| Objective:To investigate the effects and follow-up outcomes of transcatheter closure of ventricular septal defects(VSD) in309patients, the effects and complications were analyzed. The mechanisms, treatment and prognosis of complications were explored..Methods:All data of338patients with VSD who underwent transcatheter closure in Shandong Provincial Hospital from June2002to December2012were analyzed, in which140male,198female,2～45y(mean9.6±7.2y),～3years39cases,～6years165cases,～9years49cases,～12years26cases,>12years59cases. Procedure was successful in309patients. Aspirin was administered orally3～5mg/kg.d one day before procedure for6months. Routine follow-up including electrocardiogram, echocardiography and chest X-ray were made at1,3,6,12months after closure and every one year thereafter, the follow-up time is from6months to10years.The clinical date, electrocardiogram, echocardiogram, cardiovascular imaging and follow-up results were analyzed.Results:The successful closure rate is91.4%(309/338),18cases quit interventional therapy after cardiovascular imaging, attempts were frustrated in11cases, there was no death during follow up. Cardiovascular imaging shows that there were323cases with perimembranous VSD in338cases(1case with surgical postoperative residual fistula,256cases with aneurysm of the membranous septum, in which173cases with sac type,43cases with florid type,40cases with duct type),8cases with infracristal VSD,4cases with intracristal VSD,1case with supracristal VSD,2cases with muscular VSD. The maximum exit diameter of VSD in right ventricular is between1.5mm to8.8mm (mean4.3±2.1mm), the diameter of occluder implanted successfully is between4mm to18mm. Among all the cases, Amplatzer membranous VSD occluders, Amplatzer duct occluder, Pfm coils, home-made muscular VSD occluders and home-made membranous VSD occluders were implanted respectively in73,1,5,3and227patients(in which186cases with symmetric occluders,29cases with asymmetric occluders,12cases with eccentric occluders). Among309patients with successful occlusion,6cases accompanied by patent ductus arteriosus(PDA), in which PDA was closed by PDA occluder in4cases, and coil in1case, PDA was not closed in another case because of trivial shunt.2home-made symmetric occluders were successfully implanted in one6-year-old boy with a giant aneurysm of the membranous septum.At the end of follow-up, atrioventricular block occurred in1week after closure in7patients (2.26%), all the occluders were implanted at the inlet of VSD, in which2patients(0.65%) developed complete atrioventricular block which disappeared and recovered to sinus rhythm3weeks after treatment.Aamong the2patients with complete atrioventricular block, the block occurred on the sixth day after closure and recovered22days after temporary pacemaker implantation in one patient. High grade atrioventricular block occurred on the sixth day after closure and recovered on the second day after temporary pacing therapy in one patient. First and second degree atrioventricular block occurred respectively in2patients.Bundle branch block occurred in one week after closure in21patients(6.79%)in which the occluders were implanted at the inlet of VSD in14patients and the outlet of aneurysm of membranous septum in7patients. Among these21patients with bundle branch block, right bundle branch block, left anterior hemi-block, alternating left and right bundle branch block and complete left bundle branch block occurred respectively in10,8,2patients and1patient. All the bundle branch block relieved in1to3months after treatment. Accelerated junctional rhythm occurred in one week after closure and recovered completely in one week after treatment in9patients (2.91%).Ventricular premature beat accompanied by incomplete right bundle branch block occurred at the first day after closure in one patient (0.32%). The X-ray exposure time during operation and the incidence of atrioventricular block between2002and2007was both lower than that between2008and2012. It suggests that skilled operation could reduce the incidence of atrioventricular block.Mechanical hemolysis occurred on the first day after closure and recovered completely after conservative medical therapy in5patients (1.62%). Occluder detachment occurred during the procedure in2patients (0.64%), all the occluders were recaptured by snare and then another occluder was implanted successfully in all the2cases. Thrombo-embolism occurred on the first day after closure in3patients(0.97%)(2cases with femoral artery thrombosis,1case with femoral vein thrombosis) and relieved after thrombolytic therapy. Valve regurgitation occurred in18patients(5.83%), in which3cases with aortic insufficiency,1case with bicuspid insufficiency and14cases with tricuspid insufficiency. All the insufficiency were mild and did not get worse during1year follow-up, no treatment was given. Residual shunt occurred in23patients (7.44%), no patient required hospitalization and mild residual shunt still existed at the end of follow-up in7patients.Conclusion:Transcatheter closure of ventricular septal defect is a safe and effective procedure, which recover quickly with minimal trauma and no scar. The strict indications and standard operation procedures are the key to increase the success rate and decrease the complications. |
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