He Lu, Du Ya-Juan, Cheng Ge-Sheng, Zhang Yu-Shun
Department of Structural Heart Disease, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an 710061, Shaanxi Province, China.
World J Clin Cases. 2019 Mar 6;7(5):562-571. doi: 10.12998/wjcc.v7.i5.562.
The off-label use of various devices has been reported for the transcatheter closure of perimembranous ventricular septal defects (PmVSD) because of serious complications, such as heart block and tricuspid regurgitation (TR), associated with conventional ventricular septal defect devices. However, whether certain defects such as PmVSD with abnormally attached tricuspid are fit for interventional treatment is still disputable.
To explore the feasibility and safety of transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae using an improved patent ductus arteriosus (PDA) occluder.
We retrospectively analyzed 20 patients diagnosed with PmVSD with abnormally attached tricuspid chordae tendineae who underwent interventional treatment using an improved PDA occluder at our center from January 2012 to January 2016. Baseline characteristics and procedural and follow-up data were analyzed.
All 20 patients achieved procedure success. No heart block occurred during the operation. One patient had a transient complete right bundle branch block within 48 h post-procedure and reverted to normal rhythm after intravenous injections of dexamethasone for 3 d. For all 20 patients, no residual shunt was observed by transthoracic echocardiography post-procedure. During the average follow-up period of 2.4 years, no severe TR was observed.
Using of the improved PDA occluder for the transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae is a safe and promising treatment option. However, long-term follow-up in a large group of patients is still warranted.
由于传统室间隔缺损封堵器会引发心脏传导阻滞和三尖瓣反流（TR）等严重并发症，已有多种器械用于经导管封堵膜周部室间隔缺损（PmVSD）的非适应证使用的报道。然而，某些如伴有异常附着三尖瓣的PmVSD缺损是否适合介入治疗仍存在争议。
探讨使用改良动脉导管未闭（PDA）封堵器经导管封堵伴有异常附着腱索的PmVSD的可行性和安全性。
我们回顾性分析了2012年1月至2016年1月在本中心接受改良PDA封堵器介入治疗的诊断为伴有异常附着腱索的PmVSD患者。分析基线特征、手术过程及随访数据。
20例患者手术均成功。术中未发生心脏传导阻滞。1例患者术后48小时内出现短暂性完全性右束支传导阻滞，静脉注射地塞米松3天后恢复正常心律。20例患者术后经胸超声心动图均未发现残余分流。在平均2.4年的随访期内，未观察到严重TR。
使用改良PDA封堵器经导管封堵伴有异常附着腱索的PmVSD是一种安全且有前景的治疗选择。然而，仍需对大量患者进行长期随访。
