Transcatheter device closure for perimembranous ventricular septal defects with aortic valve prolapse:Effect and prognosis / 中国实用儿科杂志

OBJECTIVE: To evaluate the the effect and prognosis of transcatheter device closure for perimembranous ventricular septal defects(PmVSDs)with aortic valve prolapse(AVP). METHODS: The clinical data of 1108 patients who underwent percutaneous closure from January 2011 to January 2017 were collected to conduct this retrospective study,mainly including transthoracic echocardiography,digital subtraction angiography data,occluder type and sociodemographic information(age,weight and gender). T-test and Mann-Whitney U test were used to compare group measurement data. Wilcoxon signed rank test was used for the nonnormal distribution of paired design data. Fisher exact test was used for the four fold table. Monte Carlo approximation exact probability method was used for the R×C table.Multiple Logistic-regression analysis was used to estimate the risk factors of AR. RESULTS: Compared with 10(0.9%)of1053 patients without AVP,8(14.5%)of the 55 children with preoperative AVP presented aggravated postoperative aortic regulation(AR)and AR usually occurred in the long-term follow-up(>1 year). None of the AR progressed to moderate or severe. There were no significant changes in left ventricular ejection fraction,left ventricular shortening rate or AR before and after interventional operation in PmVSDs with AVP. CONCLUSION: Percutaneous closure for ventricular septal defect combined with AVP is an effective alternative to surgery when using appropriate occluders,meeting related standards and operated in an experienced cardiovascular center.

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

Objective To 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). Method This 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). Result Immediate 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. Conclusion Device closure of VSD in presence of mild AVP and mild AR appears to be safe. Longer follow-up is necessary to draw final conclusion.

Feasibility of diagnosis of perimembranous ventricular septal defect with right aortic valve prolapse by ul-trasonic echocardiography / 实用医学杂志

Objectives To explore the feasibility ofdiagnosis of Perimembranous Ventricular Septal Defect with Right Aortic Valve Prolapse by ultrasonic echocardiography. Methods 131 VSD patients aged 1 to 22 years, weight 8.0 to 54.0 kg, underwent transthoracic echocardiography (TTE) and left ventricular angiography to show the diameter of VSD and the degree of AVP. Results Among 131 patients, 87 cases were diagnosed as VSD,14 as VSD with slight AVP, 12 as, VSD with middle AVP, and 18 as VSD with severe AVP by ultrasonic echocardiography respectively. After the left ventricular angiography and aortic root angiography , it proved that positive rate of VSD was 44.8%, positive rate of VSD with slight AVP was 42.86%, positive rate of VSD with middle AVP was 58.3%,and positive rate of VSD with severe AVP was 83.3%. Conclusion The transthoracic echocardiography (TTE) contributes to diagnosis of severe degree of AVP,while TTE evaluates the slight degree of AVP incorrectly enough. Left ventricular angiography and aortic root angiography are needed to realize the di-agnosis of AVP.

Hemodynamic Status of Subpulmonic Ventricular Septal Defect in Relation to Morphologic Changes of Aortic Valve

PURPOSE: Subpulmonic ventricular septal defect is clinically important because the risks of aortic regurgitation and endocarditis are substantially increased. This study was conducted to evaluate the effect of hemodynamic changes induced by structural anomalies of aortic valve on the surgical outcome. METHODS: This clinical study was done by reviewing the medical records of 124 patients who were diagnosed and surgically managed at the Cardiovascular Center, Yonsei University, College of Medicine, from May 1991 to December 1994 were performed due to subpulmonic ventricular septal defect. RESULTS: The ages were between 4 months to 21 years 9 months(mean 4 years 10 months) and the sex ratio was 1.8:1 (male:female; 80:44). Patients were stratified according to the status of the aortic valves. Group 1 was comprised of those without aortic valve prolapse and aortic regurgitation, group 2 was comprised of those with only aortic valve prolapse, and group 3 had only aortic regurgitation, and group 4 had both conditions. The mean age, pulmonary arterial pressure, aortic diameter were statistically higher in group 3, those which only aortic regurgitation(p<0.05). On surgical exploration, aortic valve prolapse was found in 68(55%), and aortic regurgitation was found in 21(17%). Aortic valve prolapse was correlated with the increase in age(p<0.05), and the development of aortic valve prolapse and aortic regurgitation were statistically correlated with the decrease in pulmonary arterial pressure(p<0.05). When 108 patients were classified into 3 groups according to the degree of aortic valve prolapse and hemodynamic status around the inlet and outlet of right ventricle, higher the degree of aortic valve prolapse, the intraventricular flow was directed to inlet(p<0.05). CONCLUSIONS: Untreated subpulmonic VSD will result in aortic regurgitation and valve prolapse, thus the surgical correction is beneficial, especially performed at early age. Therefore effort should be made to carefully evaluate all patients with VSD, and if subpulmonic VSD is discovered, immediate surgical correction is should be performed.

Clinical Study of Subarterial Ventricular Septal Defect

PURPOSE: The incidence of subarterial ventricular septal defect(SA VSD) ranges 25-30% among oriental patients with VSDs, which is greater than 5% reported in western. Natural history of the disease is characterized by progressive aortic valve prolapse(AVP), frequently subarterial VSD, we evaluated clinical characteristics emphasizing on the incidence of AVP and the degree of AI as aging. METHODS: Study subjects consisted of 140 patients, who were diagnosed as subarterial VSD and operated in Seoul paik Hospital during a 5 year period from Jan.1988 to Dec. 1992. The data were analyzed detrospectively as to clinical profiles, data of cardiac catheterization, frequencies of AVP, and AI in 5 each age group, operative methods, postoperative complications and mortality. RESULTS: The incidence of subarteial VSD was 34.6% of total operated VSD cases. Data of preoperative cardiac catheterization showed mean values of Qp/Qs and systolic pulmonary artery pressure, 1.43+/-0.47 and 33.8x16.4mmHg in each. Aortic valve prolapses and aortic insufficiencies were observed in 70.0% and 20.7% among patients, which showed increasing tendencies as ages increased. As operative methods, patch closures through main pulmonary artery were done mainly. In mild cases without AI or with grade I AI, simple VSD closures were performed but in more a advanced cases, 10 aortic valvuloplasties and additional 2 aortic valve replacements were performed. Total mortality rate was 2.1%. CONCLUSIONS: In the management of subarterial VSD, early elective closure regardless of shunt volume is important to prevent progressive aortic valve prolapse leading to aortic insufficiency.