The Efficacy And Long-term Follow Up Study Of Transcatheter Closure Of Ventricular Septal Defect

ObjectivesTo analyze the clinical efficiency and adverse effect of transcatheter closure of perimembranous ventricular septal defect (PMVSD) during short-term and long-term follow-up.MethodsBetween June 2002 and December 2009, 188 patients (90 males and 98 females) with single PMVSD underwent the therapy of catheter closure at Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University. The patient's age ranged from 3 to 50 years (median, 9.01±7.09 years) and weight from 15 to 91 kg (median, 30.31±17.0 7kg).All patients were diagnosed by transthoracic echocardiography (TTE), and underwent standard right heart catheterization.Left ventriculography were performed to judge the shape and size of the VSD and its distance to the aorta. During the interventional treatment, a stable arteriovenous loop through the PMVSD were established. The appropriate device was advanced through the sheath until it reached the tip of the sheath and the LV disc was deployed. The device was slowly draw back until the LV disc was in good position, and then deployed the RV disc under the monitor of TTE., the device was released finally after the evaluation of TTE and LV angio again . TTE and ECG was repeat at 24h after the procedure. The follow-up protocol includes physical examination, ECG and TTE at l,6,and 12 months after the procedure and yearly thereafter.Results The mean diameter of PMVSD in 188 patients measured by TTE and left ventriculo- graphy was 5.73±2.66mm (range 2.0-16mm), 5.78±2.56mm (range1.1-14mm), respectively. 22 patients were not suitable for interventional therapy after left ventriculography because the VSD were too small or the aneurasm was not suitable . The interventional treatment were successful in 159 patients(95.78%), immediate complete closure rate was 88.64% and trivial to small residual shunts were found in 18 patients immediately after the procedure. Trivial residual shunts was found in 9 patients by TTE at 24h after the procedure and new ECG abnormalities were observed after device implantation in 26 children: complete right bundle branch block (CRBBB)in 2, incomplete right bundle branch block (IRBBB) in 10, complete left bundle branch block (CLBBB) in 1, left anterior fascicular block in 5, sinoatrial block in1 and junctional escape rhythm in 7 patients. Conduction abnormalities were treated with corticosteroid therapy in all cases except 10 IRBBB cases and 2 CRBBB cases. Other complications included brachial plexus injury (n=2), femoral artery thrombosis (n=2), hemolysis (n=1).Folllow-up data were obtained from 154 patients(96.9%) .The follow-up duration ranged from 1 month to 8 years. Trivial residual shunts was newly found in 1 patient. New conduction abnormalities were observed in 8 patients: IRBBB in 3,CRBBB in 1, left anterior fascicular block in 1 and occasional premature ventricualr contraction in 2. Permanent pacemaker was implanted in one patient who developed to CAVB 5 years after closure. No complications was found such as device embolization, endocardltis , thromboembolism and sudden death.ConclusionsTranscatheter closure of PMVSD can be performed safely and successfully. Proper selection of patients and standardized manipulation are essential to high successful closure rate and low complication rate.