Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Echocardiography, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Eur J Cardiothorac Surg. 2021 Jun 14;59(6):1304-1311. doi: 10.1093/ejcts/ezab015.
The feasibility of mini-invasive closure of perimembranous ventricular septal defects has been proven, but can cause surgical incision or sternum injury. A relevant but, to date, unanswered question is whether there exists a treatment without surgical trauma, radiation exposure and arterial complications.
From May 2017 to January 2020, a total of 449 patients with perimembranous ventricular septal defect [mean age 5.0 ± 6.1 years (range 0.8-52.0 years)] were involved in this study and underwent 2 different echocardiography-guided operative procedures [percutaneous device closure (group A) or percardiac device closure (group B)] based on the patients' or their parents' choice. The clinical data were collected and a retrospective analysis was performed.
Fifty-five (96.5%) cases were successfully occluded in group A, and 2 (3.5%) patients were converted to percardiac device closure; 379 (96.7%) patients in group B underwent percardiac device closure, and 13 patients (3.3%) were turned to open-heart surgery after occlusion procedure failure. There were statistically significant differences (P < 0.05) between the 2 groups in operation time, postoperative hospitalization time and blood transfusion requirement. No acute complications or severe adverse events (death, valve injury, complete atrioventricular block and embolism) occurred either in the early period or during the follow-up.
Percutaneous device closure can achieve the same validity and safety as percardiac device closure for treating perimembranous ventricular septal defects with a more rapid recovery and less trauma.
微创闭合膜周部室间隔缺损的可行性已得到证实，但可能会导致手术切口或胸骨损伤。一个相关但尚未得到解答的问题是，是否存在一种无需手术创伤、辐射暴露和动脉并发症的治疗方法。
本研究共纳入 449 例膜周部室间隔缺损患者（平均年龄 5.0±6.1 岁，范围 0.8-52.0 岁），根据患者或其父母的选择，采用 2 种不同的超声心动图引导手术方法[经皮器械闭合（A 组）或经心器械闭合（B 组）]。收集临床资料并进行回顾性分析。
A 组 55 例（96.5%）患者手术成功闭合，2 例（3.5%）患者转为经心器械闭合；B 组 379 例患者行经心器械闭合，13 例（3.3%）患者因闭合失败而改行心脏直视手术。两组患者在手术时间、术后住院时间和输血需求方面存在统计学差异（P<0.05）。两组患者在早期和随访期间均未发生急性并发症或严重不良事件（死亡、瓣膜损伤、完全性房室传导阻滞和栓塞）。
经皮器械闭合治疗膜周部室间隔缺损与经心器械闭合具有相同的有效性和安全性，但恢复更快，创伤更小。
