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Title: [Feasibility and effectiveness of percutaneous ventricular septal defect closure under solely guidance of echocardiography].
Author: Liu Y, Guo GL, Ouyang WB, Li MZ, Pan XB.
Journal: Zhonghua Yi Xue Za Zhi; 2017 Apr 25; 97(16):1222-1226. PubMed ID: 28441849.
Abstract:
Objective: To compare the efficacy and safety of percutaneous ventricular septal defect (VSD) closure under solely guidance of echocardiography and fluoroscopy. Methods: The retrospective study was conducted at Fuwai Hospital, between February 2014 and February 2015. The patients were divided into two groups. VSD closure was conducted in 42 patients under solely guidance of echocardiography, and 100 patients who were treated with percutaneous catheter closure under fluoroscopy guidance were selected as a control group. The baseline characteristics, procedural time and complications were recorded and assessed. Results: There were no significant differences in terms of age, gender and pre-operative echocardiographic characteristics (all P>0.05). Percutaneous VSD closure under traditional fluoroscopy guidance was successful in 95 patients (95%). The procedural time was (54.7±12.5) minutes. The symmetrical occluders diameter was (6.9±1.8) mm. Four patients had postoperative residual shunt, one patient developed left bundle branch block, and 6 patients developed new tricuspid regurgitation. Percutaneous VSD closure under only transthoracic echocardiography (TTE) guidance was successful in 39 patients (93%). Because of delivery catheter passage failure through the defect, one case required conversion to perventricular closure via a small transthoracic incision under transesophageal echocardiography (TEE) guidance. The other two cases underwent surgical repair because of residual shunt with more than 2 mm after closure. The procedural time was (40.3±13.2) minutes. The symmetrical occluders diameter was (6.5±1.2) mm. Four patients had postoperative residual shunt that disappeared after 1 month follow-up, and one patient developed right bundle branch block which disappeared 3 days later. During (9.3±3.6) months follow-up, there were no other complications, such as pericardial effusion, occluder malposition, atrioventricular block, aortic valve regurgitation, and aggravating tricuspid regurgitation in each group. However, the total operation time, diameter of VSD occluder, total mild complications, and the equipment cost in the study group were less than that in the control group (P<0.05). Conclusion: Percutaneous VSD closure can be successfully performed under sole guidance of echocardiography with outcomes similar to those achieved with fluoroscopy guidance. 目的： 对比分析单纯超声心动图引导下经皮室间隔缺损(VSD)封堵术与传统放射线引导经皮封堵术的有效性和安全性。 方法： 回顾性分析2014年2月至2015年2月在中国医学科学院阜外医院住院治疗，并行经皮VSD封堵术的患者临床资料，根据引导方式不同分为射线引导组(n＝100)和单纯超声引导组(n＝42)，记录比较两组患者一般情况、手术时间、术后并发症等发生情况。 结果： 两组患者在年龄、性别、体重、VSD大小、左室射血分数等方面差异均无统计学意义(均P>0.05)。射线引导组95例(95%)封堵成功，手术时间(54.7±12.5)min，封堵器直径(6.9±1.8)mm，术后出现少量残余分流4例，出现完全性左束支传导阻滞1例，术后新发三尖瓣反流6例。单纯超声引导组39例(93%)封堵成功，1例患者由于导丝无法通过缺损，中转为经胸VSD封堵术；2例患者由于残余分流>2 mm中转为外科手术修补；手术时间(40.3±13.2)min，封堵器直径(6.5±1.2)mm；封堵术后早期出现少量残余分流4例，随访至术后1个月消失；1例患者术后出现右束支传导阻滞，患者无症状，术后3 d右束支阻滞消失。患者术后的平均随访时间为(9.3±3.6)个月，至随访结束两组患者均未出现心包积液、封堵器脱落、房室传导阻滞、主动脉瓣反流和较术前加重的三尖瓣反流等并发症。单纯超声引导组在手术耗时、封堵器直径、轻微并发症、耗材费方面均优于射线引导组(均P<0.05)。 结论： 单纯超声心动图引导下经皮VSD封堵术在克服放射线及造影剂损伤的同时，保持了传统经皮介入治疗微创、安全的优点，应用前景广阔。.

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