Comparative Study Of Transcatheter Closure And Surgical Repair In Children With Ventricular Septal Defect

Aim To compare the effectivity and complications of transcatheter closure of ventricular septal defect (TCVSD) and surgical repair of VSD on treatment of VSD in children, and have better choice in clinic.Methods The applications of retrospective research methods, analysis of the patients with VSD who were treated in our hospital from 2004.5 to 2010.4. The effectivity and complications of both methods were compared.Results The TCVSD group included 408 patients (198 males, 210 females) with VSD underwent TCVSD using transcatheter VSD occluder. The surgery group included 440 patients (243 males, 197 females) with VSD underwent surgical repair in extracorporeal circulation during the same period. The ages were (5.14±3.23) years and (2.14±2.85) years (P<0.001), the VSD size were (5.27±3.04) mm and (13.24±5.00) mm (P<0.001) in TCVSD group and surgery group respectively. The technical success rate of the TCVSD group and surgery group were 99.26% and 97.73% (P=0.123) respectively. The complications of TCVSD group included: residual shunt in 46 patients (11.27%), new valve regurgitation in 51 patients (aortic regurgitation in 35 patients, tricuspid regurgitation in 2 patients, mitral regurgitation in 2 patients, pulmonary regurgitation in 1 2 patients) ,various arrhythmias in 125 patients (30.63%), transient complete atrioventricular block (cAVB) in 2 patient(0.49%). Hemolysis in 8 patients (one of whom requiring surgery), Adams-Stokes syndrome (ASS) occurred in 1 patient after 3 days, requiring a temporary pacemaker, recovery 10 days later. Device drop occurred in 1 patients. Hematoma in 1 patient.The complications of surgery group included: residual shunt in 92 patients (21.40%), new valve regurgitation in 140 patients (aortic regurgitation in 84 patients, tricuspid regurgitation in 2 patients, mitral regurgitation in 43 patients, pulmonary regurgitation in 60 patients), arrhythmias in 208 patients (61.00%), cAVB in 20 patients(4.65%), cAVB was transient in 6 patients, requiring permanent pacemakers in 3 patients. Pulmonary complications occurred in 100 patients (23.26%), pneumonia in 62 patients, atelectasis in 38 patients. Low cardiac output syndrome (LCOS) in 25 patients, pulmonary hypertension crisis in 6 patients, pericardial effusion in 30 patients, pericardial pneumatosis in 9 patients, pleural effusion in 18 patients, pneumomediastinum in 14 patients, pneumothorax in 12 patients, subcutaneous emphysema in 4 patients, laryngeal edema in 4 patients, hoarseness in 1 patient, fungal infection in 7 patients, septicemia in 1 patient, bleeding in 1 patient, stress ulcer in 1 patient, femoral vein thrombosis in 1 patient, brain injury after cardiopulmonary bypass (CPB) in 1 patient, subarachnoid hemorrhage in 1 patient, pulmonary hemorrhage in 1 patient.No patient in TCVSD group need blood transfusion, however all patients in surgery group needed blood transfusion, the average amount of blood transfusion was (409.35±251.97) ml. The days of inpatient in TCVSD group and surgery group were (5.27±0.79) days and (11.17±4.94) days (P<0.001) respectively. There were more residual shunt, new valve regurgitation and arrhythmias in surgery group than TCVSD group (P<0.001).Conclusion There are the same effectivity in method of TCVSD as surgical repair, and has fewer complications. Therefore, for part of fit patients with VSD, the TCVSD would be the first selection instead of surgical repair.