Butera Gianfranco, Carminati Mario, Chessa Massimo, Piazza Luciane, Micheletti Angelo, Negura Diana Gabriella, Abella Raul, Giamberti Alessandro, Frigiola Alessandro
Department of Pediatric Cardiology and GUCH Unit, Policlinico San Donato, Instituto Ricerca e Cura a Carattere Scientifico, San Donato Milanese, Italy.
J Am Coll Cardiol. 2007 Sep 18;50(12):1189-95. doi: 10.1016/j.jacc.2007.03.068. Epub 2007 Sep 4.
We sought to analyze safety, efficacy, and follow-up results of percutaneous closure of perimembranous ventricular septal defects (pmVSD).
Results of pmVSD transcatheter closure have been reported in the literature; however, follow-up data are still limited.
Between January 1999 and June 2006, 104 patients underwent percutaneous closure of a pmVSD at our institution. An Amplatzer VSD device (muscular or eccentric) (AGA Medical Corp., Golden Valley, Minnesota) was used in all subjects.
The mean age at closure was 14 years (range 0.6 to 63 years). The attempt to place a device was successful in 100 patients (96.2%). The median device size used was 8 mm (range 4 to 16 mm). No deaths occurred. Total occlusion rate was 47% at completion of the procedure, rising to 84% at discharge and 99% during the follow-up. A total of 13 early complications occurred (11.5%), but in all but 2 subjects (1.9%) these were transient. The median follow-up was 38.5 months. The most significant complication was complete atrioventricular block (cAVB), which required pacemaker implantation in 6 subjects (5.7%; 2 in the early phase and 4 during the follow-up). Cox proportional hazards regression analysis showed that the only variable significantly associated with the occurrence of this complication was age at the time of the procedure (p = 0.028; relative risk 0.25). All subjects experiencing this problem were <6 years old.
In the current era and in experienced hands, pmVSD closure can be performed safely and successfully. The major concern is the occurrence of cAVB; therefore, very careful monitoring of rhythm is mandatory during follow-up.
我们试图分析经皮闭合膜周部室间隔缺损（pmVSD）的安全性、有效性及随访结果。
文献中已报道了pmVSD经导管闭合的结果；然而，随访数据仍然有限。
1999年1月至2006年6月期间，104例患者在我院接受了pmVSD经皮闭合术。所有患者均使用了Amplatzer室间隔缺损封堵器（肌部或偏心型）（AGA Medical Corp.，明尼苏达州黄金谷）。
闭合时的平均年龄为14岁（范围0.6至63岁）。100例患者（96.2%）成功置入封堵器。所用封堵器的中位尺寸为8 mm（范围4至16 mm）。无死亡病例。手术结束时的完全封堵率为47%，出院时升至84%，随访期间为99%。共发生13例早期并发症（11.5%），但除2例患者（1.9%）外，其余均为短暂性并发症。中位随访时间为38.5个月。最严重的并发症是完全性房室传导阻滞（cAVB），6例患者（5.7%）需要植入起搏器（2例在早期，4例在随访期间）。Cox比例风险回归分析显示，与该并发症发生显著相关的唯一变量是手术时的年龄（p = 0.028；相对风险0.25）。所有出现该问题的患者均<6岁。
在当前时代及经验丰富的术者手中，pmVSD闭合术可安全、成功地进行。主要关注点是cAVB的发生；因此，随访期间必须非常仔细地监测心律。
