Transcatheter closure of perimembranous ventricular septal defects in infants and children using the Amplatzer perimembranous ventricular septal defect occluder

There are very few published reports of the transcatheter closure of perimembranous ventricular septal defects (PMVSDs) using the Amplatzer PMVSD occluder with encouraging initial results. This report presents initial and 1-year results from 54 patients with PMVSDs who underwent transcatheter closure at 5 different institutions with the Amplatzer PMVSD occluder. Sixty-five patients with PMVSDs were enrolled at 5 European centers. Eleven of the 65 patients did not fulfill the patient selection criteria at the initial echocardiographic evaluation or at cardiac catheterization. As a result, a total of 54 patients underwent attempted transcatheter closure using the Amplatzer PMVSD occluder. The median age of the patients was 5.1+/-3.6 years (range 0.3 to 13), and the median weight 18.5+/-10.3 kg (range 5 to 45). Devices were permanently implanted in 49 of 54 patients. Complete occlusion of the communication at 1-year follow-up was observed in 46 of 49 patients (94%). Main early procedural complications included (1) device embolization (2 patients), (2) severe bradycardia with hemodynamic compromise (2 patients), and (3) Mobitz II (2:1) heart block (1 patient). Late procedural complications included complete heart block (1 patient). No other complications were observed during follow-up. In conclusion, the Amplatzer PMVSD occluder is promising device that can be used for transcatheter closure in selected patients with PMVSDs. Further studies and long-term follow-up are required before this technique enters routine clinical practice.     

Perimembranous ventricular septal defect with aneurysm: two options for transcatheter closure

We present our experience with 2 options for device closure of perimembranous ventricular septal defect with aneurysm. Thirty-four patients with perimembranous ventricular septal defect with aneurysm, aged from 14 to 42 years, underwent transcatheter closure with modified double-disk occluders. A sheath was used to deliver the occluder after establishment of a stable "arteriovenous loop" under fluoroscopy. Electrocardiography and transthoracic echocardiography were used for follow-up. All but 1 patient experienced successful transcatheter closure of perimembranous ventricular septal defect with aneurysm, when occluders were used in 2 different positions. There were 19 patients whose perimembranous ventricular septal defects were closed at the inlet of the aneurysm and 15 patients whose defects were closed at the outlet. Eight patients had a residual shunt immediately after the procedure, which disappeared during follow-up. One patient developed minor aortic regurgitation. Four patients who manifested different types of conductive block were all in the group that underwent closure at the inlet of the aneurysm. No other complications were observed during follow-up.We infer that perimembranous ventricular septal defect with aneurysm can be successfully closed with modified double-disk occluders. Each of the 2 options that we have presented for transcatheter closure of perimembranous ventricular septal defect with aneurysm has its advantages and disadvantages. Ultimately, the configuration of the lesion should decide the type and position of the device.     

应用Amplatzer封堵器治疗膜周部室间隔缺损20例

目的:观察应用Amplatzer封堵器经导管介入治疗先天性心脏病膜周部室间隔缺损(PMVSD)的可行性、安全性和疗效。方法:采用Amplatzer封堵器治疗先天性心脏病膜部室间隔缺损20例患者,术前由经胸超声心动图确诊PMVSD,术中经左心室造影明确缺损位置、直径、在透视及超声心动图监视下经导管置入Amplatzer封堵器封堵PMVSD,术后3d、3个月、6个月及1年分别行经胸超声心动图、心电图和X线检查。评价治疗效果。结果:20例VSD病人成功置入Amplatzer封堵器,透视及超声心动图显示即刻完全堵闭。术后出现溶血和三度房室传导阻滞各1例,对症治疗后消失。分别手术后3个月、6个月、1年随访,超声心动图示封堵器位置良好,19例完全闭合,仅1例残余分流,无严重并发症。结论:经导管置入Amplatzer封堵器治疗PMVSD是一种成功率高、并发症少、疗效可靠的介入方法。     

国产封堵器介入治疗室间隔缺损69例

目的评价国产封堵器介入治疗室间隔缺损(VSD)的安全性及疗效。方法69例室间隔缺损(男24例,女45例),其中膜周部(PMVSD)50例、嵴内型(IVSD)9例、干下型(SVSD)8例、肌部2例。PMVSD使用对称型封堵器、IVSD和SVSD使用偏心型封堵器、膜部瘤形成合并多孔型使用对称型封堵器或大边封堵器、急性心肌梗死室间隔穿孔使用房间隔缺损(ASD)封堵器。结果左心室造影测量缺损直径3mm～12mm,平均7.67mm±1.59mm。69例中62例封堵成功,其中50例膜周部缺损,47例成功,8例SVSD4例成功,9例IVSD及2例肌部室缺均成功。1例在术中发生封堵器脱落;1例出现脑栓塞;1例出现溶血;1例Ⅲ度房室传导阻滞。结论介入治疗室间隔缺损,创伤小,成功率高,手术安全,国产封堵器安全、可靠。     

Device closure of ventricular septal defects by hybrid procedures: A multicenter retrospective study

Objective : This study reports on the feasibility, efficacy, and outcome of hybrid procedures to close ventricular septal defects (VSD), reflecting the experience of 11 centers in Germany, Austria, and Switzerland. Background : Beating heart closure of VSD has attracted interest in small infants, complex anomalies and postinfarction scenarios where patients are at high risk during surgery. Perventricular or intraoperative device placement allows access to the lesions where percutaneous delivery is limited. Methods : Between December 2001 and April 2009, placement of Amplatzer septal occluders was attempted in 26 patients. The defects were located in the perimembranous (n = 5) and muscular septum (n = 21). In 20 patients, a perventricular approach was used, and, in six, the occluders were placed under direct visualization being part of a complex heart surgery. Results : In 23 of 26 procedures, device placement was successful (88.5%). The mean defect size was 7.8 mm (range, 3.5–20). The occluder types were perimembranous VSD occluder (n = 4), muscular VSD occluder (n = 20), postinfarct VSD occluder (n = 1), and ASD occluder (n = 1) with a ratio device/defect of 0.9–2.4 (median 1.15). Device removal was necessary in three due to arrhythmia, malpositioning, and additional defects. Pericardial effusion occurred once. In the remaining 22 patients, there were no procedure or device‐related complications. During mean follow up of 1.4 years (range, 1 day–3.9 years), a residual shunt that was more than trivial was observed in one patient out of 21 successful procedures. Conclusions : Perventricular and intraoperative device closure of VSD is as effective as a surgical patch and averts the increased morbidity of conventional surgical repair in a subgroup of high‐risk patients. © 2010 Wiley‐Liss, Inc.     

Atrioventricular block: a serious complication in and after transcatheter closure of perimembranous ventricular septal defects

BACKGROUND: Transcatheter closure is an effective approach for perimembranous ventricular septal defects (PMVSD). However, atrioventricular blocks (AVB) emerged possibly due to the close proximity of the PMVSD to the conduction system, but concern for the complication was not adequately emphasized. In this study, we report the incidence of AVBs, in and after transcatheter closure of a PMVSD, and the outcome of the complication in our center. METHODS: One hundred and sixty-eight PMVSD patients were accepted for transcatheter closure with Amplazter PMVSD occluder (AGA Medical, Plymouth, Minn., USA). The procedure was discontinued when a second- or third-degree AVB occurred. A steroid was administered to all patients who developed AVBs. Temporary pacemakers were inserted in patients who developed a complete AVB or Mobitz type II AVB during or after the procedure. RESULTS: During the follow-up period of 6-24 mo (mean 10.6 +/- 3.9), the incidence of AVBs occurring during or after transcatheter closure of PMVSD was 3.5%. The AVB disappeared quickly after discontinuing the procedure in patients who developed AVBs during the procedure, whereas the AVBs disappeared between 2 and 21 d (mean 8.0 +/- 8.8) in the patients who developed AVBs after the procedure. However, complete right bundle branch block (CRBBB) was observed, and a transient complete AVB emerged after 8 mo in 1 case, incomplete right bundle branch block (IRBBB) in 1 case, and CRBBB and left anterior hemiblock (LAH) in 1 case. CONCLUSIONS: The AVB is a serious complication during and after transcathter closure of PMVSD. More attention should be paid to the complication, and multicentres are required to monitor the complication.     

Transcatheter closure of perimembranous ventricular septal defect in children: Safety and efficiency with symmetric and asymmetric occluders

Objectives : This study was designed to determine the safety and efficiency of asymmetric and symmetric ventricular septal occluders (AVSDOs and SVSDOs, respectively) for closure perimembranous ventricular septal defect (PMVSD) in children. Methods : Between January 2003 and December 2007, 142 children with PMVSD were treated with occluders (64 with AVSDOs and 78 with SVSDOs). Results : The defect diameter was 5.3 ± 1.1 mm in the AVSDO group and 5.4 ± 1.3 mm in the SVSDO group (P > 0.05). The success rates were similar between two groups [93.8% (AVSDO) vs. 94.9% (SVSDO), P > 0.05]. Two patients in the AVSDO group were switched to the SVSDO group due to residual shunts, and one patient in the SVSDO group was switched due to aortic regurgitation after deployment of the occluder. After procedure, 17 patients [seven with AVSDOs and nine with SVSDOs (P > 0.05)] developed various types of heart block (HB). Among them, 13 patients converted to the normal sinus rhythm. The remaining four cases had not recovered at the end of the study. Conclusions : Transcatheter closure of PMVSD using both AVSDO and SVSDO was safe and effective. Development of HB was the main complication for both devices. © 2010 Wiley‐Liss, Inc.     

Complications associated with transcatheter closure of perimembranous ventricular septal defects

Objectives : To identify the complications associated with transcatheter closure of perimembranous ventricular septal defects (PmVSD) using the Amplazter PmVSD occluder (AGA Medical, USA). Methods : Between October 2002 and November 2006, transcatheter closure PmVSD was attempted in 210 patients and performed in 206 patients. Those patients were followed‐up for 6–24 months (mean, 10.6 ± 3.9 months) to identify the complications. Results : Device implantation was successfully accomplished in 206 of the 210 patients (98%). Serious complications such as high degree atrioventricular block (AV block), infective endocarditis, and device embolization occurred in eight cases (3.8%). Other complications including mild aortic or tricuspid regurgitation, femoral pseudoaneurysm, and femoral arteriovenous fistula occurred in four cases. Conclusions : Transcathter closure of PmVSD can be performed safely and successfully. But further studies should continue to evaluate the potential complications associated with this procedure. © 2008 Wiley‐Liss, Inc.     

Arrhythmias after transcatheter closure of perimembranous ventricular septal defects with a modified double-disk occluder: early and long-term results

With the development of interventional techniques and devices, transcatheter closure of perimembranous ventricular septal defect has been widely performed. However, there has been a lack of long-term follow-up results about postoperative ECG changes of PmVSD patients. We report our experience of early and late arrhythmias after transcatheter closure of PmVSD with a modified double-disk occluder (MDVO). We performed a retrospective review of 79 patients (47 males, 32 females) between September 2002 and May 2007 who underwent transcatheter closure of perimembranous ventricular septal defect. Symmetric and asymmetric PmVSD occluders were used. The diameter of the evaluated defects ranged from 3 to 12?mm, as measured by TTE and 3 to 15?mm by left ventriculography. Most cases of PmVSD were treated successfully with a single procedure, resulting in a successful closure rate of 97% (77/79 patients). There was no death in any of the patients. After the operation, 79 patients were followed-up for a range of 10–76?months (35.3?±?17.4?months). In this series, 11 cases of incomplete right bundle branch block and five cases of complete right bundle branch block occurred during the early period after operation. During long-term follow-up, these issues declined in prevalence to five and four cases, respectively. Moreover, reversible third-degree AVB occurred during closure or after the procedure, and two of the three patients with reversible AVB received a temporary heart pacemaker implantation. These patients recovered 1?h, 6?days, and 9?days later, respectively. During 10–76?months of follow-up, no complications occurred in any of the patients, including residual shunt, severe aortic valve, or tricuspid valve regurgitation. Device closure of perimembranous ventricular septal defects with a modified double-disk occluder (MDVO) resulted in excellent closure rates and acceptably low arrhythmia rates.     

Catheter closure of congenital/acquired muscular VSDs and perimembranous VSDs using the Amplatzer devices

Over the past 10 years a variety of occluding devices has been used for transcatheter closure of ventricular septal defects (VSDs), but none has gained wide acceptance. This article presents the experience of transcatheter closure of muscular and perimembranous VSDs in 22 and 13 patients, respectively, with the new Amplatzer VSD occluders. Overall total occlusion was achieved in 95% and 92.3% of patients with muscular and perimembranous VSDs, respectively. The main complication was embolization of the device in 1/13 (7.6%) patients with perimembranous VSDs. Transcatheter closure of VSDs using the Amplatzer VSD occluders appears to be a safe and effective alternative to the standard surgical treatment.     

应用国产对称双盘封堵器经导管治疗膜周部室间隔缺损的临床疗效

目的评价应用国产对称双盘封堵器经导管治疗室间隔缺损的安全性及有效性。方法自2003年3月至2007年7月,对我科689例室间隔缺损患者应用国产对称双盘封堵器经导管进行了室间隔缺损的介入治疗,合并房间隔缺损、动脉导管未闭等均进行了同期治疗。并进行术中,术后第1、3、6个月及每年随访,包括12导联心电图及超声心动图检查,观察并发症的情况（有无房室传导阻滞、封堵器形态、对主动脉瓣及三尖瓣的影响以及有无残余分流等）,评估该方法的安全有效性。结果总体技术成功率为98.8%。因术后脑出血死亡1例,因Ⅲ度房室传导阻滞安装永久性心脏起搏器1例,半年后因三尖瓣中-重度关闭不全转外科手术1例,6例改用Amplatzer偏心伞进行封堵成功;2例封堵失败转外科手术。其余随访期间未出现明显并发症。结论应用国产对称双盘封堵器经导管治疗室间隔缺损术后出现各种与手术有关的并发症的几率较低,具有很强的安全性和可行性,应成为室间隔缺损患者的首选治疗方案,但同时应掌握好适应证,注意三尖瓣关闭不全等并发症的预防。     

婴幼儿室间隔缺损介入治疗的可行性及远期疗效

目的：探讨经导管介入治疗婴幼儿先天性心脏病室间隔缺损的可行性及远期疗效。方法研究总结海南省人民医院心内科2002年12月至2013年10月间经导管介入治疗的173例婴幼儿先天性室间隔缺损的临床资料。结果患儿年龄11个月～3岁[（2.1±0.7）岁],其中男81例,女92例,体重6～15 kg[（10.2±3.6）kg];室间隔缺损直径2.5～9.0 mm[（5.1±1.7）mm],其中单纯膜周部缺损88例（50.9%）,膜周部缺损并膜部瘤形成52例（30.1%）,膜周部缺损并主动脉瓣脱垂13例（7.5%）,嵴内型室间隔缺损20例（11.6%）,置入封堵器直径4～12 mm[（6.3±2.2）mm]。随访1个月～10年[（6.2±1.3）年]。173例患者中168例成功封堵,成功率97.1%,未成功的5例患者中,3例封堵器置入后出现中度主动脉瓣反流,2例导管通过缺损即多次出现完全性房室传导阻滞（CAVB）。随访过程中,1例患儿术后第3天发生CAVB,经地塞米松治疗4 d后恢复。3例患儿在术后即刻出现完全性左束支传导阻滞,随访中仅1例患儿发展为持续性完全性左束支传导阻滞,该患儿随访的5年中未发现心功能异常,1例患儿在随访的第4年发现完全性左束支传导阻滞,之后随访的3年中未发现心功能异常。术后第1天复查心脏彩超发现4例新发的主动脉瓣轻度反流和8例残余分流（宽约1～2 mm）,发现主动脉瓣轻度反流患儿在分别随访的6个月、2年、3.5年和8.5年中未发现进行性加重,发现残余分流患儿有4例在1个月后恢复,3例在6个月后恢复,1例在1年后恢复。随访的1个月～10年间无溶血、封堵器移位或脱落、迟发性房室传导阻滞等并发症。结论经导管介入治疗婴幼儿室间隔缺损是一项安全可行的技术,远期疗效良好。     

Early clinical experience with the new amplatzer ductal occluder II for closure of the persistent arterial duct

Objectives : To describe the early single‐center clinical experience with the Amplatzer Ductal Occluder II (ADO II). Methods : All patients undergoing attempted transcatheter closure of persistent arterial duct (PDA) with the ADO II were included. Data collected included demographic, clinical, and echocardiographic parameters. Results : From March until September 2008, 29 procedures were undertaken in 27 patients (21 female). Median age was 1.4 years (range 0.4–76 years) with median weight 9.4 kg (range 4.7–108 kg). A transarterial approach was used in 2 patients. The median minimum ductal diameter was 2.7 mm (range 1.7–5). ADO II was released in 25 patients (92.5%). Two patients had significant residual shunting following deployment of ADO II and underwent closure with Amplatzer ductal occluder (ADO I). Postprocedural echocardiography identified one occluder had changed position with development of a significant leak and one occluder had embolized to the left pulmonary artery. Both occluders were retrieved successfully at a second catheter procedure. Complete occlusion was noted predischarge in 22 of the remaining 23 occluders (96%). One patient had mild flow acceleration in the left pulmonary artery which has resolved. Conclusions : The ADO II is highly effective at providing rapid occlusion of morphologically varied PDAs. Occluder design allows closure with arterial or venous approach and delivery with 4 or 5 F delivery catheters. Stable occluder position is dependent on correct positioning of both aortic and pulmonary discs. A larger range of sizes and configurations of this occluder may be required to successfully occlude all ductal sizes and morphologies. © 2009 Wiley‐Liss, Inc.     

超声心动图检查在VSD介入封堵术中应用

目的探讨超声心动图检查在室间隔缺损(VSD)介入封堵术的适应证筛选及术中、术后的应用价值.方法对12例施行介入封堵术的患者术前用超声心动图测量VSD之形状与大小,术中进行超声心动图监测,术后以超声心动图随诊.结果 12例患者中,膜周部5例,隔瓣后型3例,膜周嵴下型2例,嵴内漏斗部1例,心肌梗死室间隔肌部穿孔1例.共放置13个封堵器,被封堵的VSD直径为3～8mm,平均为(5.2±0.8)mm.10例患者封堵术后即刻观察,穿隔分流消失,术后1周复查,封堵器位置良好、稳定、无残余分流;1例微量残余分流,术后24小时超声心动图复查分流消失;1例少量残余分流,术后即刻复查最大分流速度为1.2m/s(低于险值2m/s),6个月后复查仅见微量残余分流.结论超声心动图检查对介入封堵术的适应证的筛选、确定封堵器释放时间、释放时即刻疗效的评价及术后随访具有重要价值.     

Transcatheter device closure of intracristal ventricular septal defects

Transcatheter closure of ventricular septal defects (VSDs) is now offered as primary therapy at many institutions. We sought to evaluate the clinical feasibility and safety of device closure of intracristal VSDs using perimembranous occluders. A total of 49 patients were diagnosed with intracristal VSDs and assigned to the intracristal VSD group, and another 49 patients with the same size perimembranous VSDs were selected and assigned to the perimembranous VSD group. Two types of perimembranous occluders, symmetric and asymmetric, were used, and no difference was found between the groups with respect to successful closure. The diameter of the intracristal VSD was 3 to 10 mm (mean 5.8 ± 1.4) on the transthoracic echocardiogram. The procedure time and fluoroscope time in the intracristal VSD group were significantly greater than those in the perimembranous VSD group. More defects with a subaortic rim ≤ 2 mm on the transthoracic echocardiogram were present in the intracristal VSD group than in the perimembranous VSD group; thus, more asymmetric occluders were used in the intracristal VSD group. All devices remained in a stable position and in an optimal shape during follow-up. In conclusion, transcatheter closure of intracristal VSDs with the perimembranous occluder is feasible, safe, and effective.     

Transcatheter closure of perimembranous ventricular septal defect with amplatzer membranous occluder

BACKGROUND: Use of trancatheter device closure for membranous ventricular septal defect is still in evolving phase. We report the early and mid-term results of our experience with the new asymmetric Amplatzer membranous ventricular septal defect occluder. METHODS AND RESULTS: We attempted, transcatheter closure of perimembranous ventricular septal defect using asymmetric Amplatzer occluder in 26 patients. The patients were selected on the basis of transthoracic and transesophageal echocardiographic assessment of the ventricular septal defect. The procedure was successful in 21 (81%) patients. The age ranged from 3 to 23 years, weight from 10 to 59 kg and defect size ranged from 3 to 9 mm (mean: 5 +/- 1.8 mm). One patient had situs inversus with dextrocardia: 11 had aneurysmal tissue partly occluding the defect and the device was deployed either across (n=6) or within the aneurysmal sac (n=5). Three patients developed high degree atrioventricular block on attempts to cross the defect with the sheath and the procedure was discontinued. In two patients it was not possible to place the sheath in left ventricle despite repeated attempts. There was a residual flow in 4 (19%) patients at 24 hours. Two patients developed bundle branch block and none had complete heart block. At follow-up (1-9 months, n=20), residual flow was seen in two patients. None developed late conduction defect, aortic regurgitation, infective endocarditis or hemolysis. CONCLUSIONS: Transcatheter closure of perimembranous ventricular septal defect can be performed safely and effectively with the new asymmetric Amplatzer occluder device in selected patients with good short- and midterm results. These devices can be deployed safely in and across and the aneurysmal sacs. In selected cases, this procedure is a satisfactory alternative to surgery.     

Transcatheter closure of perimembranous ventricular septal defects using amplatzer asymmetric ventricular septal defect occluder: preliminary experience with 18-month follow up.

BACKGROUND: This study reports our experience in the nonsurgical closure of perimembranous ventricular septal defects in children and adolescents with the Amplatzer asymmetric ventricular septal defect occluder and the outcome of an 18-month follow up. METHODS AND RESULTS: Twenty patients (median age:10 years; median weight:32 kg) with perimembranous ventricular septal defect were selected for transcatheter closure with the Amplatzer device. The prosthesis diameter chosen was 1-2 mm larger than the largest measured diameter of the defect on transesophageal echo (TEE). All patients were put on oral aspirin (5 mg/kg/day in children and 150 mg/day in adults) five days prior to and for six months after closure. Follow-up evaluation at 48 hr and 1, 6, 12 and 18 months included clinical examination, electrocardiogram, and a transthoracic echocardiogram. The mean defect diameter on color flow mapping on TEE was 7.1 +/- 2.3 mm. The device diameter ranged from 6-14 mm (median = 8 mm). One patient developed an anaphylactic reaction to contrast. The procedure was successful in 17 out of 19 patients where it was attempted (89.4%). In two patients with associated significant aortic valve prolapse and mild aortic regurgitation the device could not be successfully deployed. A trivial residual shunt observed during postdeployment left ventricular angiogram in 7 of 17 patients (41.2%) completely disappeared at one month follow-up. Three patients had right bundle branch block (2 complete and 1 incomplete) whereas one developed junctional escape rhythm with a right bundle branch block morphology. One patient had clinically silent thromboembolism to the left vertebral artery and another patient had hemolysis which resolved spontaneously within 48 hr. Follow-up at 13.5 +/- 5.3 months (range 1-18 months) revealed no residual shunt. The left ventricular internal dimension in diastole decreased significantly from 45 +/- 6 mm to 40 +/- 6 mm (P < 0.01) at the time of the last follow up. The baseline tricuspid regurgitation (n = 4) and aortic regurgitation (n = 3) remained unchanged during the follow up period. None of the patients developed left ventricular outflow tract obstruction or new aortic or tricuspid regurgitation. There were no other device related complications such as device migration, systemic thromboembolism, infective endocarditis, pericardial effusion or delayed conduction disturbances. CONCLUSIONS: In carefully selected children and young adults, the Amplatzer asymmetric ventricular septal defect occluder is a promising device for transcatheter closure of perimembranous ventricular septal defect with encouraging results on short term follow up.     

Percutaneous transcatheter ventricular septal defect closure in adults with Amplatzer septal occluders

BACKGROUND: The interest in transcatheter ventricular septal defect (VSD) closure is continuously growing. Therefore, we report our experience in perimembranous (Pm) and postinfarction (Pi) VSD closure. METHODS: All patients, older than 16 years, were selected from a data base, in which Pm and Pi VSDs were registered.The patients' files were reviewed until the most recent follow-up date. RESULTS: Nine (7 male, 37.4 +/- 12.8 y) and 8 (6 male, 76.3 +/- 6.2 y) patients underwent a Pm (group A) and Pi VSD (group B) closure, respectively. One female patient was treated for a posttraumatic VSD (26 y). In group A, 7 patients were closed with the Amplatzer perimembranous VSD occluder, one with the muscular VSD occluder, and one patient with the atrial septal defect occluder. All patients in group B were treated with the muscular VSD occluder. In the post-traumatic VSD an Amplatzer patent foramen ovale occluder was used. Device implantation was feasible in all, except in two patients with extremely large VSDs (one Pm and one PiVSD). Total transcatheter closure or small residual leakage was achieved in 7/8 patients in group A, but one patient needed surgical VSD repair because of massive haemolysis, another patient died 9 months later. A small or moderate shunt was present immediately after the procedure in all patients of group B. No device-related complications were reported, but all, except one patient, died within 2 weeks after the procedure because of an extremely high co-morbidity (logistic Euroscore 70 +/- 25%).Total closure was achieved in the post-traumatic VSD. CONCLUSION: Transcatheter closure of Pm and Pi VSD with Amplatzer septal occluders in adults is feasible and safe, but the post-procedural prognosis totally depends on the aetiology of the VSD and its co-morbidity.     

室间隔缺损介入封堵治疗发生心律失常的临床研究

目的探讨室间隔缺损(VSD)经导管介入治疗发生心律失常的机制及防治对策。方法对79例VSD患者进行介入封堵治疗。膜周部VSD单纯型50例,膨出瘤型28例,肌部VSD1例。选用Rashkind双伞闭合器2例,Sideris钮扣闭合装置16例,Amplatzer PDA封堵器45例,Amplatzer偏心型膜周部封堵器11例,Am-platzer肌部VSD封堵器1例。结果79例患者75例封堵成功(94.9%)。术后新出现心律失常31例(41.3%),其中不完全性右束支传导阻滞17例(22.7%),完全性右束支传导阻滞3例(4%),完全性左束支传导阻滞6例(8%),室性早搏3例(4%),间歇性室上性心动过速2例(2.7%)。1例患者术前心电图示完全性右束支传导阻滞,术后第4天心电图表现为Ⅲ度房室传导阻滞,临床伴发阿—斯综合征。经紧急开胸心脏挤压,气管插管,安置心外膜临时起搏器,复苏成功,出院时患者心电图恢复至术前状态。其余25例束支传导阻滞,其中5例应用强的松30mg/日,一周后仅有2例存在不完全性右束支传导阻滞,1例存在不完全性左束支传导阻滞。3例室性早搏,2例为一过性,1例经抗心律失常药物治疗,出院时室性早搏仍有591次/24小时。结论经导管封堵VSD,出现心律失常达41.3%,但严重心律失常发生率低,是安全、有效可靠的治疗方法。     

Effectiveness and Safety of Transcatheter Closure of Various Ventricular Septal Defects Using Second-Generation Amplatzer Duct Occluders

Objective: This study was designed to determine the long-term safety and efficacy of using the Amplatzer Duct Occluder II (ADO II) for the closure of various ventricular septal defects (VSDs). Methods: From January 2011 to December 2019, selected VSD patients were treated through transcatheter intervention using ADO II occluders. The closure results and complications from 188 patients, involving 167 perimembranous ventricular septal defects (pmVSDs), 9 intracristal VSDs, 11 post surgery residual shunts and 1 post closure residual shunt with the mean outlet diameter3.1 ± 0.8 mm under angiography, were enrolled in this study. Results: The success rate was 98.9% for all procedures. During the median 77-month follow-up period, no cases of complete atrioventricular block (cAVB), infective endocarditis or death occurred. One major adverse event (0.5%) was recorded: cerebrovascular accident occurred 1 day after the procedure in one patient who was transferred to the neurology department. The residual shunt rate was 44.6%, which was the most common minor adverse event. The cardiac conduction block rate was 4.3%. Specifically, one pmVSD patient developed intermittent LBBB during the 28-month follow-up. There were 3 patients (1.6%) with new-onset mild tricuspid insufficiency, and the insufficiency degree was stable during follow-up. There was no new-onset aortic insufficiency that occurred. Conclusions: Transcatheter closure of pmVSDs, some intracristal VSDs, some postsurgery or postclosure residual shunts using ADO II occluders were both safe and effective and yielded excellent long-term results in selected patients.