Li Tian-chang, Hu Da-yi, Bian Hong, Wang Guo-hong, Zhu Zheng-yan, Wang Chang-hua, Xu Yu-yun
Cardiovascular Center of Beijing Tongren Hospital, Capital University of Medical Sciences, Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2005 Oct 26;85(40):2846-9.
To evaluate the curative effects of transcatheter closure on perimembranous ventricular septal defects (PMVSDs) using unbalanced Amplatzer asymmetric ventricular septal defect occluder (AAVSDO).
The data of 68 patients of PMVSDs with a diameter of 6.7 mm (3 to 12 mm) and the diameter of ventricular septal rim below the aortic valve of 2.7 +/- 1.1 mm (1-5 mm), 27 males and 41 females, aged 15.6 +/- 11.5 (1.5-44), weighing 42.8 +/- 15.2 kg (10-72 kg), treated with AAVSDO, the diameter of which was 1-2 mm larger than the largest diameter of the defects determined by angled left ventriculography, from September 2002 to January 2005 were prospectively analyzed. The patients were followed up for 221 +/- 130 days (90 to 750 days).
Seventy-one procedures were performed. The device was implanted successfully in 65 of the 68 patients (95.6%). The selected device diameter was 8.4 mm (4 to 14 mm). Device was lost in one patient during the procedure, which was successfully managed by recapturing the device with a snare device and redeploying it. During the procedure, transient complete left bundle branch block and right bundle branch block occurred in 6 and 5 patients respectively. On follow-up evaluation, transient junctional rhythm occurred in one patient, and accelerated ventricular rhythm in 1. After deployment of the device, the immediate complete closure rate was 43% (28/68), increased to 81.5% (53/68) on the day next to the procedure, and reached 100% 6 months after. One patient adopted surgical reparation because hemolysis occurred after the device implanted. The hospitalization time was 4.5 +/- 3.6 days (2-8 days). The X-ray exposure time was 14.8 +/- 10.7 min (6-48 min). The procedure time 72.6 +/- 38.7 min (35-186 min). One patient was diagnosed as with deep vein thrombosis because of right leg swelling at the seventh day after the procedure. The symptoms disappeared after anticoagulation treatment with low molecule weight heparin. During the scheduled long-term follow-up all patients were doing well. No episode of endocarditis, procedure-related death, or wire disruption was recorded.
The initial and long-term follow-up results of transcatheter closure of PMVSDs are promising with high success and occlusion rates. Transcatheter closure of PMVSDs using AAVSDO appears to be the first line choice for suitable patients with such defects.
评估使用非对称型Amplatzer室间隔缺损封堵器（AAVSDO）经导管封堵膜周部室间隔缺损（PMVSDs）的疗效。
前瞻性分析2002年9月至2005年1月期间68例PMVSDs患者的数据，缺损直径为6.7mm（3至12mm），主动脉瓣下室间隔边缘直径为2.7±1.1mm（1 - 5mm），男27例，女41例，年龄15.6±11.5（1.5 - 44）岁，体重42.8±15.2kg（10 - 72kg），使用比左心室造影测量的缺损最大直径大1 - 2mm的AAVSDO进行治疗。患者随访221±130天（90至750天）。
共进行了71次操作。68例患者中有65例（95.6%）成功植入封堵器。所选封堵器直径为8.4mm（4至14mm）。1例患者在操作过程中封堵器脱落，通过圈套器成功捕获并重新植入。操作过程中，分别有6例和5例患者出现短暂性完全性左束支传导阻滞和右束支传导阻滞。随访评估时，1例患者出现短暂性交界性心律，1例出现加速性室性心律。封堵器植入后，即刻完全封堵率为43%（28/68），术后次日升至81.5%（53/68），6个月后达100%。1例患者因植入封堵器后发生溶血而接受外科修补。住院时间为4.5±3.6天（2 - 8天）。X线暴露时间为14.8±10.7分钟（6 - 48分钟）。操作时间为72.6±38.7分钟（35 - 186分钟）。1例患者术后第7天因右下肢肿胀被诊断为深静脉血栓形成，经低分子肝素抗凝治疗后症状消失。在预定的长期随访中，所有患者情况良好。未记录到心内膜炎发作、与操作相关的死亡或导线断裂事件。
经导管封堵PMVSDs的初期及长期随访结果令人满意，成功率和封堵率高。对于合适的此类缺损患者，使用AAVSDO经导管封堵PMVSDs似乎是首选方法。
