Comparative Study Of Transcatheter And Surgery For Valvular Function Of Ventricular Septal Defects

Objective:The current methods of treatment include surgical repair and transcatheterof the ventricular septal defects. Because of smaller wound, fewer complications,transcatheter closure of ventricular septal defect have become the preferred method oftreatment in some patients. The effect of the valvular function after the transcatheterclosure of ventricular septal defect has become an important factor in its long-termprognosis. This study was done to the compare the patients who was accepted transcatheterclosure to the patients who was treated by surgical repair, and analyze the occurrence andoutcome of the valvular regurgitation by the intermediate and long-term clinical follow-up,and provide more evidence for the treatment of transcatheter closure of ventricular septaldefect in its clinical application.Methods:Between January2009to December2012,522patients with ventricularseptal defect underwent closure in our hospital:279patients were treated surgically and243patients were treated with catheter occluder. The general condition before operationjust as age, sex, size of the defect, the diagnosis of valvular regurgitation by transthoracicechocardiography(TTE) after operation and intermediate and long-term follow-up arecompared between the two groups. All the data are proccessed either by means of t test orχ2test statistically.Results:279patients treated by transcatheter closure were implanted septal279VSDoccluders. In the transcatheter group, the mean diameter of VSD was4.75±2.09(2-18)mm,the occluder diameter was7.05±2.94(4-24)mm. In the surgical group, the mean diameter ofVSD was6.77±3.82(2-16)mm. In the transcatheter group and the surgical group afteroperation, the incidence of tricuspid regurgitation was5.38%and4.12%respectively, theincidence aortic regurgitation was1.79%and1.65%, the incidence of mitral regurgitationwas3.23%and0.41%. All patients completed intermediate and long-term follow-up. Thetranscathete group mean follow-up time was33.6±12.2(12-53) months, the surgical groupwas33.5±12.4(12-54)months. There were no deaths in the two groups during the follow-up.During the follow-up, the incidence of tricuspid regurgitation was10.4%and12.8%respectively in the transcathete group and the surgical group, the incidence aorticregurgitation was3.23%and2.06%, the incidence of mitral regurgitation was3.23%and2.47%.One patient was found with large aortic regurgitation in transcathete group during the follow-up.Conclusions: In addition to the mitral regurgitation in short-term postoperative hasstatistical significance, the rest have no statistically different.The treatment of transcatheterclosure of ventricular septal defect was effective, safety and less trauma. The injury to thevalvular function, particularly the injury to the tricuspid and aortic valvular function afteroperation should pay more attention to. Patients should select strictly by usingechocardiography before treatment, skilled and stable operation during the treatment，andchoosing suitable occluder were the most important factors to reduce valvularregurgitation.