Factors influencing the choice of atrial septal occluder for transcatheter closure of secundum atrial septal defects / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze factors influencing the choice of atrial septal occluder (ASO) for transcatheter closure of patients with secundum atrial septal defect (ASD).</p><p><b>METHODS</b>A total of 1114 ASD patients [388 males, aged from 2 to 75 years, mean age (26.3 +/- 17.0) years] were enrolled. Patients were divided to adult (> 14 years, mean 34.4 years, n = 779) and child (< or = 14 years, mean 7.3 years, n = 335) groups. ASD size in different ultrasound cross-sections was determined by transthoracic echocardiography (TTE). ASO size was chosen on the basis of the maximum diameter of the defect (MD). Defect-shapes and rim lengths of ASD, the difference choice of ASO in the two groups were compared.</p><p><b>RESULTS</b>MD of the defects ranged from 5 to 40 mm [mean (19.7 +/- 7.8) mm]. ASD was successfully occluded in 1085 out of 1114 patients (97.4%). Occluder size ranged from 6 to 46 mm [mean (25.8 +/- 8.9) mm] and the difference between occluder size and MD ranged from 2 to 10 mm [mean (6.1 +/- 3.4) mm, ASO/MD ratio 1.3:1]. Though the diameter of the defect was similar between the 2 groups, the size of occluder was significantly larger in adult group than that in child group (ASO/MD ratio 1.1 - 1.6:1 vs. 1.2 - 1.8:1, P < 0.05). MD was significantly correlated with ASO in both groups (r = 0.911 and r = 0.944 in adults and child groups, respectively, all P < 0.01). The size and increment of the occluder used in patients with deficient anterior rims was significantly bigger than patients with sufficient anterior rims (P < 0.01).</p><p><b>CONCLUSION</b>The maximum diameter of the defect was the major determinant for selecting occluder size and choice of occluder size was also influenced by patient age, defect-shape and defect rim for transcatheter closure of secundum ASD.</p>

Complications of transcatheter interventional occlusion of ventricular septal defects / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the complications and their prevention in patients with perimembranous ventricular septal defect (VSD) experiencing transcatheter interventional occlusion.</p><p><b>METHODS</b>From July, 2002 to May, 2004, totally 262 (138 males, 124 females) perimembranous VSD patients underwent transcatheter interventional occlusion in the department. The age ranged from 2 to 18 years (mean 9.3 +/- 5.8 years), and the body weight ranged from 11.0 to 65.0 kg (mean 30.5 kg). The implanted occluder with imported Amplatzer eccentric perimembranous VSD occluder, domestic double-disk, domestic eccentric perimembranous VSD and PDA occluder were attempted in 12, 212, 28 and 6 cases, respectively. Among them, 3 cases were complicated with ductus arteriosus, 4 with atrial septal defects and 1 with patent ductus arteriosus plus atrial septal defect. The associated defects were treated with other occluders at the same time.</p><p><b>RESULTS</b>The diameters of VSD measured by transthoracic echocardiography before occlusion and by ventriculography during the procedure ranged from 2.7 to 13 mm (mean 6.5 mm) and from 1.3 to 14.0 mm (mean 6.8 mm), respectively. The defects in 256 cases (97.7%) were successfully occluded. The implant occluder was from 4 to 16 mm in size. Serious complications occurred in 8 cases (3.1%), including 5 cases of high degree atrioventricular block (AVB) (2.0%), 2 cases of hemolysis (0.8%) and 1 case of displacement of the occluder (0.4%). Amongst 5 cases of high degree AVB, permanent pacemaker was implanted only in 1 case due to high degree AVB 50 days after treatment, whereas the others all recovered. Two cases of hemolysis were completely recovered. One case of occluder displacement was emergently transferred to cardiac surgery. Other complications included residual shunt during 6 month follow-up in 1 case (0.4%), minor aortic regurgitation in 5 cases (2.0%), minor tricuspid regurgitation during 6 month follow-up in 4 cases (1.6%), and accelerated idioventricular rhythm or accelerated atrio-ventricular junctional tachycardia combined with atrioventricular interference-dissociation by ECG in 75 cases (29%) but they recovered after 3 - 5 days of corticosteroid treatment. Forty-one cases (16%) complicated with complete or incomplete right bundle branch block, of whom 50% recovered during follow-up. Still, there were 4 cases (1.6%) who were complicated with complete left bundle branch block but were all recovered during follow-up and 26 cases (10%) who were complicated with intraventricular block. There were no Significant difference in complications between cases who accepted imported Amplatzer occluders and domestic occluders.</p><p><b>CONCLUSION</b>Transcatheter interventional occlusion is a safe, effective and ideal method with low incidence of serious complications for perimembranous VSD. Long term follow-up and clinical research should be carried out to improve the level of VSD interventional therapy.</p>