Comparison Between Perventricular Device Closure And Extracorporeal Circulation Procedure Of Subarterial Ventricular Septal Defect In Children

Background and objective:Subarterial ventricular septal defect is a special type of ventricular septal defect because of its location where just below the aortic valve. The propensity to aortic valve prolapse and regurgitation used to make this type of VSD a contraindication of perventricular device closure procedure. In recent years, the use of asymmetric ventricular sepal defect occluder make the perventricular device closure procedure of subarterial ventricular septal defect possible but still with a lower success rate and more occurrence of aortic regurgitation compared with perimembranous VSDs, which means the surgical effect and the clinical indications for perventricular device closure procedure of subarterial ventricular septal defect remains to be verified. This study was aimed to compare surgical effect of perventricular device closure procedure with extracorporeal circulation procedure of subarterial ventricular septal defect in children and provide evidence for clinical diagnosis and treatment. Method:Retrospective analysis was conducted according to the clinical data of cases of isolated subarterial ventricular septal defect diagnosed by transthoracic echocardiography between October2009and September2014. There were54patients in group A underwent perventricular device closure procedure and91patients in group B underwent extracorporeal circulation procedure. The clinical data of these cases were collected and analyzed to compare surgical effect of the two different approaches.Result:1. There was no significance in age, gender, and body weight between the two groups. The diameter of VSD in group A was smaller than that in group B (P<0.01). The proportion of aortic valve prolapsed before procedure in patients in group A was less than that in group B (P<0.01). Group A was observed with a shorter time of mechanical ventilation in ICU and hospitalization and a less proportion of transfusion (P<0.01)2. The proportion of mild aortic valve regurgitation before procedure in group A was less than that in group B (P<0,01). In group A, the incidence of mild tricuspid regurgitation after procedure was less than that before procedure (P<0.01). The chamber size and left ventricular ejection fraction derived from transthoracic echocardiography before and after procedure of the two groups showed no statistically significant difference (P>0.05)3. The incidence of incomplete right bundle branch block in both groups after procedure was higher than that before procedure (P<0.01). One patient in group A was observed with device drop-off3hours after procedure and underwent extracorporeal circulation procedure to remove occluder and repair the VSD. The incidence of residual shunt, arrhythmia and pericardial effusion was similar (P>0.05)Conclusion:Perventricular device closure procedure is an effective option for the treatment of subarterial ventricular septal defect. It is featured with less invasive, shorter time of mechanical ventilation in ICU and hospitalization and a weaker need for transfusion compared to extracorporeal circulation procedure.