Abdelmohsen Gaser A, Gabel Hala A, Al-Ata Jameel A, Bahaidarah Saud A, Alkhushi Naif A, Abdelsalam Mohamed H, Bekheet Samia B, Elakaby Ahmed R, Zaher Zaher F, Maghrabi Khadijah A, Mashali Mohamed H, Dohain Ahmed M
Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
Pediatric Cardiology Division, Department of Pediatrics, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.
Cardiovasc Diagn Ther. 2023 Aug 31;13(4):710-727. doi: 10.21037/cdt-22-624. Epub 2023 Jun 28.
Percutaneous closure of residual ventricular septal defects (VSDs) after congenital heart surgery may provide a safer and more efficient alternative to redo surgery. This study aimed to evaluate the outcome of transcatheter closure of residual postoperative VSD.
This multicenter retrospective cohort study was conducted at the tertiary care institutions of King Faisal Specialist Hospital and King Abdulaziz University Hospital, Saudi Arabia, from March 2012 to March 2022. All patients who underwent transcatheter closure of postoperative residual VSD were included. As catheter closure of VSD related to surgical patches is challenging, patients were divided into two groups. Group 1 comprised patients with VSD related to the surgical patches, while Group 2 included residual muscular VSD. Various occluders and approaches were utilized based on the patient's weight and the VSD type, size, and proximity to the cardiac valves. Demographic, echocardiographic, catheterization, and outcome data were collected and analyzed using descriptive and comparative statistics.
Thirty-three patients underwent 37 VSD catheter closure procedures. Twenty-two procedures were done to close residual VSD related to the surgical patch, while fifteen were done for additional muscular VSD. The median age of the patients was 3.3 years, and the interquartile range (IQR) ranged between 9 months and 7 years. The median weight was 13.1 kilograms, with an IQR of 5.1 to 16.8 kilograms. The median pulmonary to systemic flow ratio (QP/QS) was 1.6 with an IQR of 1.5 to 2.44; the median systolic pulmonary pressure was 46 mmHg with an IQR of 32 to 54 mmHg. The median procedure duration was 120 minutes, with an IQR of 90 to 160 minutes. Patients in Group 1 were older and had a lower mean pulmonary pressure than Group 2 (P=0.02, P=0.007, respectively). Of the 37 procedures, 35 (94.6%) were done successfully, while two patients had redo surgery due to failed procedures (one had device embolization). Ten successful catheterizations were performed for infants weighing ≤5 kilograms. The functional heart failure class improved significantly after the closure of the residual VSD. There were three documented mortalities, none related to the procedure. No significant difference between patient groups regarding hospital stay or survival (P=0.660, P=0.791, respectively).
After congenital heart surgery, transcatheter closure of residual VSD may be a safe and effective alternative to surgical closure. It can be applied to various residual VSD using a variety of occluders with satisfactory results. Moreover, using specific approaches can close residual VSD, even in small infants.
先天性心脏手术后经皮闭合残余室间隔缺损（VSD）可能为再次手术提供更安全、更有效的替代方案。本研究旨在评估经导管闭合术后残余VSD的结果。
本多中心回顾性队列研究于2012年3月至2022年3月在沙特阿拉伯费萨尔国王专科医院和阿卜杜勒阿齐兹国王大学医院这两家三级医疗机构进行。纳入所有接受经导管闭合术后残余VSD的患者。由于与手术补片相关的VSD导管闭合具有挑战性，患者被分为两组。第1组包括与手术补片相关的VSD患者，而第2组包括残余肌部VSD患者。根据患者体重以及VSD的类型、大小和与心脏瓣膜的距离，采用了各种封堵器和方法。收集人口统计学、超声心动图、心导管检查和结果数据，并使用描述性和比较性统计方法进行分析。
33例患者接受了37次VSD导管闭合手术。22次手术用于闭合与手术补片相关的残余VSD，15次手术用于额外的肌部VSD。患者的中位年龄为3.3岁，四分位间距（IQR）在9个月至7岁之间。中位体重为13.1千克，IQR为5.1至16.8千克。中位肺循环与体循环血流量比值（QP/QS）为1.6，IQR为1.5至2.44；中位收缩期肺动脉压为46 mmHg，IQR为32至54 mmHg。中位手术持续时间为120分钟，IQR为90至160分钟。第1组患者比第2组年龄更大，平均肺动脉压更低（分别为P = 0.02，P = 0.007）。在37次手术中，35次（94.6%）成功完成，2例患者因手术失败接受再次手术（1例发生装置栓塞）。对体重≤5千克的婴儿进行了10次成功的导管介入治疗。残余VSD闭合后，心功能不全分级显著改善。有3例记录在案的死亡病例，均与手术无关。两组患者在住院时间或生存率方面无显著差异（分别为P = 0.660，P = 0.791）。
先天性心脏手术后，经导管闭合残余VSD可能是手术闭合的一种安全有效的替代方法。它可以使用各种封堵器应用于各种残余VSD，效果令人满意。此外，采用特定方法甚至可以闭合小婴儿的残余VSD。
