Prognosis Of Aortic Regurgitation With Transcatheter Closure Of Ventricular Septal Defect And The Effect On Cardiac Structures,Cardiac Function

Objective:To investigate the effect and analyze the relative factors of aortic regurgitation with transcatheter closure of ventricular septal defect(VSD), to follow-up the regurgitation prognosis of the patients with aortic valve regurgitation(AR) diagnosed by ascending aortic closure before and after transcatheter closure, and the effects on cardiac structure and cardiac function. Methods:From November 2011 to August 2015, we selected 92 patients with AR diagnosed by ascending aortic angiography before and after transcatheter closure in our hospital. Before transcatheter closure, we measured the size of the cardiac chambers, LVEF and the regurgitation of aortic valve by the transthoracic echocardiography(TTE). During the surgery, left ventriculography were performed to record the type and size of VSD, the distance from the aortic valve, the size and type of the occluder. Before and after the transcatheter closure, we observe the regurgitation of aortic valve by ascending aortic angiography. We followed up the condition of aortic regurgitation, cardiac structure and cardiac function on the 3 days, 1 month, 3 months, 6 months and 12 months after transcatheter closure. Then those indexes were recorded to compared with preoperative by thoracic echocardiography. Results:(1).Nineteen patients in 92 VSD patients had AR diagnosed by ascending aortic angiograph before the transcatheter closure(about 20.6%), average age was 12.84±12.55 years old, average weight was 29.55±20.17 kg. There were 9 males(47.4%), 10 females(52.6%). One year after transcatheter closure of VSD, 9 VSD patients with AR returned to normal(about 47.4%); 9 VSD patients with AR constant(about 47.4%) and 1 case(about 5.2%) with mild aortic regurgitation had been in aggravating to mild-moderate. The development of AR had no significant correlation with the type and size of VSD, the distance from the aortic valve, the size and types of the occluder(P>0.05). We found that the cardiac function and the cardiac structure had no obvious change in the group which keep regurgitation of aortic valve constant. In addition, there was no significant changes in heart function, but, the left ventricular diameter was statistically significant decreased compared with preoperative in the group that aortic regurgitation disappeared(P<0.05).(2). Seventy-one patients in 92 VSD patients diagnosed aortic valve regurgitation by ascending aortic angiograph after the transcatheter closure(about 76.1%), 3 cases(about 3.3%) had moderate aortic regurgitation after transcatheter closure, and then change to repair by the surgery. There were 31 males(42.5%), 42 females(57.5%). The average age was 10.53±12.34 years old, average weight was 24.34±15.10 kg. 3 patients had lost to follow-up after transcatheter closure(about 4.3%). The aortic valve regurgitation disappeared in 47 patients as follow-up(about 67.2%); aortic regurgitation of 19 patients constant(about 27.1%) and 1 case(1.4%) with aortic regurgitation is aggravating. With long term follow up by TTE, we found that the heart function had no significant change, the left ventricular diameter was significant decreased compared with preoperative. Conclusion:1. The VSD patients with AR, after transcatheter closure of VSD, the regurgitation can be relieved. The middle and short term follow-up found that the cardiac function was not seen obvious change, but the heart structure can be improved.2. The middle and short term follow-up did not see heart function and cardiac structure deterioration in the new-onset aortic valve regurgitation patients after transcatheter closure, and also found that the cardiac structure can be improved.