Wang Shouzheng, Ouyang Wenbin, Liu Yao, Zhang Fengwen, Guo Gaili, Zhao Guangzhi, Pan Xiangbin
Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China.
J Thorac Dis. 2018 Sep;10(9):5222-5231. doi: 10.21037/jtd.2018.08.03.
Transcatheter device closure has become an alternative therapy for ventricular septal defect (VSD). This study aimed to investigate the feasibility and safety of transcatheter perimembranous VSD (pm-VSD) closure under transthoracic echocardiography (TTE) guidance alone.
Between October 2012 and July 2016, 118 patients with pm-VSD underwent an attempt of transcatheter device closure for pm-VSD through the femoral artery under TTE guidance alone. Patients were followed-up at 1, 3, 6, and 12 months after the procedure and yearly after discharge.
The mean age was 11.7±12.5 years (range, 1.0-53.0 years) and the mean body weight was 32.2±21.6 kg (range, 11.5-102.0 kg). The mean diameter of the VSD was 4.0±1.1 mm (range, 3.0-8.0 mm). Transcatheter device closure under TTE guidance alone was successful in 111 patients. The average procedural time was 44.9±7.3 minutes (range, 29.0-65.0 minutes). All 111 patients were followed-up for 3.4±2.3 years. At the last follow-up, two patients had a residual shunt smaller than 2 mm, seven patients had right bundle branch block (RBBB) including one patient with complete RBBB, six patients had mild or less tricuspid regurgitation, and two patients still had trivial aortic regurgitation including one patient that had it before the procedure. Occluder malposition, complete atrioventricular block, or other complications were not observed.
Transcatheter pm-VSD closure can be successfully performed under TTE guidance alone with outcomes similar to those achieved with fluoroscopic guidance in selected patients with weight more than 10 kg and VSD smaller than 8 mm. However, long-term follow-up in a large number of patients would be necessary.
经导管装置封堵术已成为室间隔缺损（VSD）的一种替代治疗方法。本研究旨在探讨单纯经胸超声心动图（TTE）引导下经导管膜周部室间隔缺损（pm-VSD）封堵术的可行性和安全性。
2012年10月至2016年7月期间，118例pm-VSD患者在单纯TTE引导下经股动脉尝试行经导管装置封堵pm-VSD。术后1、3、6和12个月以及出院后每年对患者进行随访。
平均年龄为11.7±12.5岁（范围1.0 - 53.0岁），平均体重为32.2±21.6 kg（范围11.5 - 102.0 kg）。VSD平均直径为4.0±1.1 mm（范围3.0 - 8.0 mm）。111例患者单纯在TTE引导下经导管装置封堵成功。平均手术时间为44.9±7.3分钟（范围29.0 - 65.0分钟）。111例患者均随访3.4±2.3年。末次随访时，2例患者有小于2 mm的残余分流，7例患者有右束支传导阻滞（RBBB），其中1例为完全性RBBB，6例患者有轻度或以下三尖瓣反流，2例患者仍有微量主动脉反流，其中1例术前即有。未观察到封堵器位置不当、完全性房室传导阻滞或其他并发症。
对于体重超过10 kg且VSD小于8 mm的部分患者，单纯TTE引导下经导管pm-VSD封堵术可成功实施，其结果与透视引导下封堵相似。然而，需要对大量患者进行长期随访。
