Pediatric Department, Provincial Hospital Affiliated to Shandong University, Shandong, China.
Catheter Cardiovasc Interv. 2013 Mar;81(4):666-73. doi: 10.1002/ccd.24638. Epub 2013 Feb 14.
Whether or not to close perimembranous VSDs (pmVSDs) by transcatheter techniques is controversial because of a high rate of complications as compared with surgical alternatives.
We report the short- and long-term follow-up results of the use of several kinds of devices to close pmVSDs and the annual incidence of postimplant complications in our center.
From June 2002 to June 2011, 232 patients with pmVSD underwent attempted transcatheter closure; closure was successful in 209 cases (90.1%). Six types of occlusive devices were used. Patient age, defect size, device type, device size and its relation to defect size, and transcatheter and fluoroscopy time were analyzed for correlation with annual incidence of postimplant complications.
There were no deaths during the follow-up period. Within 1 month after transcatheter closure, we found 91 adverse events (43.5%), but only 32 cases showed a trace amount of residual shunting. From 2002 to 2011, the annual incidence of postimplant complications gradually decreased, from 50% in 2002 to 17.6% in 2011. The use of Amplatzer occluder devices (r = 0.71, P = 0.033), double-disc symmetrical occluder devices (r = -0.68, P = 0.045), and transcatheter (r = 0.87, P = 0.003), and fluoroscopy time (r = 0.78, P = 0.02) were significantly correlated with the incidence of post-implant complications.
Results of transcatheter closure of pmVSD in terms of postimplant complications are encouraging in our center. It seemed that eccentric Amplatzer and domestic occluder may be at rather higher risk for postimplant complications. The incidence of postimplant complications may be minimized by skilled maneuvers, excluding rather small patients, and selecting the appropriate kind of occlusive device.
经导管技术关闭膜周部室间隔缺损（pmVSD）是否可行尚存争议，因为与手术方法相比，并发症发生率较高。
我们报告了在我们中心使用几种封堵器关闭 pmVSD 的短期和长期随访结果，以及植入后并发症的年发生率。
从 2002 年 6 月至 2011 年 6 月，232 例 pmVSD 患者接受了经导管封堵术尝试；209 例（90.1%）封堵成功。使用了 6 种封堵器。分析患者年龄、缺损大小、封堵器类型、封堵器大小与缺损大小的关系以及经导管和透视时间与植入后并发症年发生率的相关性。
在随访期间无死亡病例。经导管封堵术后 1 个月内，我们发现有 91 例不良事件（43.5%），但只有 32 例有微量残余分流。从 2002 年到 2011 年，植入后并发症的年发生率逐渐降低，从 2002 年的 50%降至 2011 年的 17.6%。Amplatzer 封堵器的使用（r = 0.71，P = 0.033）、双盘对称封堵器（r = -0.68，P = 0.045）、经导管（r = 0.87，P = 0.003）和透视时间（r = 0.78，P = 0.02）与植入后并发症的发生率显著相关。
在我们中心，经导管封堵 pmVSD 的植入后并发症结果令人鼓舞。偏心 Amplatzer 和国产封堵器发生植入后并发症的风险似乎更高。通过熟练的操作、排除较小的患者和选择合适的封堵器，可将植入后并发症的发生率降至最低。
