Clinical analysis of transcatheter closure of perimembranous ventricular septal defects with occluders made in China

Background Results of perimembranous ventricular septal defects （pmVSD） transcatheter closure have been reported in the literature mostly using a Amplatzer VSD device. However, the data of percutaneous closure of pmVSD with VSD occluder （VSD-O） made in China are still limited. We sought to analyze safety, efficacy, and follow-up results of percutaneous closure of pmVSD with VSD-O made in China.Methods Between February 2005 and June 2009, 78 patients underwent percutaneous closure of pmVSD at our institution. A VSD device made in China was used for all subjects. The safety and the efficacy of the VSD-O were investigated.Results The average age at closure was 11 years （range 2.5 to 44 years）. The attempt to place device was successful in 74 patients （94.9%）. The average device size used was 8 mm （range 5 to 16 mm）. No deaths occurred. Total occlusion rate was 62.8% at completion of the procedure, rising up to 87.2% at discharge and 99.0% during follow-up. A total of eight early complications occurred （10.3%）, but in all subjects these were transient. The average follow-up period was 40.5 months. The most significant complication was complete atrioventricular block （cAVB） in the early phase （five subjects, 6.4%） and during the follow-up （1 subject, 1.3%）, which saw no need for pacemaker implantation in six subjects.Cox proportional hazards regression analysis showed that the age was only the variable significantly associated with the occurrence of this complication during the procedure （P=0.025; relative risk 0.22）. The subjects who experienced this complication were less than five years old.Conclusions Percutaneous pmVSD closure used VSD-O made in China is associated with excellent success and closure rates, no mortality, and low morbidity. Longer follow-up data and improvements in device characteristics are needed to reduce the risk of cAVB.

Clinical Study on Amplatzer Occluder Device to CloseVentricular Septal Defect

Objectives To evaluate the therapeutic effect of transcatheter Amplatzer device on the closure of ventricular septal defect （VSD）. Methods Among 143 patients with VSD, 135 patients with perimembrane VSD and 2 with muscular VSD aged 2.5 -28 years old, were successfully closed with Amplatzer oeeluder device by the pereutaneous guidwire through femoral artery-VSD-femoral vein route under the guidance of fluoroscopy, ventrieulography and transthoracic echocardiography （TIE）. The diameters of the VSDs were 2.3-15.7 （6.90±2.76）mm by left ventriculography. Results The success rate of transcatheter closure of VSD with Amplatzer devices was 96%（137/143）. Minimal residual amount of shunts were found in one patient, although the shunts was decreased one month after the procedure. There were one patient who had respiratory arrest during the procedure, 7 patients（5%）had conduction disturbance, 3 patients had complete left bundle branch block, 2 patients had complete right bundle branch block, 1 patient had Ⅰ degree atrial-ventricular block and 1 patient had Ⅲ degree atr/al-ventricular block during hospitalization. The diameters of the occluder ranged from 4 to 23 （9.13±3.31）mm and were symmetrical in 122 patients and asymmetrical in 15 patients. Conclusions Transcatheter closure of the perimembranous ventrieular septal defect using Amplatzer VSD occluder device is an efficient method for patients with the perimembranous VSD. The operation is simple with a high success rate and a good effect.

Postprocedural Outcomes and Risk Factors for Arrhythmias Following Transcatheter Closure of Congenital Perimembranous Ventricular Septal Defect： A Single-center Retrospective Study

Background： Currently, transcatheter closure of perimembranous ventricular septal defect （pmVSD） is a widely accepted therapeutic modality. However, arrhythmias, especially postprocedural heart blocks, are a concern and outcomes are not very clear. This study explored the outcomes and risk factors of arrhythmias associated with transcatheter device closure ofpmVSD. Methods： A total of 395 patients diagnosed with pmVSD who successfully underwent transcatheter intervention between January 2010 and December 2015 in our center were retrospectively reviewed. Electrocardiographic data before and after the procedure were collected and analyzed. We first evaluated the potential risk factors including gender, age, weight, inlet and outlet diameters of defect, subaortic rim length, occluder size, corrected occluder size into body surface area, fluoroscopy time, presence of aneurysm, and deployment position. We compared the potential risk factors between arrhythmia and nonarrhythmia groups using univariate analysis, followed by logistic analysis for independent risk factors. Results： Various arrhythmias were detected in 95 cases （24.1%） following transcatheter closure procedure. Logistic regression analysis revealed that eccentric （odds ratio [OR] 2.9, 95% confidence interval [（CI]： 1.2-7.2） and large occluders （OR 2.0, 95% （.7： 1.6-2.5）, as well as long fluoroscopy time （OR 1.1, 95% CI： 1.1-1.2）, were correlated with postprocedural arrhythmia. During 35.5 months （range： 9-80 months） of follow-up, most of the patients （74 out of 95） reverted to normal heart rhythm. Conclusions： The mid-term outcome of patients with arrhythmias after transcatheter closure of pmVSD was satisfactory as most of the patients recovered normal rhythm. Eccentric, large device and long fluoroscopy time increase the risk of arrhythmias after transcatheter closure of pmVSD.

Transcatheter Closure of Multiple Membranous Ventricular Septal Defects with Giant Aneurysms Using Double Occluders in Four Patients

The transcatheter closure of perimembranous ventricular septal defect （pmVSD） has become a promising treatment modality. However, transcatheter closure of multiple pmVSDs with giant aneurysm is still very challenging. We present our preliminary experiences.