The Clinical Follow-up Analysis Of Transcatheter Closure Of Ventricular Septal Defect

ObjectiveTo evaluate the efficacy and major complications of transcatheter closure of ventricular septal defects (VSD) at immediate, intermediate and long-term follow-up.Materials and MethodsBetween June2002and February2012,173VSD patients (76men,97women) underwent transcatheter closure in Qi Lu Hospital. The mean age of patients was19.73±14.15years (ranged from3to72years). There were143patients with infracristal VSDs,23patients with intracristal VSDs,3patients with muscular VSDs,72patients with aneurysm like VSDs,1patient with infracristal and intracristal VSDs,2patients with infracristal and muscular VSDs.2patients combined with atrial septal defects (ASD),3patients combined with patent foramen ovale (PFO),2patients combined with patent ductus arteriosus (PDA),1patient combined with patent ductus arteriosus and aortic coarctation.1patient associated severe pulmonary hypertension (PAH). All patients were treated with the percutaneous procedure guided by fluoroscopy and transthoracic echocardiography (TTE). All patients underwent left ventricular and ascending aorta angiography and TTE immediately after the VSD occluder (VSDO) was deployed at VSD to evaluate the immediate efficacy. All subjects underwent clinical examination, electrocardiography and TTE before discharge and at1,3,6,12months,3-5years after the procedure. Data were analyzed by SPSS17.0statistical software. Continuous variables were presented as mean±standard deviation. Categorical variables were presented as frequency or percentage. Pre-and postoperative continuous variables were compared by paired Student’s t-est. A two-tailed P<0.05was considered as statistically significant.ResultsTotal of155patients’ VSDs were successfully closed with155VSD occluders whereas18patients were given up with an immediate procedure success rate of89.6%. The mean diameter of VSD was4.23±2.10(2-15) mm. The mean device (VSDO) diameter was8.09±3.08(4-18) mm. One hundred patients had follow-up data (ranged3days to84months). Among them,38patients were followed up for3days,27patients were followed up for1～3months,7patients were followed up for4-6months,12patients were followed up for7-12months,7patients were followed up for1-3years,9patients were followed up for at least3years. Left atrial diameter, left ventricular diameter, right ventricular diameter decreased after VSD was closed in adult group. Left ventricular diameter decreased after VSD closed in children group. Left ventricular ejection fraction (LVEF) had no significant changes in neither of the two groups. Trivial to small residual shunts were found immediate after procedures in35patients,11of them were lost to follow up, in the other24patients, the residual shunts disappeared in17patients, remained trivial residual shunts in4patients, more than a small residual shunts in3patients. Mild tricuspid regurgitations occurred in24patients, mild regurgitation developed to mild-moderate regurgitation in4patients, mild regurgitation developed to moderate regurgitation in1patient. Mild aortic regurgitation was present in11patients, mild mitral regurgitation was present in14patients. Complete left bundle branch block (cLBBB) occurred in1patient, second degree atrioventricular blocks (AVB) occurred in3patients, all of them recovered after treatment. One patient developed haemolysis, even though his urine reverted to clear after the device was removed and the VSD closed by surgical, he still developed acute renal failure and dead. Pulmonary pressure elevated in1patient, Mild stenosis of right ventricular outflow tract developed in4patients. There were no sudden death, embolization of the device, complete atrioventricular block, endocarditis and thromboembolism occured.ConclusionsTranscatheter closure of ventricular septal defect is an effective method with low incidence of serious complications in early, intermediate and long term follow up. Patients with VSD need receive individualized treatment, the devices were chosen according to different patients. Left atrial diameter, left ventricular diameter, right ventricular diameter decreased after VSD closure in adult group. Left ventricular diameter decreased after VSD closed in children group. LVEF had no significant changes in two groups.