Transcatheter closure of membranous ventricular septal defects with home-made nitinol occluder / 介入放射学杂志

ABSTRACT

Objective To evaluate the feasibility and efficacy of transcatheter perimembranous ventricular septal defects (VSD) occlusion with home-made nitinol occluder.Methods Transcatheter closure was attempted in 196 patients with perimembranous VSD. The diameter of VSD measured by echocardiography was 3 to 15 mm, mean (4.94?2.23) mm. The angiographic diameter of the VSD was 3 to 6 mm, mean (3.92?1.44) mm. A 7-10F delivery sheath was advanced across the perimembranous VSD over a wire from femoral vein to deploy the occluder with the guidance of echocardiography and fluoroscopy. The device diameter selected was from 4 to 20 mm, mean (6.68?2.76) mm. Left ventriculography and transthoracic echocardiography were repeated to assess the closure of the defects 15 min after the procedure. Continuous electrocardiogram monitoring lasted for 5 days. The echocardiography and electrocardiogram examination were scheduled for 1, 6, and 12 months of follow-up. Results The occluders were successfully deployed in 191 patients. There were five procedural failures, two with device-related aortic insufficiency, and three of inability to pass through VSD. After deployment of the devices, there were no residual shunt in 180 of 191 patients, 11 patients with a trivial residual shunt that disappeared in 8 patients after one month of follow up. 3 patients developed mild tricuspid insufficiency. 12 developed transient complete right bundle branch block, and 5 transient complete left bundle branch block, and 2 transient complete atrioventricular block. There were repetitive nonparoxysmal ventricular tachycardia in 4 patients 1 week after the procedure. One patient had a detached device embolized into the left pulmonary artery but with a successful catheter retrieval by snare and transcatheter closure. The devices were similarly applied to patients with VSD associated with patent ductus arteriosus, and 4 patients with VSD complicated by atrial septal defects. The fluoroscopy time for the procedure was (13.2?7.7) min(range from 5 to 60 min). The procedure time was (59.5?18.2) min(range, 39 to 160 min). On follow-up evaluation of 1 month to 2 years, there were no episodes of endocarditis, thromboembolism and hemolysis. Conclusion Transcatheter closure of membranous ventricular septal defects with homemade nitinol occluder is effective, easy and safe.