and X-ray examination at 3-day, 3-month, 6-month and 1-year after the procedure to evaluate the efficiency. Results: The mean diameter of AAVSDOs selected was 9.12 ± 2.71mm (ranging from 6 to 18mm). The success rate of placement of the occluders was 100%. There were no serious complications occurred during the procedure, such as hemolysis, thramboe-mbolism and acute pulmonic regurgitation, and no emergency surgical removal. There were immediate complete closures of the defects in 23 patients and trivial to small residual shunts were found in 2 cases (8%) immediately after the procedure showed by TTE. A 3-month follow-up was completed in 21 patients and no residual shunt was found through TTE. AAVSDOs remain in proper place except one during the whole of follow-up. The median left ventricle end-diastolic dimension (LVEDD) had significant decreased from 47.57± 8.23 to 45.67 ±8.40mm (P<0.05). One patient had transient junctional rhythm during the procedure. Anther one had left handle branch block after catheter closure, and recovered one month later. One patient had been placed temporary pacing because of complete heart block within 12 hours after the procedure, and recovered 36h later. Bandle branch block was showed in three patients (14.2%) at 3-month follow-up, while the patients had normal ECG after catheter closure. X-ray examination showed that pulmonary vascularity had improved at 3-day follow-up, and heart size was improved at 3,6,12-month follow-up. Conclusion: Transcatheter closure of perimembranous ventricular septal defects with the Amplatzer asymmetris ventricular septal defect occluder is an good method with a high success rate of placement, a good occlusion effect, no significant complications and reliable long-term effect. Further new complications with this device remains to be observed.