Liu Jing, You Xiao-hua, Zhao Xian-xian, Hu Jian-qiang, Cao Jiang, Xu Rong-liang, Wu Hong, Chen Shao-ping, Zhang Jian-liang, Zheng Xing, Qin Yong-wen
Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2010 Apr;38(4):321-5.
To evaluate the efficacy and adverse effects of transcatheter closure of perimembranous ventricular septal defect (pmVSD) with modified double-disk occluder device (MDVO).
Clinical data including clinical examination, electrocardiography daily after the procedure for a week, chest-X-rays and TTE before discharge and at 3-5 days after the procedure were analyzed from 604 patients underwent percutaneous closure of a pmVSD with MDVO at our department between December 2001 and December 2008.
Procedure was successful in 576 out of 604 patients (95.4%) and 583 VSD occluders were placed. Endocarditis, thromboembolism, or deaths were not observed after procedure. Conduction block occurred in 81 patients (56 RBBB, 14 LBBB) and transient nonparoxysmal ventricular tachycardia in 31 patients after the procedure. Complete heart block occurred in 11 patients, 9 of them recovered in 3 weeks, permanent pacemaker was implanted in 2 patients (one had transient III degrees AVB before the procedure, the other underwent simultaneous closure of ventricular septal defect and atrial septal defect). Trivial/small residual shunts were found in 69 patients (12.0%). The residual shunts disappeared in 31 patients and remained unchanged in 38 patients (6.6%) 7 days after procedures. Aortic regurgitation developed in 5 patients (2 trivial/small, 3 small/moderate), and tricuspid regurgitation was present in 35 patients (32 trivial/small, 3 moderate). Five patients developed haemolysis (device retrieved via catheter in 1 patient due to persistent haemolysis, the other 4 patients recovered 3-14 days post procedure). Pseudoaneurysm of femoral artery occurred in 1 patient, and disappeared by pressure dressing. Device was successfully replaced in 2 patients with either device embolization (n = 1) or device misplacement (n = 1) after device retrieval by catheter.
It is safe and effective to close congenital perimembranous ventricular septal defect with domestic-made occluder device.
评估应用改良双盘封堵器（MDVO）经导管闭合膜周部室间隔缺损（pmVSD）的疗效及不良反应。
分析2001年12月至2008年12月在我科采用MDVO经皮闭合pmVSD的604例患者的临床资料，包括临床检查、术后一周内每日心电图、出院前及术后3 - 5天的胸部X线及经胸超声心动图（TTE）。
604例患者中576例（95.4%）手术成功，共植入583个室间隔缺损封堵器。术后未观察到心内膜炎、血栓栓塞或死亡病例。术后81例患者发生传导阻滞（56例右束支传导阻滞，14例左束支传导阻滞），31例患者出现短暂性非阵发性室性心动过速。11例患者发生完全性心脏传导阻滞，其中9例在3周内恢复，2例患者植入永久性起搏器（1例术前有短暂性三度房室传导阻滞，另1例同时进行室间隔缺损和房间隔缺损闭合术）。69例患者（12.0%）发现微量/少量残余分流。术后7天，31例患者残余分流消失，38例患者（6.6%）残余分流无变化。5例患者出现主动脉瓣反流（2例微量/少量，3例少量/中度），35例患者存在三尖瓣反流（32例微量/少量，3例中度）。5例患者发生溶血（1例因持续性溶血经导管取出封堵器，其他4例患者术后3 - 14天恢复）。1例患者发生股动脉假性动脉瘤，经压迫包扎后消失。2例患者分别因封堵器栓塞（n = 1）或封堵器位置不当（n = 1），在经导管取出封堵器后成功更换封堵器。
应用国产封堵器闭合先天性膜周部室间隔缺损安全有效。
