Li Yifei, Hua Yimin, Fang Jie, Wan Chaomin, Wang Chuan, Zhou Kaiyu
Dept. of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041, China.
J Invasive Cardiol. 2015 Aug;27(8):E158-66.
Arrhythmias are frequently observed after transcatheter closure of perimembranous ventricular septal defect (pmVSD), especially in the early postprocedure period. Independent risk factors associated with postclosure arrhythmias are still elusive. The current study aimed to identify such risk factors via regression analysis with a long-term follow-up.
A group of 553 patients from June 2003 to December 2010 who received symmetric Amplatzer-type pmVSD occluders for pmVSD in our center were followed for 2-8 years. The complications during the follow-up period were classified as early (within 1 year), continuous (persisted >1 year), or late (recurrent or onset after 1 year). We first evaluated the potential risk factors (age, procedure time, size of the defect, size of the occluder, diameter of the defect, distance of lesion to aortic rim, distance of lesion to tricuspid rim, presence of aneurysm, orifice size on aneurysm, arrhythmia before procedure, procedure time) by comparing complicated and uncomplicated cases using univariate analysis, then logistic analysis for independent risk factors.
We identified 90 cases of early, 59 cases of continuous, and 13 cases of late complications. The size of the occluder was identified as an independent risk factor for early, continuous, and late arrhythmias. Preexisting arrhythmias were found to be risk factors for early and late arrhythmias, while the distance between the defect and the tricuspid rim was identified as a risk factor for continuous arrhythmias.
The size of the occluder, preexisting arrhythmias, and the distance between the defect and the tricuspid rim were found to be risk factors for arrhythmias after transcatheter closure of pmVSD. Selection of properly sized occluders might be crucial to reduce postclosure complications.
经导管封堵膜周部室间隔缺损（pmVSD）后心律失常很常见，尤其是在术后早期。与封堵术后心律失常相关的独立危险因素仍不明确。本研究旨在通过长期随访的回归分析来确定此类危险因素。
对2003年6月至2010年12月期间在本中心接受对称型Amplatzer式pmVSD封堵器封堵pmVSD的553例患者进行了2至8年的随访。随访期间的并发症分为早期（1年内）、持续性（持续>1年）或晚期（复发或1年后出现）。我们首先通过单因素分析比较有并发症和无并发症的病例，评估潜在危险因素（年龄、手术时间、缺损大小、封堵器大小、缺损直径、病变距主动脉边缘的距离、病变距三尖瓣边缘的距离、有无瘤样膨出、瘤样膨出的开口大小、术前心律失常、手术时间），然后进行独立危险因素的逻辑分析。
我们确定了90例早期并发症、59例持续性并发症和13例晚期并发症。封堵器大小被确定为早期、持续性和晚期心律失常的独立危险因素。术前存在的心律失常被发现是早期和晚期心律失常的危险因素，而缺损与三尖瓣边缘之间的距离被确定为持续性心律失常的危险因素。
封堵器大小、术前存在的心律失常以及缺损与三尖瓣边缘之间的距离被发现是经导管封堵pmVSD后心律失常的危险因素。选择尺寸合适的封堵器可能对减少封堵术后并发症至关重要。
