Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.
Department of Echocardiography, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.
BMC Pediatr. 2019 Aug 31;19(1):302. doi: 10.1186/s12887-019-1687-0.
Traditional percutaneous device closure of perimembranous ventricular septal defects (PmVSDs) is a minimally invasive technique, but can result in high radiation exposure and can result in potential arterial complications. Here, we aimed to assess the safety and feasibility of device closure of PmVSDs via the femoral vein approach under transesophageal echocardiography (TEE) guidance in children.
From January 2014 to December 2017, a total of 46 PmVSD patients (mean age, 6.5 ± 2.3 years [range, 4.2-12.0 years]; mean body weight 22.1 ± 6.6 kg [range, 16.0-38.5 kg]; VSD diameter, 4.1 ± 0.6 mm [range, 3.2-5.0 mm]) underwent attempted transcatheter closure via the femoral vein approach under the guidance of TEE without fluoroscopy.
The transcatheter occlusion procedure under TEE guidance was successful in 44 (95.7%) patients. Surgery was necessary in 2 (4.3%) patients. The procedure duration was 28.2 ± 8.7 min (range, 12.0-42.0 min). One patient had immediate post-operative trivial residual shunt and three patients had immediate incomplete right bundle branch block (IRBBB) after operation; the new IRBBB in 1 case was noted in the first postoperative month. No residual shunt was noted at 3 months after the procedure, and no intervention related complications were detected at 1-24 months follow-up.
Percutaneous device closure of PmVSDs under TEE guidance solely by femoral vein approach is effective and safe, avoids radiation exposure, potential arterial complications and a surgical incision.
传统的经皮器械闭合膜周部室间隔缺损（PmVSD）是一种微创技术，但可能导致高辐射暴露，并可能导致潜在的动脉并发症。在这里，我们旨在评估在经食管超声心动图（TEE）引导下经股静脉途径行 PmVSD 器械闭合的安全性和可行性。
从 2014 年 1 月至 2017 年 12 月，共有 46 例 PmVSD 患者（平均年龄 6.5±2.3 岁[范围 4.2-12.0 岁]；平均体重 22.1±6.6kg[范围 16.0-38.5kg]；VSD 直径 4.1±0.6mm[范围 3.2-5.0mm]）在 TEE 引导下尝试经股静脉途径进行经导管闭合，无需透视。
在 44 例（95.7%）患者中，TEE 引导下的经导管封堵术成功。2 例（4.3%）患者需要手术。手术时间为 28.2±8.7min（范围 12.0-42.0min）。1 例患者术后即刻出现微量残余分流，3 例患者术后即刻出现不完全性右束支传导阻滞（IRBBB）；1 例新的 IRBBB 发生在术后第 1 个月。术后 3 个月无残余分流，术后 1-24 个月随访无介入相关并发症。
TEE 引导下单纯经股静脉途径行 PmVSD 器械闭合是有效且安全的，可避免辐射暴露、潜在的动脉并发症和手术切口。
