RESUMO
Objective To review and summarize the experiences of transcatheter closure of left ventricular-right atrium communication,and discuss the feasibility of interventional therapy for this kind of cardiac abnormalitis.Methods 22 patients who suffered from left ventricular-right atrium communication underwent transcatheter interventional therapy with ventricular septal defect(VSD) occluder.The operating procedures were performed as like as the transcatheter closure of VSD:established the pathway from femoral artery to femoral vein through left ventricle,VSD,right atrium (or from left ventricle to right atrial through the communication) and inferior vena cava,then inserted the polysheath from femoral vein,introduced by the pathway to left ventricle,and implanted VSD occluder through the polysheath to close the shunt.Results The operation succeeded in 21 patients.The cardiac murmur was disappeared in all patients,and there was no residual shunt or aortic regurgitation that conformed by postoperative ventriculography and echocardiography in follow up phase,and the tricuspid regurgitation was lessened than preoperative.The operation abort in 1 patient because of aortic regurgitation after implanting occluder.Conclusions Transcatheter closure of left ventricular-right atrium communication is feasible as the selected occluder is accordant,and atrioventricular block,aortic regurgitation and tricuspid regurgitation can be avoided.
RESUMO
Objective To investigate the cause and development of atrioventricular block (AVB) occurred during and after transcatheter closure of ventricular septal defect (VSD), and to explore its feasible prevention and treatment. Methods From Mar, 2005 to Dec, 2005, 157 patients who suffered from congenital VSD underwent transcatheter interventional occlusion. Transient Ⅲ degree AVB occurred in 2 patients during the transcatheter therapy and Ⅱ degree AVB in 2 patients and Ⅲ degree AVB in 3 patients were observed 4 hours to 8 days after the therapy. Two of them suffered from Adams-Stokes syndrome. All patients were treated by intravenous injection of glucocorticosteroid, diuretic and dehydrator. One of them was also treated with temporary pacing. Results AVB did not re-occurred after the transcatheter closure in 2 patients who suffered from transient Ⅲ degree AVB during the transcatheter interventional therapy. The cardiac rhythm in 3 patients who suffered from Ⅲ degree AVB after the transcatheter closure reverted to sinus rhythm in 7, 8 and 18 days after the operation respectively. However, 2 of them suffered recurrent Ⅲ degree AVB after discharge, and one of them could not be restored to sinus rhythm. Three patients who suffered from the Ⅱ degree AVB resumed to sinus rhythm in 5, 7 and 8 days after the transcatheter closure respectively, and the type Ⅰ and the type Ⅱ of Ⅱ degree AVB alternated before the rhythm completely reverted. Conclusion AVB is a frequent complication during and after transcatheter closure of VSD. AVB occurred after transcatheter occlusion should be treated actively, or it may become permanent AVB. Improving the cardiac transcatheter interventional device and technique can prevent the high degree AVB in certain degree.
RESUMO
Objective: To review the results with an approach of primary repair for tetralogy of Fallot (TOF) and double-outlet right ventricle (DORV) with anomalous coronary arteries. Methods: From June 1995 to June 2002, 12 patients with TOF and DORV associated with anomalous coronary arteries crossing an obstructed right ventricle outflow tract underwent primary surgical repair. To avoid injury of the anomalous coronary arteries, some modified surgical techniques were used. Main pulmonary artery translocation in 2 patients, repair under a mobilized left anterior descending coronary artery in 3, displaced ventriculotomy with subcoronary suture lines in 5, and the right ventricle outflow tract was repaired via the arteriotomy and/or pulmonary incision in 2. Results: There were no early or late death, and no myocardial infarction. Follow-up ranged from 3 months to 6 years, there were no residual leakage and obstruction of right ventricle outflow tract. Conclusion: Primary repair of TOF with anomalous coronary arteries can be done with excellent results. A proper surgical technique should be used during operation.