The Efficiency And Safety Of Interv Entional Occlusion Of Perimembranous Ventricular Septal Defect With Aortic Valve Prolapse In Children

Objective:To investigate the efficiency and safety of transcatheter closure of perimembranous ventricular septal defect(pVSD)with aortic valve prolapse(AVP)in children by analysing the success rate of intervention,postoperative complications,and the morphology and function of aortic valves before and after intervention.Methods:A total of 164 children with pVSD and AVP who underwent interventional occlusion from January 2013 to November 2014 were analyzed retrospectively.AVP was divided into mild,moderate and severe AVP according to the morphology of right coronary leaflet at the end of diastole during angiography.To analyze the success rate of intervention,postoperative arrhythmia,tricuspid regurgitation,bleeding,femoral arteriovenous fistula,thrombosis and other complications of pVSD with different degrees of AVP,and to compare the morphology and function of aortic valves before and after intervention.Results:A total of 164 patients were included in the study,including 97 males and 67 females.The success rates of interventional occlusion in mild AVP(n=63),moderate AVP(n=89)and severe AVP(n=12)were 93.7%,89.9%and 58.3%,respectively.Immediately after procedure,there was no new-onset AR above trivial degree,residual shunt above mild degree,bleeding,thrombosis,femoral arteriovenous fistula,severe valve regurgitation or arrhythmias needed drug or operation,except 1 patient developed transient complete atrioventricular block.The width and depth of prolapsed aortic valves were reduced in all patients after intervention.In the 35 patients who initially had trivial-to-moderate aortic regurgitation(AR),AR was ameliorated or disappeared in 25(71.4%),aggravated from trivial to mild AR in 1(2.9%).In 111 patients without preoperative AR,1(0.9%)patient had mild AR and 24(21.6%)patients had trivial AR after intervention.During follow-up period,newly mild AR developed in mild,moderate and severe AVP were 2%,1.8%and 20%,respectively.AR disappeared in 17 patiens(12.4%).Immediately after procedure,9(6.2%)patients had residual shunt.At the end of follow-up,5(3.6%)had residual shunt.During the 70-month(range,54-77)follow-up period,no serious cardiovascular events such as thrombosis,cardiac arrest,shock,more than moderate residual shunt,surgical removal of occluder and installation of pacemaker due to severe arrhythmia or AR occurred.The 5-year cardiovascular event-free survival rates of children with mild,moderate and severe AVP were 89.6%,94.5%and 80.0%,respectively.Conclusion:The success rate of interventional occlusion in mild and moderate AVP in children is high,the complications are few,the morphology and function of prolapsed aortic valves improved after intervention and the long-term follow-up is safe and efficient,which is suitable for interventional occlusion.The success rate of severe AVP in children is low and the incidence of AR is high,which is not recommendeed for interventional occlusion.