The Efficacy,Complications And Risk Factors Of Percutaneous Catheter Closure Of Perimembrane Ventricular Septal Defect In Children

?Background?Patch closure through sternotomy is regarded as the standard treatment for perimembranous ventricular septal defect(pmVSD)all the time.Transcatheter device closure is becoming a viable alternative to surgical approach in major cardiovascular centers in China because of shorter recovery time,less invasive operation and no extracorporeal circulation related complications.However,post procedure complications such as arrhythmias,aortic valve prolapse and tricuspid regurgitation in turn limit the clinical application of transcatheter closure of pmVSD.At present there is still a lack of long-term follow-up study of domestic occluders,especially on young patients.?Objective?Postoperative follow-up data based on 1108 cases of transcatheter device closure of pmVSD was involved in this retrospective study,the aim of which is to explore the related complications,risk factors and prognosis of this procedure.We reviewed our experience and draw the conclusion on the effectiveness and safety of transcatheter device closure.This study may help to provide some clinical evidence for establishing consensus statement in the future.?Methods?Clinical data,including electrocardiograph,transthoracic echocardiography and digital subtraction angiography data,treatment options and sociodemographic information(age,weight and gender)of 1108 patients who underwent percutaneous closure of pmVSDs were collected for the years 2011.7 through 2017.7.The incidence,prognosis and related risk factors of severe arrhythmia,aortic regurgitation and tricuspid regurgitation were analysed.?Results?Complete atrioventricular block was observed in 6 patients with the rate of 0.54% and 1 permanent pacemaker implantation with the rate of 0.09%.Complete left bundle branch block was observed in 13 patients with the rate of 1.17% and 4 unrecovered cases are now following up with normal ejection fraction.The longer distance between the defect and the aortic valve,the larger diameter of occluder and thin-waist occluders were risk factors for severe arrhythmias.Our data also suggested that aortic regulation(AR)aggravation was more common in children with preoperative aortic valve prolapse(AVP)than children without and usually occurs in the long-term follow-up(>1 year)period.None of these AR progressed to moderate nor severe.Follow-up time was the only risk factor for aggravated AR.Left ventricular-right atrial channel tricuspid regurgitation can be further alleviated by blocking pmVSD.The incidence of new onset tricuspid regurgitation after operation was 2.1% with 24 cases,and all of them were mild to moderate regurgitation without clinical intervention.Early postoperative tricuspid regurgitation has a probability of recovery.Larger size of occluder is a risk factor for new tricuspid regurgitation after surgery.?Conclusion?Children with appropriate indications,standard operation and experienced cardiovascular center are necessary for percutaneous pmVSD closure,wich is a safe and effective method of treating pmVSD with less trauma.However successful intervention should also be closely followed up with echocardiography and electrocardiogram.