| ObjectivesThrough the retrospective analysis of Ventricular septal defect(VSD)in children with interventional treatment of preoperative and postoperative Ultrasonic cardiogram(UCG)related index[Left Ventricular end-diastolic diameter(LVDd),Inner diameter of Left atrium(LAD),Left ventricular ejection fraction(EF),Left ventricular shortening fraction(FS),mitral and tricuspid regurgitation degree],height,weight,and ECG changes,to evaluate the efficacy of transcatheter interventional occlusion in the treatment of VSD.Clinical data and methods1.The research objects and the inclusion criteria:Children with congenital VSD who were admitted to the department of pediatrics of linyi people’s hospital from June 2014 to December 2016 and received transcatheter closure were selected.235 children,including 1 15 males and 120 females,aged between 2 years to 13 years were selected in the present study.According to age groups,the above 235 VSD children were divided into 4 age groups:<3-year age group～,3-year age group～,6-year age group～,>9-year age group.The age of the children at 1 year after the interventional operation was added 1 year on the basis of the age of the children at the time of admission.Since the youngest age of the children before the operation was≥2 years old,the children were divided into 3 age groups according to the age of the children after the operation,namely,3-year age group～,6 year age group～,and 9 year age group～.Inclusion criteria:age ≥2 years,weight≥10kg;Systolic murmurs can be heard between 3 and 4 ribs in the anterior region of the heart by auscultation.The color doppler ultrasonography was diagnosed as VSD,and the size and location of VSD were suitable for interventional therapy.Finally,left ventricular angiography confirmed the appropriate transcatheter closure;Patients with good compliance and timely follow-up;Consent to and receiving VSD interventional therapy,The patients are informed and sign the informed consent.Exclusion criteria:Nonperimembranous VSD;or more types of congenital heart disease;serious complications such as respiratory arrest and/or cardiac arrest occurred during interventional therapy;intraoperative ECG showed left bundle branch or complete atrioventricular block;patients who have undergone cardiac surgery or other cardiac interventions.2.Interventional occlusion methods:Under general anesthesia or local anesthesia,the above children were treated with interventional therapy according to VSD interventional therapy routine.All the selected occluders were domestic models(approval no.:YZB/country 0277-2009 "ventricular septal defect occluder").Success criteria of interventional therapy:the positions of the intraoperative color doppler ultrasonography and angiography monitoring occluders were good,no obvious residual shunt was observed,no serious arrhythmias such as atrioventricular block occurred in intraoperative ECG monitoring,and no serious complications occurred during postoperative hospitalization observation.3.Clinical data analysis:Clinical data of all cases were retrospectively analyzed,including preoperative and postoperative ECG,UCG,height,weight,and other data,and the following three aspects of control analysis were summarized(1).The observation indexes of the children before interventional occlusion were compared with the reference values of normal children of the same age.(2).The observation indexes of the children 1 year after interventional occlusion were compared with the reference values of normal children of the same age.(3).The observation indexes of the children before interventional occlusion were compared with those one year after interventionResults1.Comparison of preoperative UCG indexes,height,weight and ECG in all group children:(1)Comparison of preoperative UCG indexes,height and weight:①Preoperatively,the mean values of LAD and LVDd in the<3-year and>9-year age group were significantly higher than that in the control groups(P<0.05),while the mean values of LAD and LVDd in the other age groups were significantly higher than that in the control group(P<0.001);②The mean EF and FS values of all age groups were significantly higher than that of the control group(P<0.05);③The numbers of cases of mitral regurgitation and tricuspid regurgitation were significantly higher than that of the control groups(P<0.05);④The preoperative mean height of each age group was significantly lower than that of the control group of the normal age group(P<0.05);the preoperative mean weight of the group<3-year age group was significantly lower than that of the control group of the normal age group(P<0.001);the mean weight of other age groups was significantly lower than that of the control group of the normal age group(All P<0.05).(2)Preoperative ECG comparison:Incomplete right bundle branch block(IRBBB)and Complete right bundle branch block(CRBBB)before VSD were 2.1%and 3%,respectively,significantly higher than the normal control groups(P<0.05);the proportion of left ventricular high voltage was 18.2%,significantly higher than the control group(P<0.001).2.Comparison of UCG indexes,height,weight and ECG 1 year after interventional occlusion:(1)UCG indexes,height and weight were compared one year after interventional occlusion:①There were no significant differences in the mean LAD and LVDd of each age group compared with the control groups(all P values were>0.05);②There were no significant differences in the mean EF and FS values of each age group compared with the control groups(P>0.05);③There were no significant differences in the numbers of cases of mitral regurgitation and tricuspid regurgitation between different age groups and the control groups(P>0.05);④There were no significant differences between the mean height and weight of each age group and the control groups(P>0.05).(2)Comparison of ECG one year after interventional occlusion:the proportions of IRBBB and CRBBB after VSD were 3.8%and 4.3%,respectively,significantly higher than that of the control groups(P<0.001);the proportion of left ventricular high voltage was 2.1%,and there was no significant difference compared with the control group of normal children(P>0.05).3.Comparison preoperative UCG indexes,height,weight,ECG with 1 year after interventional occlusion:(1)Comparison of UCG indexes,height and weight before and after interventional occlusion:①The mean values of LAD and LVDd were significantly lower than those of the control groups(P<0.001);②The mean values of EF and FS were significantly lower than those of the control group(P<0.001);③The numbers of cases of mitral regurgitation and tricuspid regurgitation were significantly lower than that of the control groups(P<0.001);④The mean height and weight of the children were significantly higher than that of the control groups(P<0.001).(2)Comparison of electrocardiograms after interventional occlusion:the proportions of IRBBB and CRBBB were significantly increased one year after the interventional occlusion compared with that of the preoperative control groups(P<0.05),the proportion of high left ventricular voltage in the 1 year after intervention was significantly lower than that in the preoperative control group,and the difference was statistically significant(P<0.05).Conclusions1.There were significant differences in LAD,LVDd,EF,FS,mitral regurgitation,tricuspid regurgitation,height and weight between children with VSD and normal children of the same age before interventional occlusion.2.There were no significant differences in LAD,LVDd,EF,FS,mitral regurgitation,tricuspid regurgitation,height and weight between the children with VSD and normal children of the same age one year after interventional occlusion.3.The incidences of IRBBB and CRBBB after interventional plugging were higher than that before intervention,and the ratio of high left ventricular voltage was significantly lower than that before interventional occlusion. |
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