The Study Of Occurrence And Influencing Factors Of Heart Block In Perioperative Period Of Transcatheter Closure Of CVSD By Using Data Platform

ObjectiveTo establish a digital platform for management of Congenital Ventricular Septal Defect (CVSD) patients who undergone transcatheter closure. Analysis of heart block and risk factors after transcatheter closure. Provide a scientific basis for optimization of the major complications prevention strategy.Method1. Design and establish Digital Platform For Congenital VSD Patients After Transcatheter Closure and its Database Management System basis on database management software developted by a nonprofit organization in Odense, Denmark, recorded all related information of Congenital Ventricular Septal Defect (CVSD) patients who undergone transcatheter closure in department of cardiology, First Affiliated Hospital of Kunming Medical University since July2007. Storing patient demographic characteristics, preoperative baseline information, diagnostic information, operation information, outcome evaluation of discharged efficacy and the related information of complications treatment by setting multiple qualitative, quantitative field. The quality control of data platform using CHK file in system,then encrypt it, double entry, to ensure accuracy and specification of the information.2. Continuously collected patients from July2007to July2012who diagnosis of CVSD and accepted the transcatheter closure from Digital Platform for Congenital VSD Patients After Transcatheter Closure. Review the perioperative body surface patient’s synchronous12-lead ECG and echocardiographic images, observed of occurrence location, severity, treatment, and outcome of the situation of the heart block. Analysis of relationship of heart block development and patient demographic characteristics, disease characteristics, operation procedures, and operation equipment, postoperative management and other factors.3. Using SPSS19.0package deal with all observed datas, P<0.05ruled there was significant difference.Results1. A CVSD clinical database has been established independently and successfully. The database settings reflect the VSD clinical features approximately800field (see Appendix). Successful entry relational information of CVSD patients who undergone transcatheter closure since July2007in Kunming Medical University, Department of Cardiology. Completion one patient data entry takes an average (?)5minutes, the average time than the hand shortened by10minutes. To achieve the functionality of the database that fast and accurate entry data, maintenance, safeguard, retrieval, printing, statistics, remote transport.2. From July2007to July2012, there is a total of412CVSD cases (male193, female219cases, maximum age62years old, minimum age2years, an average of15.05±12.22years) who accepted transcatheter closure in Department of Cardiology, First Affiliated Hospital of Kunming Medical University. CVSD defects size minimum2mm diameter,19mm maximum,average7.18±2.81mm, Including muscular VSD3cases (0.73%), membranous VSD409cases (99.27%).3.412patients were accepted interventional therapy, total implanted332occluder of different types (symmetric294,35thin waist and large side type, asymmetrical type3). Closure plate minimum diameter of4mm, the lagest22mm, average8.41±3.41mm. Shortest hospital stay1day, the longest45days, an average of6.73±4.21days, postoperative different parts and different degrees heart block total95cases,23.0%. Incidence in descending order for RBBB60cases (14.6%), LAFB29cases (7.0%), Ⅰ degree AVB6cases (1.5%), CLBBB2cases (0.5%), Ⅱ degrees type Ⅱ AVB1cases (0.2%), height and CAVB0patients (0%). Difference between the groups was significant (P<0.001). At discharge, there are still70patients (17.0%) heart block persists including RBBB44cases (10.7%), LAFB20cases (4.9%), I-degree AVB5cases (1.2%). Find seven cases (1.7%) IRBBB progressed to CRBBB. Total of five types of25patients (6.1%) heart block disappeared or reduced (IRBBB16cases, RBBB2cases, LAFB5cases, CLBBB1case, Ⅱ degree type Ⅱ AVB lease), constituent ratio in descending order for79cases (19.2%)> disappear/reduce (6.1%)> increased (1.7%), difference was significant (P<0.001).4. During hospitalization of412CVSD patients,95cases (100%) heart block received drug therapy,0(0%) heart block to accept a temporary or permanent cardiac pacing, no operation-related heart block leads to death (0%).5. Analysis of age,gender,body weight, operation time, LVEF,presence or absence of ventricular septal aneurysm, right ventricular diameter,septum range of motion, VSD type, occluder waist diameter et cetera that may be relevant heart block factors of perioperative. The results of relative risk factors for heart block include CVSD defect location high, too large or larger occluder size(OR values were1.172,P values were0.003).6. Analysis of age, gender,body weight, presence or absence of ventricular septal aneurysm, right ventricular diameter, pulmonary artery width, Septal thickness,VSD type,waist diameter occluder et cetera that may be relevant RBBB factors of perioperative period. The result of relative highest risks are larger models occluder,(OR values were1.128and,P values were0.015).7. Analysis of possible factors related to the above, Pulmonary artery and right ventricular diameter width are Protective factors of occurrence of LAFB in the perioperative period.(OR values respectively were0.833and0.806, P values respectively were0.042and0.036).Conclusions1. The research and development of Database of Congenital VSD Patients After Transcatheter Closure and Database Management System with efficient, accurate, fast, standardized management of patients who undergone transcatheter closure. In the side of implementation of CVSD information management thereby improving the prognosis of patients with practical value.2. Although CVSD overall incidence of perioperative heart block in transcatheter closure reach up to23%, mostly without therapeutic intervention RBBB and LAFB that is part of low-risk types. Serious heart block incidence of less than1%and better on its own, if necessary, can be completely repair of cardiac pacing, does not increase postoperative the risk of death. Prompt intervention current transcatheter treatment CVSD efficient and safe.3. Larger CVSD defect and larger occluder size are independent risk factor for multiple heart block occurrence and development in the perioperative period of CVSD transcatheter closure.4.larger Occluder diameter are independent risk factor for RBBB occurrence and development in the perioperative period of CVSD transcatheter closure.5. Right ventricular diameter being smaller and/or minor pulmonary width maybe increase the incidence of LAFB risk in perioperative period of CVSD transcatheter closure.In this study, although the number of samples is too small, observed indicators not enough, without making post-discharge follow-up track, but results are still show that focus on transcatheter closure of postoperative heart block risk factors and actively prevent detection, allows CVSD patients treatment more efficient, security.