Marinakis Andreas, Vydt Tom, Dens Joseph, Gewillig Marc, Van Deyk Kristien, Budts Werner
Department of Cardiology, University Hospitals, Leuven, Belgium.
Acta Cardiol. 2007 Aug;62(4):391-5. doi: 10.2143/AC.62.4.2022283.
The interest in transcatheter ventricular septal defect (VSD) closure is continuously growing. Therefore, we report our experience in perimembranous (Pm) and postinfarction (Pi) VSD closure.
All patients, older than 16 years, were selected from a data base, in which Pm and Pi VSDs were registered. The patients' files were reviewed until the most recent follow-up date.
Nine (7 male, 37.4 +/- 12.8 y) and 8 (6 male, 76.3 +/- 6.2 y) patients underwent a Pm (group A) and Pi VSD (group B) closure, respectively. One female patient was treated for a posttraumatic VSD (26 y). In group A, 7 patients were closed with the Amplatzer perimembranous VSD occluder, one with the muscular VSD occluder, and one patient with the atrial septal defect occluder. All patients in group B were treated with the muscular VSD occluder. In the post-traumatic VSD an Amplatzer patent foramen ovale occluder was used. Device implantation was feasible in all, except in two patients with extremely large VSDs (one Pm and one PiVSD). Total transcatheter closure or small residual leakage was achieved in 7/8 patients in group A, but one patient needed surgical VSD repair because of massive haemolysis, another patient died 9 months later. A small or moderate shunt was present immediately after the procedure in all patients of group B. No device-related complications were reported, but all, except one patient, died within 2 weeks after the procedure because of an extremely high co-morbidity (logistic Euroscore 70 +/- 25%). Total closure was achieved in the post-traumatic VSD.
Transcatheter closure of Pm and Pi VSD with Amplatzer septal occluders in adults is feasible and safe, but the post-procedural prognosis totally depends on the aetiology of the VSD and its co-morbidity.
经导管室间隔缺损（VSD）封堵术的关注度持续上升。因此，我们报告我们在膜周部（Pm）和心肌梗死后（Pi）VSD封堵方面的经验。
所有年龄大于16岁的患者均从一个登记有Pm和Pi VSD的数据库中选取。查阅患者病历直至最近的随访日期。
分别有9例（7例男性，年龄37.4±12.8岁）和8例（6例男性，年龄76.3±6.2岁）患者接受了Pm（A组）和Pi VSD（B组）封堵术。1例26岁女性患者接受了创伤后VSD治疗。A组中，7例患者使用Amplatzer膜周部VSD封堵器封堵，1例使用肌部VSD封堵器，1例使用房间隔缺损封堵器。B组所有患者均使用肌部VSD封堵器治疗。对于创伤后VSD，使用了Amplatzer卵圆孔未闭封堵器。除2例VSD极大的患者（1例Pm和1例Pi VSD）外，所有患者均可行装置植入。A组8例患者中有7例实现了经导管完全封堵或少量残余分流，但1例患者因大量溶血需要进行外科VSD修补，另1例患者9个月后死亡。B组所有患者术后即刻均存在少量或中度分流。未报告与装置相关的并发症，但除1例患者外，所有患者均因极高的合并症（逻辑欧洲评分70±25%）在术后2周内死亡。创伤后VSD实现了完全封堵。
在成人中使用Amplatzer间隔封堵器经导管封堵Pm和Pi VSD是可行且安全的，但术后预后完全取决于VSD的病因及其合并症。
