| Objective: To evaluate the feasibility,safety and effectiveness of interventional occlusion with thin waist occluder and normal symmetric occluder for perimembranous ventricular septal defect.Methods: 68 cases with pm VSD were selected in our hospital from March 2013 to March 2015,they were screened by transthoracic echocardiography and diagnosed by cardioangicgraphy.According to the occcluder type chozed in surgery,these cases were randomly divided into two groups: group symmetric occluder: 30 cases were operated with Symmetrical occluder devices and group thin-waist-big-side occluder: 38 cases were treated with thin-waist-big-side occluder devices.The immediate treatment effect of two types devices were evaluated by left ventricular and ascending aorta angiography,transthoracic echocardiography postoperative.They were followed by ecocardiography,ECG and X-ray before surgeryed and after surgeryed 24 hours,1,3,6,12 months.The preoperative data(including age,body weight,VSD diameter,preoperative cardiothoracic ratio and operation time)were detected to estimate two types occluders..The occlusion effect,postoperative hospital stay,success rate and complication rate were detected to estimate two types occluders.Results: According to the preoperative data,there were 32 males and 36 females;aged 2.6-12 years(5 ± 2.2 years),weight 11-43Kg(15.4 ± 5.1Kg),height 90-146cm(101 ± 10.2cm).There were no significant differences in age,body weight,cardiothoracic ratio,VSD diameter and operation time of patients between the two groups(P>0.05).Among 68 patients,60 cases were successfully placed with VSD occluders,the success rate of group thin-waist-big-side occluder(36/38)was higher than that of the group symmetric occlude(24/30).All the chamber volume and ventricular end diastolic diameter(LVDd)after operation were decrease than those before operation,but the difference was not statistically significant(P > 0.05).There were no significant differences in heart size and cardiac systolic function between the two groups at different time points(P> 0.05).Before operation,there were 6 different types arrhythmias,including 2 cases complete right bundle branch block(CRBBB),2 cases incomplete complete right bundle branch block(IRBBB),2 cases left bundle branch block(LAFB)and one case I°AVB(I°AVB).After operation,early data analysis showed that 4 cases new arrhythmia(1 case complete RBBB,2 cases incomplete RBBB,1 case complete LBBB)and 6 cases valve regurgitation(5 cases with small tricuspid regurgitation,1 case with aortic regurgitation by trace to reflux),and 2 cases Residual shunt occurred in group symmetric occlude.While 2 cases new arrhythmia(1 case complete RBBB,1 case incomplete RBBB)and 3 cases value regurgitation(2 cases with small tricuspid regurgitation,1 case with aortic valve regurgitation by trace to reflux),and 0 case residual shunt were found in group thin-waist-big-side occluder.Of all the 60 patients,57 were followed up and 3 were lost.There were not dead cases,no occluder shedding,occluder shift,and severe PAH occurred in all follow-up children.During follow-up,there was no residual shunt and 1case new tricuspid regurgitation and 1 new case incomplete RBBB in the group thin-waist-big-side,meanwhile there were still 2 case residual shunt and 2 cases new tricuspid regurgitation with a small amount of reflux and 1 case complete RBBB in the group symmetric occlude.There was no new case aortic regurgitation and was not aggravated in early postoperative between two groups.Conclusion: Transcatheter closure with domestic small waist lumbar occluder has obvious advantages of reliable,high success rate,fewer complications compared with ordinary symmetric occluder in the treatment of of perimembranous ventricular septal defect(pm VSD).But the valve regurgitation and delayed arrhythmia(such as atrioventricular block)require further observation in the long term. |
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