Transcatheter Ventricular Septal Defect Closure with Nit-Occlud Lê VSD Device—Five Years’ Experience and Literature Review

Introduction: Transcatheter closure is an alternative to ventricular septal defect (VSD) occlusion surgery. Nit-Occlud Lê VSD coil is a new device yet to be evaluated. The study aimed to evaluate immediate and midterm results after transcatheter closure with the Nit-Occlud Lê VSD device. Methods: The retrospective analysis included 30 patients with VSD referred for closure during the period from October 2015 to December 2020. Results: At the time of intervention, the patients’ mean age and body weights were 7.5 ± 5.6 years and 29.3 ± 19.1 kg. The majority of the defects had perimembranous location (24/30), four defects had muscular and two outlet subaortic position. The mean effective right-side diameter of the VSDs was 3.6 ± 1.3 mm. Single ventricular fibrillation, device embolization, and hemolysis developed in different patients and were successfully treated. None of the patients had a complete atrioventricular block. The coil was successfully placed in 25/30 (83.3%) patients. The majority of the devices were 10 mm × 6 mm (11/25) and 12 mm × 8 mm (8/25) in size. Two patients required the implantation of a second device. The follow-up period was 2.1 ± 1.4 years. Complete VSD closure was achieved in 48% of cases immediately after the intervention, 74% during 2.1 ± 1.6 months after the procedure, and 81% over follow-up. The remaining patients had a trivial residual defect. During the follow-up, approximately one-third of patients developed trivial aortic and mitral valve regurgitation, and half of the patients acquired trace/mild tricuspid regurgitation. Standardized (z-score) left ventricular end-diastolic diameter (0.15 ± 0.37 vs. 0.92 ± 0.82, p = 0.005) and left atrium dimension (0.47 ± 0.58 vs. 1.89 ± 1.11, p = 0.005), as well as the left atrium to aortic root ratio (1.2 ± 0.1 vs. 1.4 ± 0.2, p = 0.005) showed a significant decrease over follow-up related to the period before intervention. Conclusion: Intervention with Nit-Occlud® Lê VSD coil showed appropriate results regarding VSD closure rate, complications, and chamber remodeling. The introduction of this device into clinical practice is a significant step forward in transcatheter perimembranous VSD occlusion.     

Morphology and Function of the Aortic Valve after Transcatheter Closure of Ventricular Septal Defect with Aortic Valve Prolapse

Objective: This study aims to evaluate the morphology and function of the aortic valve after transcatheter closure of ventricular septal defect (VSD) with aortic valve prolapse (AVP) abased on clinical and radiological outcomes. Methods: From January 2013 to November 2014, 164 consecutive patients (97 males, 59.1%) with VSD and AVP were treated by transcatheter closure. The patients were divided into the mild AVP group (n = 63), moderate AVP group (n = 89) and severe AVP group (n = 12). The clinical and radiological outcomes of these patients were analyzed retrospectively. Results: In total, 146 (89.0%) patients were successfully treated with VSD occluders, including 59/63 (93.7%) with mild AVP, 80/89 (89.9%) with moderate AVP and 7/12 (58.3%) with severe AVP. The degree of AVP was ameliorated or disappeared in 39 (26.7%) patients, and remained unchanged in 103 (70.5%) patients after the intervention. In the 35 patients who initially had trivial-to-moderate aortic regurgitation (AR), the degree of AR was ameliorated or disappeared in 25 (71.4%) patients, aggravated from trivial to mild AR in 1 (2.9%) patient, and remained unchanged in 9 (25.7%) patients. In 111 patients without AR, 1 (0.9%) patient had mild AR and 24 (21.6%) patients had trivial AR after intervention. The depth and width of the prolapsed aortic valve decreased after transcatheter closure of VSD in all three groups. During the 70-month (range, 54–77) follow-up period, no patients with AVP and AR needed an aortic valve intervention. Conclusions: Transcatheter closure of VSD with AVP is feasible. The morphology and function of the prolapsed aortic valve improved and remained stable for a long period after intervention.     

Outcomes of Early Versus Delayed Transcatheter Closure of Post-Myocardial Infarction Ventricular Septal Defect

BackgroundPost myocardial infarction ventricular septal defect (VSD) is a rare, but devastating complication which carries a poor prognosis if left untreated. Optimal therapy remains unclear and surgical repair is associated with high mortality.ObjectiveThe aim of our study is to compare 30-day survival in patients with early versus late primary transcatheter repair of post myocardial infarction ventricular septal defect.MethodsWe performed a comprehensive search of published data through SCOPUS and identified published reports of primary transcatheter closure of post myocardial infarction VSD. We included case reports and series that reported timing of VSD closure and 30-day survival and excluded those with prior surgical repair. Early repair was defined as transcatheter closure within 14 days of diagnosis of VSD while late repair was defined as transcatheter closure after 14 days of diagnosis of VSD.ResultsA total 27 publications describing 193 patients were identified in the SCOPUS search. We excluded 8 publications with no reported timing of VSD repair or 30-day outcome. Of the 193 patients initially included, a total of 126 patients fulfilled all the criteria and were included in the final analysis. The overall 30-day survival rate was found to be 62.7% (79 patients). In the early repair group, only 36.2% of the patients were still alive at 30 days compared to 85.3% in the delayed repair group, P < .01. No significant difference in age, gender, presence of shock, VSD size, presence of significant residual shunt, location of VSD or infarction was observed. The early repair group was found to have a significantly larger Qp: Qs ratio as well as larger occluder size and lower rate of successful repair.ConclusionCompared to the late repair group, the early transcatheter VSD repair group had a larger pre-procedure Qp:Qs and worse 30-day survival. Further studies are needed to determine the optimal timing of transcatheter repair of a post myocardial infarction VSD.     

Assessment of Intracardiac and Extracardiac Deformities in Patients with Various Types of Pulmonary Atresia by Dual-Source Computed Tomography

Background: Pulmonary atresia (PA) is a group of heterogeneous complex congenital heart disease. Only one study modality might not get a correct diagnosis. This study aims to investigate the diagnostic power of dual-source computed tomography (DSCT) for all intracardiac and extracardiac deformities in patients with PA compared with transthoracic echocardiography (TTE). Materials and Methods: This retrospective study enrolled 79 patients and divided them into three groups according to their main diagnosis. All associated malformations and clinical information, including treatments, were recorded and compared among the three groups. The diagnostic power of DSCT and TTE on all associated malformations were compared. The surgical index (McGoon ratio, pulmonary arterials index (PAI), and total neopulmonary arterial index) and radiation dose were calculated on the basis of DSCT. Results: Of the patients, 32, 30, and 17 were divided into the groups of PA with ventricular septal defect (VSD), PA with VSD and major aortopulmonary collateral arteries, and PA with other major malformations, respectively. Consequently, 182, 162, and 13 intracardiac, extracardiac, and other major malformations were diagnosed, respectively. Moreover, DSCT showed a better diagnostic performance in extracardiac deformities (154 vs. 117, p < 0.001), whereas TTE could diagnose intracardiac deformities better (159 vs. 139, p = 0.001). The McGoon ratio, PAI, and treatment methods were significantly different among the three groups (p = 0.014, p = 0.008, and p = 0.018, respectively). Conclusion: More than one imaging modality should be used to make a correct diagnosis when clinically suspecting PA. DSCT is superior to TTE in diagnosing extracardiac deformities and could be used to roughly calculate surgical indices to optimize treatment strategy.     

Transcatheter membranous ventricular septal defect closure through a mechanical aortic prosthesis using the Amplatzer membranous ventricular septal defect occluder

An iatrogenic ventricular septal defect (VSD) after aortic valve replacement is rare, but represents a significant complication. Repeat surgery to repair such a defect carries a high surgical risk. The transcatheter approach (either transvascular or transapical) could be considered as an alternative to open chest surgery. We describe the successful transcatheter closure of an iatrogenic VSD with an Amplatzer Membranous VSD Occluder in a patient with previous combined mitral and aortic mechanical valve replacements. The device was implanted through a CarboMedics mechanical valve in the aortic position. © 2008 Wiley‐Liss, Inc.     

Pulmonary Atresia with Ventricular Septal Defect and Multifocal Pulmonary Blood Supply: Does an Intensive Interventional Approach Improve the Outcome?

Introduction. Pulmonary atresia with ventricular septal defect (VSD) continues to be associated with significant morbidity and mortality, with significant institutional variation in therapeutic strategies. This study reports a single center experience utilizing an intensive transcatheter approach to promote pulmonary vascular growth. Methods. A retrospective analysis of 20 patients undergoing surgical and transcatheter treatment for pulmonary atresia with VSD between 2002 and 2010. Results. The median age at initial surgical palliation was 6.3 months (8 days to 2.5 years). Eleven patients (group 1) underwent initial surgical palliation without VSD closure and nine patients (group 2) underwent an initial complete repair with fenestrated or complete VSD closure. Group 1 had a smaller Nakata index (54 mm²/m² vs. 134 mm²/m², P= .04) and a smaller absolute native pulmonary artery diameter (2.7 mm vs. 4.5 mm, P= .01) than group 2. Intraoperative angiography was performed in 10 cases to evaluate if early transcatheter intervention was warranted. The median follow‐up during the study period was 2.3 years (1.6 months to 8.3 years). Of the 16 patients who survived the initial early postoperative period, 15 patients (94%) went on to receive surgical (n = 11) and/or interventional (n = 25) catheterization procedures. There was improvement in the mean Nakata index from the initial presurgical evaluation to the most recent catheterization data (38.4 mm²/m² vs. 169.7 mm²/m², P≤ .05). To date, two of 11 (18%) patients in group 1 ultimately underwent surgical VSD closure. Overall mortality was six of 20 (30%) with four deaths in group 1 and two deaths in group 2. There were no procedural deaths. Conclusions. Combining surgical unifocalization procedures with subsequent early and intensive catheter‐based pulmonary artery rehabilitation may improve vascular growth, ultimately rendering many patients suitable for fenestrated VSD closure. Risk stratification, including intraoperative exit angiography, is essential to determine the need for early transcatheter interventions.     

Transcatheter closure of ventricular septal defect in aortic valve prolapse and aortic regurgitation

ObjectiveTo report intermediate follow-up result of transcatheter closure of ventricular septal defect (VSD) in presence of aortic valve prolapse (AVP) with or without aortic regurgitation (AR).MethodThis is a retrospective review of 19 patients with VSD with AVP with AR who underwent transcatheter closure in between September 2011–July 2014. Mean age was 8 years (1–16 years, standard deviation [SD] 4.08 years) and mean weight was 26.03 kg (9–81.5 kg, SD 16.57 kg). Among them 2 had subarterial VSD, 6 had subaortic VSD and 11 had perimembranous VSD. All of them had mild AVP and 13 of them had AR (trivial or mild). Median VSD size was 4.3 mm (4–6 mm). Transcatheter closure was done either by retrograde technique using the Amplatzer Duct Occluder-II in 17 patients or antegrade technique using the Duct Occluder-I in 2 cases. Mean follow-up period was 18 months (12–36 months).ResultImmediate major complications were encountered in 2 (10.5%) cases. Significant aggravation of device related AR was seen in one case & device embolised to right pulmonary artery in another case and both of them were managed surgically.During follow up, 1 child had significant additional VSD requiring device closure. One child developed moderate AR, requiring surgery. None of the other had shown any increase in severity of AR.ConclusionDevice closure of VSD in presence of mild AVP and mild AR appears to be safe. Longer follow-up is necessary to draw final conclusion.     

Transcatheter versus surgical treatment for isolated superior sinus venosus atrial septal defect

Background

The superior sinus venosus atrial septal defect is a congenital communication between the left and right atria. Open surgical approach by patch closure has historically been the only treatment option. Recently, a transcatheter approach has been developed. This study aims to compare the efficacy and safety of surgical and transcatheter approach in treatment of sinus venosus atrial septal defect.

Methods

Between March 2010 and December 2020, 58 patients (median age: 45.4, range 14.8−73.8) underwent either surgical or transcatheter correction of superior sinus venosus atrial septal defect with partial anomalous pulmonary venous drainage.

Results

Twenty-four patients (median age: 35.4, range 14.8−66.8) underwent surgery while 34 patients (median age: 46.8, range 15.5−73.8) had a transcatheter treatment. During the catheterization era, 41 patients was considered suitable for a transcatheter closure. In 5 patients, surgery was the patient's or referring physician's choice. In 2 cases, the procedure was unsuccessful; the remaining 34 were successfully closed (94.4% of cases). Intensive care unit stay (median of 1 day, range 0.5−4, vs. 0, range 0−2, p < 0.0001) and hospital stay (median 7 days, range 2−15 vs. 2 days, range 1−12, p < 0.0001), were significantly longer in the surgery group. Total early complication rate, consisted on procedural and in-hospital complication, were higher in the surgical group (62.5% vs. 23.5%; p = 0.005). However, complications in both groups were clinically mild. At follow-up, a small residual shunt was present in 6 patients (surgery group: 2 pts; catheterization group: 4 pts; p: NS). Imaging studies showed significant improvement of right ventricular size and unobstructed pulmonary venous return in all patients. No late complications occurred at follow-up.

Conclusions

Transcatheter correction of sinus venosus atrial septal defect is effective and safe in selected patients and may be considered as a valid alternative to surgery.     

The results of transcatheter closure of VSD using amplatzer® device and nit occlud® Lê coil

Objective: We retrospectively reviewed the result of patients who underwent transcatheter closure of ventricular septal defect (VSD) using Amplatzer® Perimembranous or Amplatzer® muscular VSD device (the Amplatzer® group) and Nit Occlud® Lê VSD Coil (the Pfm group). Background: Perimembranous type (PmVSD) and doubly committed subarterial (DCSA) VSD were the major isolated congenital heart defects in Thai children. Transcatheter device closure technique for both types of VSD has emerged as an alternative treatment to surgery. Methods: Retrospectively, data was reviewed between 2003 and 2009. Results: 116 patients were enrolled. Device or coil was successfully implanted in 94%. Complete closure at 24 hr is slightly higher in the Amplatzer® group. The average size of VSD in the Amplatzer® group was larger than the Pfm group (P = 0.001). The Pfm coil was primarily deployed in DCSA VSD when compared with the Amplatzer® group (P < 0.01). At 6 months follow‐up the residual shunt was comparable (P = 0.054). There was only one transient AV block (AVB) in the Pfm group and 5 AVB in the Amplatzer® group. Four pacemakers were placed in the Amplatzer® group. Conclusions: Transcatheter closure of VSD in both Pm VSD and DCSA can be achieved by using either of the device. The Amplatzer® VSD device had the advantage of closure of larger defects with immediate less residual shunt but appeared to have a significant number of 3° AVB, which required pacemaker implantation. The Nit Occlud® Lê VSD Coil had the advantage of closure of both types of defects, in particular DCSA VSD with only small residual shunt. © 2011 Wiley Periodicals, Inc.     

Transcatheter closure of perimembranous and intracristal ventricular septal defects with the SHSMA occluder

Objectives : The objective of this study was to evaluate the safety and efficacy of transcatheter closure of perimembranous ventricular septal defect (pmVSD) and intracristal VSD (icVSD) using the Shanghai Shape Memory Alloy (SHSMA) pmVSD occluder. Background : There is still limited experience with transcatheter closure of pmVSD and icVSD. Methods : Between January 2003 and September 2010, 348 patients with pmVSD and 47 patients with icVSD underwent transcatheter closure using a SHSMA pmVSD occluder. Results : The total successful closure rate in pmVSD and icVSD subjects was 97.4 and 78.7%, respectively. During the perioperative period, no death, major bleeding or hemolysis occurred in both groups. In pmVSD group, one case of occluder dislodgement, one case of pericardial tamponade, and two cases of thromboembolism occurred. None in icVSD group had these complications. During a median of 3.2 years of follow‐up, there was no evidence of significant residual shunt and device‐related valve regurgitation. None in icVSD group and 10 patients (2.9%) in pmVSD group had a persistent arrhythmia. Overall, only one patient (0.3%) with pmVSD acquired complete atrioventricular block requiring implantation of a permanent pacemaker. The rim from the tricuspid valve to the defect < 4 mm was the only predictor of arrhythmic complications after procedure (OR = 4.24; P = 0.021). Conclusions : Transcatheter closure of pmVSD in selected patients using the SHSMA occluder is effective and safe. Transcatheter closure of icVSD in experienced hands using this device is also feasible and safe. © 2011 Wiley Periodicals, Inc.     

封堵器介入治疗室间隔缺损失败原因影像学分析

目的 用影像学方法分析封堵器介入治疗室间隔缺损的失败病例,以提高介入治疗室间隔缺损手术成功率。方法 未能成功行室间隔缺损堵闭术47例（47/774）,男27例,女20例,年龄2～30岁。对比其手术前后左心室和主动脉造影影像资料。结果 膜部瘤破裂15例,其中8例有多个破口,堵闭主要破口后仍有其他的破口分流,2例术前造影只显示单个破口,堵闭破口后出现新的破口,5例封闭基底部后仍存在大量分流;放置堵闭器后出现了中度以上的主动脉瓣反流28例,7例高位嵴下型室间隔缺损,室间隔缺损上缘到主动脉瓣距离小于适应证标准。21例伴有主动脉瓣脱垂,封堵器影响主动脉瓣从而造成主动脉关闭不全;封堵器移位2例;2例术后出现溶血。结论 封堵器介入治疗室间隔缺损是安全可靠的治疗方法,但是应该严格把握适应证,恰当地选择堵闭方式和堵闭器,避免治疗失败及术后并发症。     

Transcatheter closure of ventricular septal defect: a nonsurgical approach to the care of the patient with acute ventricular septal rupture.

Acute ventricular septal rupture is a potentially fatal complication of myocardial infarction. In the past, surgical repair was the only treatment option for this life-threatening event. However, not all patients are good surgical candidates. Transcatheter closure of a ventricular septal defect (VSD) with a prosthesis called the Rashkind Patent Ductus Arteriosis Occluder System allows closure of the VSD without the possible complications associated with open-heart surgery. This treatment has potential as a temporary measure for patients awaiting surgical repair of VSD. Transcatheter closure may also be used as a permanent treatment for those patients considered to be poor surgical candidates. This case presentation addresses the use of a state-of-the-art nonsurgical approach to VSD closure. The focus is on the unique medical and nursing interventions used in caring for the patient suffering from a myocardial infarction complicated with postinfarction ventricular septal defect.     

Transcatheter Closure of Atrial Septal Defect with Attenuated Anterior Rim after Transcatheter Aortic Valve Implantation: Can It Be Carried out as a Single Procedure?

Transcatheter aortic valve replacement (TAVR) has emerged as a highly effective minimally invasive treatment for symptomatically critical aortic stenosis (AS) in patients at high or prohibitive surgical risk. We report a case of staged transcatheter management of critical AS combined with an atrial septal defect (ASD) with attenuated anterior superior rim. The clinical result of this case suggests that both procedures can be safely performed simultaneously. Therefore, combined transcatheter treatment may appear as a possible strategy in patients with concomitant cardiac conditions.     

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.     

Post-Myocardial Infarction Ventricular Septal Defect: A Comprehensive Review

Post-myocardial infarction (MI) ventricular septal defect (VSD) is a rare but potentially catastrophic mechanical complication that occurs in <1% of patients following a myocardial infarction and it is associated with a high morbidity and mortality despite improvements in medical and surgical therapies. Post-MI VSD is a medical emergency and outcome is very poor in medically treated patients. Treatment of choice remains surgical closure of defect and transcatheter defect closure less so. We performed a comprehensive review of the clinical presentation and management options of post-MI VSD.     

Transcatheter closure of a residual postmyocardial infarction ventricular septal defect with the Amplatzer septal occluder

Acute ventricular septal rupture following myocardial infarction carries a high mortality. Early surgery improves survival but long term outcome depends on residual shunting and left ventricular function. Residual shunting is common despite apparently successful closure and may require reoperation. Transcatheter closure is an established method of treating selected congenital defects but clinical experience of transcatheter closure in postinfarction ventricular septal rupture is minimal. Transcatheter closure of a residual ventricular septal defect was successfully done using a new device, the Amplatzer septal occluder, in a 50 year old Indian man who had previously undergone emergency surgical repair for postinfarction acute ventricular septal rupture. The technique is described and its potential as a treatment in postinfarction ventricular septal rupture, its possible complications, and the important aspects of case selection and device design are discussed.

Keywords: ventricular septal defect; transcatheter closure; Amplazter septal occluder     

Comparison of immediate results and mid-term follow-up of surgical and percutaneous closure of ruptured sinus of Valsalva aneurysm

BackgroundThe past decade has witnessed considerable improvement in implantation techniques for percutaneous closure of ruptured sinus of Valsalva aneurysm. This study was undertaken to compare the immediate results and mid-term follow-up of traditional surgery and percutaneous closure of ruptured sinus of Valsalva aneurysm in China.MethodsBetween January 1993 and January 2013, a total of 35 patients with ruptured sinus of Valsalva aneurysm were enrolled for attempted closure in our institution. Twenty patients (57.1%) underwent surgical repair and the other 15 patients (42.9%) underwent percutaneous closure.ResultsNineteen patients (95.0%) in the surgical group had complete closure and 14 patients (93.3%) in the percutaneous closure group were treated successfully (p = 0.681). Twelve patients with ruptured sinus of Valsalva aneurysm combined with subarterial ventricular septal defect (VSD) underwent surgical repair concomitantly. Two patients in the percutaneous closure group were treated for ruptured sinus of Valsalva aneurysm and perimembranous VSD using occluders concomitantly. One case of severe hemolysis developed 8 h after the procedure in the percutaneous closure group. One death and one case of patch leak occurred in the surgical group during hospitalization. The time of hospital stay in the percutaneous closure group was shorter than that in the surgical group (p = 0.004). The total medical cost of isolated ruptured sinus of Valsalva aneurysm in the percutaneous closure group was lower compared with that in the surgical group (p = 0.046). During a median follow-up of 15 months (2–240 months), there were no deaths, infective endocarditis, device embolization, or malposition.ConclusionsPercutaneous closure is an attractive alternative to surgery in selected patients with ruptured sinus of Valsalva aneurysm for the better clinical advantages and economic benefits.     

Efficacy,Safety and Characteristics of the Amplatzer Vascular Plug II and IV Utilization for Various Percutaneous Occlusions in Children under 10 Years

Objectives: We aim to describe the efficacy, safety, and characteristics of the Amplatzer Vascular Plug (AVP) II and IV “off-label” use for multiple cardiovascular occlusions in children under 10 years. Methods: Observational retrospective multicenter (2007–2020, 6 centers) review of paediatric procedures using AVP II or IV. Results: A total of 125 children (49.6% aged ≤ 1 year, 147 lesions) underwent 136 successive procedures (success rate: 98.5%) using 169 devices (109 AVP IV, 60 AVP II). The mean device diameter was 7.7 ± 3.2 mm (4–20 mm). The median AVP size to vessel diameter ratio was 1.3 (0–2). The median age and weight at implantation were 1.0 year (0.01–9.98) and 8.4 kg (1–69). Procedures were heterogeneous (55 patent ductus arteriosus (PDA), 28 collaterals, 18 sequestrations, 22 arteriovenous/veinovenous/coronary fistulas, 6 vertical veins, 6 conduits, 5 ventricular septal defects, 7 miscellaneous). Day 1 and 6-month occlusion rates were respectively 94.8% and 98.5%. Major adverse events (MAE) occurred in 5.2% of cases (no procedure-related deaths), and more frequently in weight ≤ 5 kg (p = 0.01), younger patients (p = 0.03) during PDA closure (p = 0.02) of tubular types (p = 0.02) using larger devices (p = 0.03) and AVP II (p = 0.003). Independent predictor of MAE risk was a higher AVP diameter to patient weight ratio (Odds-ratio: 2.33, 95% confidence interval 1.31–4.13, p = 0.004, optimal cut off: 1.45). Conclusions: Both AVPs are safe and effective for percutaneous occlusions in children under 10. Such devices represent an alternative “off label” use for well selected paediatric patients.     

Immediate primary transcatheter closure of postinfarction ventricular septal defects

Aims: Immediate surgical repair of ventricular septal defect (VSD)complicating acute myocardial infarction is associated withhigh mortality. Percutaneous device closure appears to be safeand effective in patients treated for a residual shunt afterinitial surgical closure, as well as in patients with a chronicpost-infarct VSD. Primary transcatheter VSD closure in the acutesetting may also offer advantages over surgery. Methods and results: Between September 2003 and February 2008, 29 consecutive patientsunderwent primary transcatheter VSD closure. Clinical, procedural,and outcome data were collected. Patients were divided intothose with and those without cardiogenic shock at presentationfor risk stratification. The median follow-up time of survivingpatients was 730 days. The median time between VSD occurrenceand closure was 1 day [interquartile range (IQR) 1–3]and the initial procedural success rate was 86%. The shunt (Qp:Qs)could be reduced from 3.3 (IQR 2.3–3.8) to 1.4 (IQR 1.2–1.7;P < 0.001). Procedure-related complications such as majorresidual shunting, left ventricular rupture, and device embolizationoccurred in 41%. The overall 30-day survival rate was 35%. Mortalitywas higher for cardiogenic shock in comparison to non-shockpatients (88 vs. 38%, P < 0.001). Conclusion: Interventional acute VSD closure is a promising technique thatcan be performed with a high procedural success rate and mayoffer an alternative to surgery. Despite the less invasive technique,mortality of postinfarction VSD remains high, particularly inpatients with cardiogenic shock. Further developments in devicesand delivery techniques are required.     

超声心动图评价室间隔缺损封堵术后左心功能及形态的变化

目的 探讨超声心动图对室间隔缺损封堵术后左心功能及形态变化的评价作用.方法 60例接受Amplatzer封堵器封堵治疗的室间隔缺损患者,于术前1天、术后3天、3月及6月行经胸超声心动图检查,测量左心室舒张期末内径、左心室舒张期末容积、左心室收缩期末容积、左心房收缩期末内径、左心室射血分数、左心室侧壁基底部组织收缩期运动速度、舒张早期运动速度及舒张晚期运动速度.结果 室间隔缺损封堵术后3月、6月左心室舒张期末内径、左心室舒张期末容积、左心室收缩期末容积、左心房收缩期末内径、左心室射血分数、左心室侧壁基底部组织收缩期运动速度、舒张早期运动速度及舒张晚期运动速度均较术前1天及术后3天明显减少(P<0.05或0.01),但术后3天与术前1天比较差异无显著性(P>0.05).结论 室间隔缺损封堵术在消除异常分流的同时,可有效改善左心功能及几何形态.