Analysis The Complications Following Transcatheter Occlusion Of Ventricular Septal Defect In Children

Objective: To evaluate the complication following the transcatheter interventional occlusion of ventricular septal defect (VSD) in children,in order to decrease the incidence and increase the success of the treatment.Methods: To retrospectively study VSD patients successfully received transcatheter interventional closure from May 2004 to April 2010 in Children's Hospital of Chongqing Medical University. Complications appeared immediately, 24 hours,1 months,3 months,6 months,1 year after the procedure were analyzed in all patients by the follow-up transthoracic echocardiography (TTE) and electrocardiogram (ECG) .Results: There were 408 VSD patients involved, 198 males, 210 females ,aged from 1 year 6 months to 16 years 3 months (average 5.14±3.22 years), weighted from 8kg to 56kg (average 17.54±7.83kg). The diameter of VSD was from 0.5 mm to 17.1mm (average 5.27±3.04mm) measured by angiography before occlusion. The diameter of implanted occluders was from 4mm to 16mm (average 6.50±2.20mm). 1 Serious complications:Serious complications occurred in 12 patients (2.94%) , including 1(0.25%) withⅢ°Atrioventricular block (AVB) during the procedure, 1(0.25%) hadⅢ°AVB with temporary pacemaker after implanted VSD occluder, 1 (0.25%) happened occluder device displaced , 1 (0.25%) had aortic valve clampped by occluder device, 8 (1.96%)had hemolysis . Finally, 3 cases were displaced the occluder device and closured by surgical therapy because the serious complication. There was no death in all patients.2 Mild complications : Mild complications occurred in 121 patients(29.66%) after implanted VSD occluder, including mild residual shunt in 49 cases (12.01%), new-onset mild aortic regurgitation (AR) in 35 cases(8.58%) , moderate AR in 1 case(0.25%), AR aggravates in 1 case(0.25%), new-onset mild pulmonary regurgitation (PR) in 10 cases(2.45%), new-onset moderate tricuspid regurgitation (TR) in 2 cases(0.49%), TR aggravates in 13 cases(3.19%), new-onset mild mitral regurgitation (MR) in 1 case(0.25%), MR aggravates in 2 cases(0.49%), right bundle branch block (RBBB) in 49 cases(12.01%), left bundle branch block (LBBB) in 11 cases(2.70%),Ⅰ°AVB in 5 cases(1.23%), idionodal rhythm in 4 cases(0.98%), nodal escape beat in 8 cases(1.96%), ventricular premature beat in 7 cases(1.72%), ventricular escape beat in 2 cases(0.49%), junctional escape beat in 3 cases(0.74%), atrioventricular interference block in 1 case(0.25%), atrioventricular interference dissociation in 5 cases(1.23%), sinus bradycardia in 1 case(0.25%).3 One month' s follow-up :After 1 month' s follow-up, there were mild residual shunt in 10 cases(2.45%), moderate residual shunt in 1 case(0.25%), moderate TR in 3 cases(0.74%), mild AR in 16 cases(3.92%), moderate AR 1 case(0.25%), RBBB in 16 cases(3.92%), LBBB in 3 cases(0.74%),Ⅰ°AVB in 1 case(0.25%).4 Three months' follow-up: There were mild residual shunt in 7 cases(1.72%), mild AR in 9 cases(2.21%), moderate TR in 1 case(0.25%), RBBB in 10 cases(2.45%),LBBB in 1 case(0.25%).5 Six months' follow-up: There were mild residual shunt in 4 cases(0.98%), mild AR in 6 cases(1.47%), RBBB in 5 cases(1.23%), LBBB in 2 cases(0.49%).6 One year's follow-up: There were only mild residual shunt in 2 cases(0.49%), mild AR in 2 cases(0.49%), RBBB in 3 cases(0.74%), LBBB in 2 cases(0.49%).Conclusion: Transcatheter interventional occlusion of VSD is a safe, effective treatment method, with low serious complication and most of mild complications can be disappeared with time-lapse. We still need to pay attention to the procedure to prevent the serious complication.