Chen Renwei, Luo Jinwen, Deng Xicheng, Huang Peng
Department of Cardiothoracic Surgery, Maternal and Child Health Hospital of Hainan Province (Hainan Children's Hospital), Haikou, Hainan Department of Cardiothoracic Surgery, Hunan Children's Hospital, Changsha, Hunan, China.
Medicine (Baltimore). 2018 Jul;97(27):e11327. doi: 10.1097/MD.0000000000011327.
Ventricular septal defects are the most common congenital heart defect in children. As this method avoids sternotomy, the post-procedural morbidity is lower. However, transcatheter closure of perimembranous ventricular septal defects are still associated with complications such as arrhythmia (particularly, Atrioventricular Block), device embolization, atrioventricularvalve and/or aortic valves regurgitation, residual shunts. Some complications can be life threatening and require urgent surgical intervention.
An 32-months-old boy was admitted for a significant precordial systolic murmur. The patient underwent transcatheter perimembranous ventricular septal defects closure. 12 months later, Transthoracic echocardiography revealed the device displaced, 4 mm shunt acrocss the ventricular septum and moderate tricuspid regurgitation detected.
According to the echocardiography result, the patient was diagnosed with displacement of the ventricular septal defect occluder and tricuspid regurgitation.
After the diagnosis, the patient underwent removal of the ventricular septal defect occluder and closure of the perimembranous ventricular septal defect.
The post-operative recovery was uneventful. One year post-procedural follow-up transthoracic echocardiography showed there was no residual shunt and no tricuspid regurgitation.
Transcatheter closure of Ventricular septal defects is an attractive alternative to surgery in simple perimembranous ventricular septal defects. Proper follow-up should be emphasized to the patient.
室间隔缺损是儿童最常见的先天性心脏病。由于这种方法避免了开胸手术，术后发病率较低。然而，经导管闭合膜周部室间隔缺损仍会伴有一些并发症，如心律失常（尤其是房室传导阻滞）、封堵器栓塞、房室瓣和/或主动脉瓣反流、残余分流。一些并发症可能危及生命，需要紧急手术干预。
一名32个月大的男孩因心前区明显的收缩期杂音入院。该患者接受了经导管膜周部室间隔缺损封堵术。12个月后，经胸超声心动图显示封堵器移位，室间隔有4毫米分流，检测到中度三尖瓣反流。
根据超声心动图结果，该患者被诊断为室间隔缺损封堵器移位和三尖瓣反流。
诊断明确后，患者接受了室间隔缺损封堵器取出及膜周部室间隔缺损修补术。
术后恢复顺利。术后一年的经胸超声心动图随访显示无残余分流，无三尖瓣反流。
对于单纯膜周部室间隔缺损，经导管封堵术是一种有吸引力的手术替代方案。应强调对患者进行适当的随访。
