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Title: [Clinical analysis of transcatheter closure of ventricular septal defect with right coronary cusp bulge].
Author: Ji W, Zhang ZF, Shen J, Fu LJ, Shi L, Chen YW, Li F.
Journal: Zhonghua Er Ke Za Zhi; 2019 Feb 02; 57(2):103-107. PubMed ID: 30695883.
Abstract:
Objective: To access the feasibility, effectiveness and safety of transcatheter closure of ventricular septal defect (VSD) with right coronary cusp bulge. Methods: The study population consisted of 40 children (22 boys and 18 girls) undergoing transcatheter intervention for VSD with right coronary cusp bulge in Shanghai Children's Medical Center from August 2013 to June 2017. All patients were examined using transthoracic echocardiography and cardiovascular angiography before occlusion and received transcatheter closure of VSD by placing an occlude. During the operation, angiography and transthoracic echocardiography were used to detect residual shunts, new-onset or aggravation of aortic regurgitation, and surface electrocardiogram was used to assess the impact of occlusion on the conduction system. The children were followed up to evaluate the degree of aortic regurgitation and the presence of heart block by transthoracic echocardiography and electrocardiogram in outpatient department. Comparative analysis between two groups was used by t test. Results: The average age of the patients was (5.1±3.2) years, weight(20.6±10.7) kg. The diameter of defect shunt was (3.3±0.9) cm. The VSD of all 40 patients were successfully occluded immediately, and three patients (8%) with filament residual shunt were observed during the operation. No major surgical complication such as death, pericardial tamponade, embolism of important organs, infective endocarditis occurred during the perioperative period. During the follow-up period, the positions of all the occluders were good, the residual shunt in three patients disappeared, and no new-onset or aggravated aortic regurgitation occurred. Electrocardiogram did not reveal any atrioventricular block, and one patient suffered from an incomplete right bundle branch block. There were significant differences between pre- and post-occlusion regarding the left ventricular end diastolic diameter ((3.8±0.5) vs. (3.7±0.5) cm, t=2.092, P=0.043), the left ventricular end systolic diameter ( (2.4±0.3) vs. (2.2±0.4) cm, t=2.068, P=0.045), and the QRS interval ((75.4±10.4) vs. (79.8±11.4) ms, t=-2.277, P=0.028). No significant differences were found between pre- and post-operation regarding the left ventricular ejection fraction (67.8%±4.7% vs. 68.1%±4.6%, t=-0.447, P=0.657) and the PR interval ((125.6±14.7) vs. (122.6±14.2) ms, t=1.540, P=0.132). Conclusions: Interventional closure of VSD with right coronary cusp bulge has small impact on aortic valve activity in children. With appropriate indications and methods, transcatheter interventional occlusion should be considered because it is effective for children diagnosed with VSD combined with right coronary cusp bulge. 目的： 评价经导管介入法封堵室间隔缺损（VSD）伴主动脉右冠瓣膨出的临床效果及安全性。 方法： 选择2013年8月至2017年6月上海交通大学医学院附属上海儿童医学中心收治的40例VSD伴右冠瓣膨出的患儿（男22例，女18例）作为研究对象，行经导管介入治疗。术前通过经胸超声心动图（TTE）及心血管造影诊断为VSD伴主动脉右冠瓣膨出。术中经导管将封堵装置安装关闭VSD，通过造影及TTE检查有无残余分流，有无引起新发主动脉瓣反流，或使原有主动脉瓣反流加重，采用体表心电图评估介入封堵是否影响传导系统。术后通过TTE和体表心电图对患儿进行随访，重点观察主动脉瓣反流程度和有无心脏传导阻滞。组间比较采用t检验。 结果： 40例患儿年龄（5.1±3.2）岁，体重（20.6±10.7）kg，缺损分流口直径（3.3±0.9）cm。即刻操作成功率为100%（40/40），3例（8%）出现细丝残余分流。围手术期无死亡、心包填塞、重要脏器栓塞、感染性心内膜炎等重大手术并发症，后续随访发现所有封堵器位置良好，3例残余分流消失，未出现新发主动脉瓣反流，心电图检查未发现各型房室传导阻滞，仅出现1例新发不完全右束支传导阻滞。封堵前左心室舒张末期内径（3.8±0.5）cm，封堵后（3.7±0.5）cm，差异有统计学意义（t=2.092，P=0.043）。封堵前左心室收缩末期内径（2.4±0.3）cm，封堵后（2.2±0.4）cm，差异有统计学意义（t=2.068，P=0.045）。封堵前左心室射血分数（67.8±4.7）%，封堵后（68.1±4.6）%，差异无统计学意义（t=-0.447，P=0.657）。封堵前PR间期（125.6±14.7）ms，封堵后（122.6±14.2）ms，差异无统计学意义（t=1.540，P=0.132）。封堵前QRS间期（75.4±10.4）ms，封堵后（79.8±11.4）ms，差异有统计学意义（t=-2.277，P=0.028）。 结论： VSD伴主动脉右冠瓣膨出的患儿行介入封堵术对主动脉瓣膜活动影响小，可以考虑行经导管介入封堵术，如适应证及方法学合适，效果良好。.

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