Pekel Nihat, Ercan Ertuğrul, Özpelit Mehmet Emre, Özyurtlu Ferhat, Yılmaz Akar, Topaloğlu Caner, Saygı Serkan, Yakan Serkan, Tengiz İstemihan
Department of Cardiology, İzmir Medicalpark Hospital; İzmir-Turkey.
Anatol J Cardiol. 2017 Jun;17(6):461-468. doi: 10.14744/AnatolJCardiol.2017.7507. Epub 2017 Feb 21.
The standard transcatheter ventricular septal defects (VSD) closure procedure is established with arteriovenous (AV) loop and is called as antegrade approach. The directly retrograde transarterial VSD closure without using AV loop might be better option as shortens the procedure time and decreases radiation exposure.
Our series consist of twelve sequential adult cases with congenital VSDs (seven with perimembranous, four with muscular, one with postoperative residuel VSD). The mean age was 26.9 (Range 18-58), the mean height was 168.75 cm (Range 155-185cm), and the mean body mass index was 23.4 (Range 17.3-28.4). Maximum and minimum defect sizes were 10 and 5 mm and the mean defect size was 6.24 mm. The procedure was performed with left heart catheterization and advancing the delivery sheath over the stiff exchange wire then VSD occlusion from left side.
The defects were successfully closed with this technique in eleven patients. In sixth patient, the defect could not be cannulated by the delivery sheath, as the tip of the sheath did not reach the defect and VSD was closed with same sheath by standard transvenous approach using AV loop. We didn't encounter any complication releated to semilunar or atrioventricular valves. Atrioventricular conduction system was not affected by the procedure in any patients. The median procedure and fluoroscopy times were 66 and 16.5 minutes respectively.
Transarterial retrograde VSD closure without using AV loop simplifies the procedure, decreases the radiation exposure, and shortens the procedure time. The only limitation in adult patients is delivery sheath length.
经导管室间隔缺损（VSD）封堵术的标准方法是采用动静脉（AV）襻，称为顺行法。不使用AV襻直接经动脉逆行封堵VSD可能是更好的选择，因为它可缩短手术时间并减少辐射暴露。
我们的系列研究包括12例连续性成年先天性VSD患者（7例膜周部、4例肌部、1例术后残余VSD）。平均年龄26.9岁（范围18 - 58岁），平均身高168.75 cm（范围155 - 185cm），平均体重指数23.4（范围17.3 - 28.4）。最大和最小缺损大小分别为10和5 mm，平均缺损大小为6.24 mm。手术通过左心导管检查进行，在硬交换导丝上推进输送鞘管，然后从左侧封堵VSD。
11例患者采用该技术成功封堵缺损。第6例患者，输送鞘管无法插入缺损，因为鞘管尖端未到达缺损处，遂使用AV襻通过标准经静脉途径用同一鞘管封堵VSD。我们未遇到与半月瓣或房室瓣相关的任何并发症。所有患者的房室传导系统均未受手术影响。手术和透视时间的中位数分别为66分钟和16.5分钟。
不使用AV襻经动脉逆行封堵VSD简化了手术，减少了辐射暴露，并缩短了手术时间。成年患者唯一的限制是输送鞘管的长度。
