Zhang Bo, Liang Jiali, Zheng Xiaozhou, Jiang Guanhua, Yang Zhe, Zhang Luying, Zhang Yong, Sun Haofeng
Department of Cardiovascular Surgery, The General Hospital of Jinan Military District, Jinan, China.
J Invasive Cardiol. 2013 Aug;25(8):402-5.
The reoperations of postoperative residual ventricular septal defects (VSDs) are associated with higher risks. Our aim is to assess the efficacy and safety of transcatheter closure of postoperative residual VSDs using perimembranous VSD occluders.
Twenty-one patients with residual VSDs underwent transcatheter closure in our center from January 2005 to January 2012. The study population consisted of 9 males and 12 females whose ages ranged from 1.9 to 54 years (median age, 8.7 years). Eighteen cases had perimembranous VSD repair previously, 3 cases had tetralogy of Fallot surgical treatment. All patients had signs of left ventricle volume overload (Qp/Qs ≥ 1.5). Two types of perimembranous VSD occluders, symmetric and asymmetric, were used in 14 and 7 cases, respectively. The diameter of residual VSDs ranged from 4-16 mm (mean, 7.8 mm). The waist size of occluders ranged from 6-18 mm.
There were 0 deaths and 1 serious adverse event. Intravascular hemolysis occurred in 1 patient (4.8%), lasted for 7 days, and recovered with therapy. A trivial intraprosthetic residual shunt was observed in 2 patients (9.5%) after the procedure and 1 patient (4.8%) at 6 months. Two patients (9.5%) had transient left anterior hemiblock and recovered within the first week after the procedure. At the latest follow-up, no atrioventricular block and new-onset aortic regurgitation occurred.
Transcatheter closure is a feasible and safe management option for patients with postoperative residual VSDs and obviates the need for a second surgery and cardiopulmonary bypass.
室间隔缺损（VSD）术后再次手术风险较高。我们的目的是评估使用膜周部VSD封堵器经导管闭合术后残余VSD的有效性和安全性。
2005年1月至2012年1月，21例残余VSD患者在我院接受经导管闭合治疗。研究人群包括9例男性和12例女性，年龄范围为1.9至54岁（中位年龄8.7岁）。18例曾接受膜周部VSD修补术，3例曾接受法洛四联症手术治疗。所有患者均有左心室容量超负荷体征（Qp/Qs≥1.5）。分别使用对称和不对称两种类型的膜周部VSD封堵器，14例和7例。残余VSD直径范围为4 - 16mm（平均7.8mm）。封堵器腰部尺寸范围为6 - 18mm。
无死亡病例，1例发生严重不良事件。1例患者（4.8%）发生血管内溶血，持续7天，经治疗后恢复。术后2例患者（9.5%）和6个月时1例患者（4.8%）观察到轻微的人工瓣周残余分流。2例患者（9.5%）出现短暂性左前分支阻滞，术后第一周内恢复。在最近一次随访时，未发生房室传导阻滞和新发主动脉瓣反流。
经导管闭合术是术后残余VSD患者可行且安全的治疗选择，避免了二次手术和体外循环的需要。
