| Ventricular septal defect(VSD) is the most common type of left to right shunt heart malformation, which can develop pulmonary artery hypertension and even Eisenmenger syndrome, leading to reduce cardiac function, cause patients with recurrent pulmonary infection, affecting their growth, severe cases can lead to heart failure or sudden death. At present, the common modes of operation are surgical repair operation treatment and the transcatheter closure. The former is more mature, successful rate is high, but the need to open the chest, extracorporeal circulation, transfusion. While because of minimal invasion and quicker recovery the latter gradually become a hot and difficult issue about the treatment of VSD though its development is late and limited by the equipment size and patient age. Now there are few studies about long term safety and effectiveness. The purpose of this paper is to observe the effect of the two groups through followed up patients who accept two surgical methods respectively for treatment.Research into perimembranous ventricular septal defect patient 109 cases who treated in General Hospital of the Air Force PLA Heart Center Hospital in 2010 January to 2011 December. Patients are divided into two groups according to the operation mode, interventional group(61 cases) and surgical group(48 cases). Comparison of two groups preoperative basic information(gender, age, weight, size, ventricular septal defect, whether there is aneurysm of membranous etc.), intraoperative, postoperative(two groups success rate of operation, the volume of blood transfusion, hospital stay and cost and so on) and the incidence of complications of patients and prognosis. On the comparison of two kinds of operation methods influence of heart function, such as ejection fraction(EF), fraction shortening(FS), ECG indexes, such as the QT dispersion(QTd), corrected QT dispersion(QTcd), a V1 lead terminal potential(PTFV1), Macruz index through follow up to observe the two groups changes of electrocardiogram and echocardiography that collected in the preoprative, 1 day after operationin and 3 years after operation.The study found that some information such as sex, age, weight, size and ventricular septal defect complicated with membranous aneurysm cases were no difference before operation in two groups. Interventional group and surgical group success rate were 96.72% and 100% respectively; volume of blood transfusion were 0ml and(629.17±300.32)ml respectively; hospital stay were(6.11 + 1.82) days and(12.90 + 1.68) days respectively; the total cost of hospitalization were(23973 + 2551) yuan and(20395 + 4357) yuan respectively. Hospital stay of interventional group was significantly shorter than the surgical group, and interventional group does not need a blood transfusion, but surgery total cost is relatively low, the difference was statistically significant(P<0.05). Interventional group and surgical repair group total complication rate were 22.95%, 37.50% after operation, two groups had no significant difference. The new arrhythmias rates of two groups were 8.20%, 10.42% respectively, the main arrhythmia were right bundle branch block, ventricular premature, APB, junctional rhythm and short P-R interval. There were no serious arrhythmia, such as left bundle branch block and three degree atrioventricular block in two groups. New valvular regurgitation were 6.56% and 6.25% respectively, mainly for small amounts of valvular regurgitation, two groups were no serious valvular regurgitation occurs. Residual shunt were 3.28% and 2.08% respectively. There were small amount of micro- residual shunt in two groups. Compare to two groups, new incidence of cardiac arrhythmias, valvular regurgitation, residual shunt were no statistical differences, and most complications recovered gradually during follow-up. Cardiac function was significantly improved compared with preoperative in two groups and there was no significant difference(P>0.05). Two groups changes in QTd, QTcd, PTFV1 and Macruz value were significant shorter than preoperative, compared the two groups had no significant difference(P>0.05).Compared with surgical repair, individual transcatheter closure has the characteristics of high success rate and less complications to treatment perimembranous VSD, and does not need a blood transfusion and thoracotomy and recovery faster. The improvement of long-term efficacy, heart function and heart electricity indexes in interventional group were not second to surgical group. Transcatheter closure had long-term safety and effectiveness. For perimembranous ventricular septal defect patients which in line with the interventional treatment standard, the use of individual transcatheter closure can be used as one of effective methods in the treatment. |
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