Clinical Feasibility Of Percutaneous Closure For Subarterial Ventricular Septal Defect Using Patent Ductus Arteriosus Occluder Device

Objective:The study is aimed to investigate the effect and security of transcatheter closureof doubly committed subarterial(DCSA) ventricular septal defect (VSD) with patentductus arteriosus（PDA）occluder device.Methods:Between October2011and May2013,46patients (older than3years) withDCSA VSD underwent interventional therapy in Jiangxi Provincial People’sHospital.27males (56.1%) and19females (43.9%),the mean age of patients was9.69±7.01S years (ranged from3to29years).All patients were treated with thepercutaneous procedure guided by fluoroscopy and transthoracic echocardiography(TTE).The domestic-made patent ductus arteriosus occluder was used in allpatients.All patients underwent left ventricular and ascending aorta angiography andTTE immediately after the patent ductus arteriosus occluder was deployed at VSD toevaluate the immediate efficacy. All patients underwent left ventriculography beforecatheter closure and rechecked echocardiography, ECG, chest X-ray at1week,3months,6months and12months after the procedures.Results:1.The devices were implanted successfully in42of46patients. The waist size ofdevices in achieved cases ranged from3to8mm (mean6.14±1.29mm).The averagediameter of the occluder8.14±1.28(4-12) mm. Four cases of failure in patients withaortic compression after one case for occluder placement impact closed, one patienthad complete atrioventricular block during surgery, one case of right ventricularoutflow tract stenosis, one case of defect is too big for12mm.2. Left ventricular diameter decreased after VSD closed in group(P <0.05); Leftatrial diameter increased slightly,LVEF had no significant changes in group.there wasno significant difference in two groups.3. Minimal aortic valve regurgitation occurred only in3patients after theprocedure. Minimal tricuspid regurgitation occurred only in3patients after the procedure.Complete right bundle branch block (cRBBB) occurred in2patients,all ofthem recovered after treatment. Residual occurred in4patients, no patient requireshospitalization and mild residual shunt still existed at the end of follow-up in2patients. Other cases back to normal.4.There was no device embolism, residual shunt, atrioventricular block ormortality during follow up period. Occluder had no effect on aortic and pulmonaryvalve,None of serious complications had happened in Intraoperative andpostoperative.Conclusions:1. Use Echocardiography to preoperative examination, Intraoperativemonitoring and combined with left ventricular angiography, it can play an importantrole in choice of the surgical indications and occluder type.2. As long as no prolapse or aortic valve regurgitation and diameter of defectless than or equal to9mm, the distance from the top of the aortic valve1.5mm ormore, there is enough to support the edge of the umbrella,the distance from the top ofthe Pulmonary valve2.0mm or more.Transcatheter closure of DCSA VSD withdomestic-made patent ductus arteriosus occluder is safe and effective, short-termoutcome is good.3.DCSA VSD has specially anatomical structure, it is close to the aortic andpulmonary valve,therefor we should strictly selected clinical indications and detailedpreoperative examination to avoid complications.