Wu Hong, Qin Yongwen, Zhao Xianxian, Hu Jianqiang, Zheng Xing, Wang Ersong, Li Weiping, Wang Yanyan, Liu Bo, Liu Jing, Wang Shengqiang
Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China.
Clin Res Cardiol. 2009 Sep;98(9):563-9. doi: 10.1007/s00392-009-0044-y. Epub 2009 Jul 10.
The majority of ventricular septal defects (VSDs) are perimembranous, accounting for 75-80% of all VSDs. The objective of this study was to investigate occluder selection and transcatheter closure technique for multi-hole perimembranous VSD with aneurysm, and to evaluate clinical efficacy and safety. Patients with multi-hole VSDs and aneurysm (n = 64) were selected for the procedure using transthoracic echocardiography. Double-disc symmetrical, small-waist double-disc asymmetrical and zero eccentricity occluders were selected based on left ventricular angiography. The closure was successful in 63 of 64 patients (98%). The double-disc symmetrical occluder was used in 16 cases, the small-waist double-disc asymmetrical occluder in 42 cases, and the zero eccentricity occluder in 8 cases (2 occluder types were used in 2 cases). Fifteen minutes after the procedure, 52 cases had no residual shunt and 12 had a trace amount of residual shunt. The residual shunt disappeared in five cases 5-7 days post procedure, with a trace amount of shunt remaining in seven cases. Transient conduction abnormalities related to the procedure occurred in six patients; however, none required permanent pacemaker implantation. At the 1-month, 6-month, 1-year, 2-year, and 3-year follow-up visits, echocardiography indicated that the position of the occluders was fixed, and there were no complications including residual shunt, newly developed atrioventricular block, thromboembolism, or bacterial endocarditis. The study results indicate that left ventricular angiography is useful in selecting the most appropriate device for transcatheter closure of multi-hole perimembranous VSD with aneurysm. The transcatheter closure procedure is safe and effective with little residual shunt and no major complications for up to 3 years of follow-up.
大多数室间隔缺损（VSD）为膜周部，占所有VSD的75 - 80%。本研究的目的是探讨多孔膜周部VSD合并瘤样膨出的封堵器选择及经导管封堵技术，并评估其临床疗效和安全性。采用经胸超声心动图选择多孔VSD合并瘤样膨出的患者（n = 64）进行该手术。根据左心室造影选择双盘对称型、小腰双盘不对称型和零偏心封堵器。64例患者中有63例（98%）封堵成功。使用双盘对称型封堵器16例，小腰双盘不对称型封堵器42例，零偏心封堵器8例（2例使用了2种封堵器类型）。术后15分钟，52例无残余分流，12例有微量残余分流。术后5 - 7天，5例残余分流消失，7例仍有微量分流。6例患者出现与手术相关的短暂性传导异常；然而，无一例需要植入永久性起搏器。在1个月、6个月、1年、2年和3年的随访中，超声心动图显示封堵器位置固定，无残余分流、新出现的房室传导阻滞、血栓栓塞或细菌性心内膜炎等并发症。研究结果表明，左心室造影有助于选择最合适的装置用于经导管封堵多孔膜周部VSD合并瘤样膨出。经导管封堵术安全有效，残余分流少，随访3年无重大并发症。
