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GW24-e2167 Transcatheter closure greater than or equal 10mm membraneous ventricular septal defects
  1. Zhu Xian-Yang
  1. Department of Congenital Heart Disease, Institute of Cardiovascular Research of PLA, Shenyang Northern Hospital, Shenyang, Liaoning 110840, China

Abstract

Objectives To evaluate the feasibility of transcatheter closure ≥ ventricular septal defect (VSD).

Methods 379 cases with ≥ 10 mmVSDs underwent attempted transcatheter closure with various devices in this study. Of those,166 were male and 213 were female. The age ranged from 3 to 70 (16.5 ± 14.3) years. Physical exam showed an accentuated pulmonic second heart sound and a grade 3 to 4 systolic murmur over the left third or fourth intercostal space. The left ventricular diameter of the defect on echocardiography ranged from 3 to 15 (4.6 ± 1.2) mm.

Results VSDs was successfully closed in 376 of 379 patients (99.0% closure rate). The size of defect ranged from 10 to 32 (13.2 ± 3.3) mm at left ventricular side and from 3 to 16 (5.1 ± 2.5) mm at right ventricular side with distance from 0 to 11 (3.0) mm between aortic valve and the upper margin of the defect. Associated abnormalities were membraneous aneurysm in 318, PDA in7, ASD in 3 and PFO in 1 patients. The devices used to close VSDs and associated abnormalities were domestic-made devices including symmetrical VSD devices (n = 104), unsymmetrical VSD devices (n = 247), inequilateral VSD devices (n = 14), PDA devices (n = 7), ASD devices (n = 4), and foreign devices including Amplatzer unsymmetrical VSD devices (n = 10) and PDA devices (n = 1). The diameter of VSD devices ranged from 4 to 16 (7.55 ± 2.17) mm. The associated ASD and PDA were closed after VSD closure, while the muscular VSD were closed simultaneously with membraneous VSDs. Check cardiac angiography after device deployment showed complete closure in 350 (93.2%), trace residual shunt in 9 (2.5%) and small residual shunt in 17 (4.3%), but only 3 had residual shunt at discharge which were still at follow-up. Four patients developed third degree A-V block, which resolved itself in 3 but did not in one patient until the device was surgically taken out. Twelve patients developed transient complete left bundle branch block after the procedure, which resolved in 10 patients or developed incomplete left bundle branch block at follow up.

Conclusions Large VSD is the relative indications for interventional therapy. Preoperative UCG must be strictly conducted to select the patients. The patients who had membranous aneurysm, the distance >2 mm from upper rim of VSD to the right aortic valve cusp or elder patients may have a higher success rate of interventional therapy. Standardised operational procedures, professional skills, multiple occlusion apparatus, short operation time, avoiding repetitive manipulations and reducing complications are the guarantee of success in interventional therapy of ≥10 mmVSDs.

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