| ObjectivesBy reviewing132cases of average of age less than12years old and complete information of the ventricular septal defects (VSD) childrens’ cases, the choice of indications in the VSD occluder preoperative, intraoperative and operation analysis and depth of echocardiography in VSD occluder preoperative patient selection and intraoperative monitoring, the membranous VSD and pseudo-membranous aneurysm occlusion, and application experience in the ridge within the VSD occluder problem. Efficacy of VSD transcatheter interventional therapy, surgery, postoperative complications and long-term follow-up results, evaluation of VSD safety and efficacy of transcatheter interventional therapy.MethodsSelect132cases of ventricular septal defects less than12years old in Childrens’Medical Center Department of Cardiology of our hospital from2002.08to2011.06and Qilu Childrens’ Hospital Heart Center from2008.06to2011.06(67males,65females) as the object of study, age5.15±2.90years (1.6to12years), body weight15.73±6.39kg (839kg). Initial screening, surgery Bank of cardiac catheterization and left ventricular angiography clearly VSD size, shape and distance from the aortic valve by transthoracic echocardiography (Transthoracic echo-cardiography, TTE). Suitable for intervention therapy in patients with VSD and the establishment of dynamic, vein track, select the appropriate occluder sent to the left ventricle along the transfer unit, open the left side of the umbrella, the overall retracement of the transfer unit so that the umbrella on the left close to the septal left ventricular surface, back withdrawal of the sheath to the right side of the umbrella open, TTE and left ventricular angiography confirmed good position of occluder observed no residual shunt, tricuspid and aortic regurgitation after the release of the occluder.24h after review of TTE,7days in a row to check the ECG (electrocardiogram, ECG),1month,3months,6months,1year after surgery were followed up regularly every year.Results1、This group of patients with a total of132cases, preoperative TTE examination by two to determine the VSD anatomical classification mainly perimembranous VSD, about47.7percent of this group of patients (63/132), pseudo-membranous aneurysm about31.8%(42/132), under the ridge type accounts for about11.4%(15/132), within-ridge type accounting for6.1%(8/132), the septal leaflet about3.0%(4/132).。It has good relevance between preoperative TTE and diameter of VSD in operation with X-ray left ventriculography and occluder size (r=0.617and0.588)2、132patients were the pilot ventricular septal defect occluder, including the technical success rate was95.5%(126/132), six cases are not suitable for interventional therapy. Six cases of unsuccessful cases: with aortic right coronary valve with severe prolapse (without regurgitation) is not OK to block one cases; pseudo-membrane aneurysm base is too large is not OK to block one cases; pseudo-membranous aneurysm mouth more than3tumor wall is not solid and not OK to block one cases; intraoperative atrioventricular block (Ⅲ°) to interrupt the operation is not OK to block one cases; exploration defects mouth cardiac arrest while to give up one cases continue to operate; and after the release of the occluder off to the abdominal aorta.3、Pre-operative cardiac auscultation, all patient clinical auscultation may be the third and fourth intercostal Wen and2to3systolic murmur in the left sternal border.75.0%(99/132) of patients noise for3,25%(33/132) of patients noise2.90.9%(120/132) of patients with pulmonary valve, the second heart sound enhancement,75.8%(91/120) of patients with mild enhancement,24.2%(29/120) patients with moderately enhanced.9.1%(12/132) of patients with pulmonary valve second heart sound is quite the strength of the aortic second heart sound.After surgery, the technical success of100%of the patients (126/126) of the whole systolic murmur disappeared,10.3%(13/126) of patients could be heard and shrinkage of the early and mid-murmur, the intensity of two. Follow-up one month,4.0%(5/126) patients could be heard and shrinkage of the early and mid-murmur intensity2, were followed up for6months,1.6%(2/126) patients could be heard and shrinkage of the early and mid-murmur intensity2, follow-up of12months,0.80%(1/126) patients could be heard and shrinkage of the early and mid-murmur intensity2, followed for24months,0.80%(1/126) of patients could be heard and contraction as early as medium-term noise, intensity2. Patients by postoperative X-ray left ventricular angiography and repeated transthoracic echocardiography confirmed the rupture has not been blocked, for the pseudo-membranous aneurysm Another rupture is less than2mm in diameter.4、Premature ventricular contractions was100%(126/126), intraoperative complications:intraoperative analysis found that, premature ventricular contractions occurred in the defect mouth exploration, the guide wire through the right ventricle and the delivery sheath returned by the aortic-left occur when the ventricle, are over.88.9%(112/126) of patients completed this step premature beats disappear, only11.1%(14/126) of patients cease operations, to be premature after the disappearance of re-operation. Paroxysmal supraventricular tachycardia rate of58.73%(74/126), also occurred in the above steps, more than the same steps repeated operations to stimulate the heart wall and triggered to stop the operation or adjustment of the catheter or guidewire headend to stop the attack. One cases of patients with ventricular tachycardia after intravenous infusion of lidocaine to alleviate repeated in the same step. Two cases of patients in the intraoperative atrioventricular block Ⅱ°Ⅱ of type1cases, Ⅲ°1cases, to stop the operation and use of medication and remission. Shedding one cases of abdominal aorta after the release of the occluder.(Due to defects in the mouth too much, for the larger models occluder is expected to occur AVB) of the operation was stopped after removing the catheter.Postoperative complications:3cases of atrioventricular block after the first5days.1cases of persistent Ⅲ°A-VB,1cases of intermittent Ⅲ°A-VB,1cases of Ⅱ°ⅡA-VB。5-7big dose of albumin, the impact of the amount of adrenal cortical hormone, isoproterenol epinephrine, furosemide, and myocardial nutrition drug treatment to restore normal sinus rhythm.1cases due to local multiple puncture injury shares arteriovenous local pulsatile hematoma, aneurysm by ultrasound probe. Alleviate after to bandaged Taigaohuanzhi and drug treatment.Conclusions1、VSD occluder is a safe and effective treatment of congenital heart disease VSD. Shorter operative time, to avoid cardiopulmonary bypass, less patient trauma and healing well, and can keep the surface perfect, can partially replace surgery, clinical application. 2、VSD sub-complex, close to the passage of the aortic, tricuspid, mitral, and tracts, prone to a variety of complications, strictly controlled clinical indications, detailed preoperative examination to avoid complications occur.3、Echocardiography to check the the Figure secondary preoperative screening, intraoperative guidance, monitoring and combined with left ventricular angiography and left ventricular angiography, can play a decisive indication of the occluder and the occluder type and model choice role.4、After a decade of clinical applications, and combined with12to24months of follow-up found no serious complications, and the high technical success rate, we concluded that the application of individual experience in the treatment of intervention is reasonable and effective. |
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