Department of Paediatric Cardiology and Cardiac Surgery and Adult Congenital Heart Defect, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
Catheter Cardiovasc Interv. 2010 Feb 1;75(2):246-55. doi: 10.1002/ccd.22262.
The incidence of residual ventricular septal defects (VSDs) after surgery is 5-25%. Redo surgery is associated with higher risks.
Between January 2000 to December 2008, 170 patients underwent percutaneous VSD closure in our centre: 22(16M) of these had 23 closures for residual VSDs. Median age was 32.5 yrs (1.4-79). All patients had echocardiographic signs of left ventricle volume overload (Q(p)/Q(s) >or= 1.5). Nine patients had previous VSD closure, 6 tetralogy of Fallot repair, and 7, other procedures. There were 15 muscular, 6 perimembranous and 2 apical VSDs.
Amplatzer VSD devices were used in all. Median VSD size was 8 mm (4.3-16). Median fluoroscopy time was 33 minutes (15-130). There were three adverse events: 1 ventricular fibrillation requiring DC cardioversion; 1 transient complete atrio-ventricular block reverting to sinus rhythm at 24-hours; one patient had transient atrial flutter during the procedure. All procedures were successful; no additional procedures were required. Trivial residual shunts were seen in 3 patients at follow-up. There were no late events. One patient experienced arrhythmic death 5-yrs after procedure. One patient was reoperated due to dehiscence of VSD patch 2-yrs after the second successful percutaneous closure.
Transcatheter closure of postsurgical residual VSD is safe and efficacious management option and obviates the need for further surgery and by-pass.
手术后残余室间隔缺损（VSD）的发生率为 5-25%。再次手术风险较高。
2000 年 1 月至 2008 年 12 月，我院 170 例患者接受了经皮 VSD 封堵术：其中 22 例（16 例为男性）因残余 VSD 进行了 23 次封堵。中位年龄为 32.5 岁（1.4-79 岁）。所有患者均有左心室容量超负荷的超声心动图征象（Q(p)/Q(s)≥1.5）。9 例患者曾行 VSD 封堵术，6 例法洛四联症矫治术，7 例其他手术。15 例为肌部 VSD，6 例为膜周部 VSD，2 例为心尖部 VSD。
所有患者均使用 Amplatzer VSD 封堵器。中位 VSD 大小为 8mm（4.3-16mm）。中位透视时间为 33 分钟（15-130 分钟）。有 3 例不良事件：1 例出现心室颤动，需直流电复律；1 例发生一过性完全性房室传导阻滞，24 小时后恢复窦性心律；1 例患者在手术过程中出现短暂性房性心动过速。所有手术均成功，无需进一步手术。3 例患者在随访中发现轻微残余分流。无晚期事件。1 例患者在术后 5 年发生心律失常性死亡。1 例患者在第二次经皮成功封堵后 2 年因 VSD 补片撕裂再次手术。
经导管封堵术后残余 VSD 是一种安全有效的治疗方法，可避免进一步手术和旁路手术。
