Pediatric Cardiology Department, Lille University Hospital, University Nord de France, 59000 Lille, France; Perinatal Growth and Health, University of Lille, EA4489, 59000 Lille, France; Department of Neonatology, CHU Lille, Jeanne-de-Flandre Hospital, 59000 Lille, France.
Pediatric Cardiology Department, Lille University Hospital, University Nord de France, 59000 Lille, France; Perinatal Growth and Health, University of Lille, EA4489, 59000 Lille, France.
Arch Cardiovasc Dis. 2020 Feb;113(2):104-112. doi: 10.1016/j.acvd.2019.11.004. Epub 2020 Jan 22.
Transcatheter perimembranous ventricular septal defect (pmVSD) closure remains challenging and is seldom used in France given the risk of atrioventricular block (AVB). pmVSD closure with the Nit-Occlud Lê VSD coil was recently introduced in France as an alternative to occluder devices.
To study the safety and feasibility of pmVSD closure with the Nit-Occlud Lê VSD coil.
All consecutives cases of pmVSD closure with the Nit-Occlud Lê VSD coil in 20 tertiary French centres were included between January 2015 and December 2018.
Among 46 procedures in five centres, indications for pmVSD closure were left ventricle overload (76.1%), exertional dyspnoea (17.4%), history of infective endocarditis (4.3%) and mild pulmonary hypertension (2.2%). The median (interquartile [IQR]) age of the patients was 13.9 (5.7-31.8) years. Aneurismal tissue was identified in 91.3% of patients. VSD median (IQR) size was 8 (7-10) mm on the left ventricle side and 5 (4-6) mm on the right ventricle side. Implantation was successful in 40 patients (87.0%; 95% confidence interval [CI] 73.7-95.1%). Severe complications occurred in six patients (13.0%, 95% CI 4.9-26.3%), mainly severe haemolysis (8.7%, 95% CI 2.4-20.8%). One aortic valve lesion required surgical aortic valvuloplasty. Occurrence of severe complications was significantly related to the presence of haemolysis (P=0.001), residual shunt (P=0.007) and multi-exit VSD (P=0.005). Residual shunt was observed in 40% of cases with the implanted device shortly after closure and 15% after a median follow-up of 27 months. No immediate or delayed device embolization or complete AVB was recorded.
pmVSD closure with the Nit-Occlud Lê VSD Coil is feasible in older children and adults. However, residual shunting (leading to haemolysis) is a dreaded complication that should not be tolerated. pmVSD closure with the Nit-Occlud Lê VSD as a therapeutic strategy remains controversial and is limited to selected patients.
由于房室传导阻滞（AVB）的风险，经导管膜周部室间隔缺损（pmVSD）封堵术在法国仍具有挑战性，很少使用。最近，Nit-Occlud Lê VSD 线圈被引入法国，作为封堵器的替代方法，用于 pmVSD 封堵。
研究使用 Nit-Occlud Lê VSD 线圈进行 pmVSD 封堵的安全性和可行性。
2015 年 1 月至 2018 年 12 月，在法国 20 个三级中心，对使用 Nit-Occlud Lê VSD 线圈进行的所有连续 pmVSD 封堵病例进行了研究。
在五个中心的 46 例手术中，pmVSD 封堵的适应证为左心室负荷过重（76.1%）、运动性呼吸困难（17.4%）、感染性心内膜炎病史（4.3%）和轻度肺动脉高压（2.2%）。患者的中位（四分位距 [IQR]）年龄为 13.9（5.7-31.8）岁。91.3%的患者存在动脉瘤组织。左心室侧 VSD 中位（IQR）大小为 8（7-10）mm，右心室侧为 5（4-6）mm。40 例患者（87.0%；95%置信区间 [CI] 73.7-95.1%）的植入术成功。6 例（13.0%；95%CI 4.9-26.3%）发生严重并发症，主要为严重溶血性贫血（8.7%；95%CI 2.4-20.8%）。1 例主动脉瓣损伤需要手术主动脉瓣成形术。严重并发症的发生与溶血性贫血（P=0.001）、残余分流（P=0.007）和多出口 VSD（P=0.005）显著相关。术后即刻或延迟的器械栓塞或完全性 AVB未发生。
在年龄较大的儿童和成人中，使用 Nit-Occlud Lê VSD 线圈进行 pmVSD 封堵是可行的。然而，残余分流（导致溶血性贫血）是一种可怕的并发症，不能被接受。使用 Nit-Occlud Lê VSD 进行 pmVSD 封堵作为一种治疗策略仍存在争议，并且仅限于选择的患者。
