Short-term Cliniacl Analysis Of Residual Shunt After Ventrieular Septal Defect Closure Through Transthoracic In Children

Objective: To summarize the status of residual shunt after ventrieular septal defect closure through transthoracic in our hospital and investigate the risk factors of its occurrence.Methods: According to the inclusion and exclusion criteria,127 patients who accepted ventrieular septal defect closure through transthoracic in the Department of Thoracic Surgery,Children’s Hospital of Chongqing Medical University from January 2018 to July 2019 were collected as the research objects.The clinical data were extracted from the electronic medical record system,to explore the risk factors of residual shunt after operation,statistical analysis was performed between the group with residual shunt after operation immediately and the group without residual shunt,to find out the optimal critical value for statistically independent risk factors.Results:(1)The incidence of residual shunt after operation was14.2%(18/127),with a shunt size of 1-2.3 mm.Two cases were lost to follow-up,follow-up showed that the residual shunt disappeared in 3months after operation in 15 patients.At six months and twelve months after the operation,no residual shunt was found in all patients.(2)Univariate logistics regression showed that the related independent risk factors of postoperative residual shunt include: age,weight,size of defect,size of occluders,pressure difference and LVFS,putting statistically significant independent risk factors into multivariate logistics regression showed that the size of the occluders(OR: 1.950,95% CI: 1.325-2.869,P value: 0.001)was independently associated with postoperative residual shunt.(3)The area under the ROC curve of the residual shunt group and the non-residual shunt group after operation was 0.752,the optimal critical value of the occluders size corresponding to the Youden index was 6mm,and the corresponding sensitivity was 88.89,the specificity is 54.13.Conclusion: A small and moderate amount of residual shunt can occur after septal defect closure through transthoracic.The size of the occluder is related independent risk factors to the residual shunt that occurs after operation.At the same time,patients who use an occluder larger than6 mm during surgery had a greater risk of residual shunt than other patients.After septal defect closure through transthoracic,a small or medium amount of residual shunt can disappear spontaneously.