| Objective:The aim of this study was to analyze the clinical data of the pediatric patients who accepted the operation of transcatheter closure of ventricular septal defect in our hospital,to investigate the occurrence and development of complications,and reduce the occurrence of adverse events.Subjects and Methods:SubjectsrWe selected332cases with VSD and received transcatheter closure of VSD at our hospital from2004jul. to2013May.All patients underwent electrocardiographic monitoring for2days and TTE before discharge, at1month and3,6,and12months during follow up, and every12months there after. Some of them got X ray data after operation to see the shape of occluders.Methods:Through analysis the data of the332cases,we statisticed the success rate,the complication rate of many types, comparative analysis of long-term complications and short-term complications and found out the relativity of many factors with complications.Results:1.In the332cases,including male151cases and female181cases.The mean age was (8.23±8.12) years(range from1year to18years) and mean body weight was (23.15±10.94)Kg(range from10Kg～69Kg).305patients (91.87%) underwent VSD closure successfully,299of them used symmetrical occluders,50cases with eccentric occluders,37cases used slender waist occluders,6cases used PDA occluders and6cases used muscular occluders.2.The average diameter of ventricular septal defect was (7.58±3.36) mm, the diameter of the occluder was from4mm to18mm, the average diameter of occluder was (5.72±1.88) mm, The operation time was30minutes to385minutes, and the average time was (94.05±53.47) minutes. X-ray exposure time was4minutes to151minutes, and the average time was (26.23±20.01) minutes. The total successful rate of operation was91.87%(305/332).3.1n the failure27cases(8.13%):9cases were gave up because of the shunt in the defect is too tiny for occluder;9cases were gave up because of the defect and aortic valve are adjacent to placement the occluder;4cases had too large residual shunt after the placement of occluders, so we got out the occluder;1cases with aneurysm of membranous, the two outlets of the defects are faraway to plug at the same time;1cases appeared Ⅰ°AVB and bundle branch block after we plugged the occluders, so we removed the occluders; the last1cases we gave up because it’s too hard to establish rail;after the occluder placement, the tricuspid got confined in1case; aortic valve moderate reguritation after the occluder was placed in1case.4.Four cases of atrioventricular block(1.42%),including three cases occurred Ⅰ°AVB,one occurred cAVB, include one case occurred A-S syndrome six days after the operation,the ECG showed CRBBB,discontinuous high degree AVB,gave dexamethasone and temporary pacemaker implantation,2days later the child returned to normal.incomplete right bundle-branch block three cases, the other one appeared cAVB two days after the operation, ECG showed high degree atrioventricular block and CRBBB.gave temporary pacemaker to maintain a normal rhythm.22days later we got the temporary pacemaker out.Six(1.81%) of the patients were found to have CRBBB.twenty eight cases (8.43%) were found to have ICRBBB after the procedure.Five(1.51%) of the patients were found to have CLBBB,while five(1.51%) were found to have LAFB.The data showed that the happening of conduction block has no relevance with age,weight, sex,the diameter of the VSD or the type of the occluder,but has obvious relevance with the diameter of the occluder.5. Accelerated rhythm appeared22cases in our study(6.63%),12cases of them are ventricular arrhythmia,8cases had supraventricular arrhythmia,2case both had ventricular and supraventricular arrhythmia after the operation. Disappeared after withdrawal of the catheter, we considered that the catheter stimulated abnormal pacemaker, without any treatment, postoperative electrocardiogram were normal, follow up showed ECG has no change.6.There are35cases(10.54%) appeared residual shunt after operation,all of them were trace or tiny shunt,and disappeared in a week.There are6cases(1.81%) occurred hemolysis in24-48h after operation.The data showed that the size of occluder,and postoperative residual shunt associated with hemolysis(P<0.05).8. Valvular regurgitation occurred in71cases(21.39%),including aortic regurgitation15cases(4.52%),tricuspid regurgitation48cases(14.46%),mitral regurgitation4cases(1.20%),2cases(0.6%) both has AR and TR,1case(0.3%) AR and MR,the last one case(0.3%) had TR and MR.Only one case occurred aggravate,from mild regurgitation to moderate regurgitation,the rest are micro-small reflux.9.There is no pericardial tamponade, pericardial effusion, large amounts of residual shunt, severe aortic injury or incompetence, infective endocarditis, left ventricular enlargement, ventricular aneurysm, heart failure and death cases happen in this investigation.Conclusion:1.In this study,the most common complication after the operation was valvular regurgitation.The incidence of other complication from high to low was arrhythmia,rsidual shunt and hemolysis.2.This study shows that the factors of complications including diameter of VSD,diameter of occluder and the type of occluder.To reduce the incidence of complication,we should select smaller occluder as far as possible.3.Larger diameter of occluder may cause serious conduction block,residual shunt,hemolysis and tricuspid regurgitation more easily than smaller occluder. |
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