What is the best management option for non-significant residual shunt after device closure of perimembranous ventricular septal defect A case report based on the lessons from post-procedure endocarditis
What is the best management option for non-significant residual shunt after device closure of perimembranous ventricular septal defect A case report based on the lessons from post-procedure endocarditis
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膜周室间隔缺损装置封堵后无显着残余分流的最佳处理方案是什么 基于术后心内膜炎经验教训的病例报告
DOI：
10.1097/md.0000000000017347
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发表时间：
2019
期刊：
影响因子：
1.6
通讯作者：
Wang Chuan
中科院分区：
文献类型：
--
作者：
Shao Shuran;Luo Chunyan;Zhou Kaiyu;Hua Yimin;Wang Chuan
干预措施：万古霉素治疗6周后，赘生物消失，没有瓣膜功能障碍的迹象。出院三周后，植入第二个装置，以消除持续的残余血流。结果：不幸的是，孩子在第二个装置植入后因严重溶血最终被转入外科。移除封堵器并用心包补片封闭 VSD。还进行了三尖瓣成形术，随后的过程平安无事。教训：对于 PmVSD 装置闭合后无显着残余分流的情况，与终身抗生素预防或不进行干预相比，植入第二个装置或手术修复可能是更好、更令人满意的替代方案，因为相关 IE 确实可能发生，尽管其罕见，并且抗生素相关不良事件的风险可能超过其益处。
Interventions:After 6 weeks of vancomycin treatment, the vegetation disappeared with no sign of valvular dysfunction. Three weeks after discharge, a second device was implanted to abolish persistent residual flow.Outcomes:Unfortunately, the child was ultimately transferred to surgical department due to severe hemolysis after the second device implantation. The occluders were removed and the VSD was closed with a pericardial patch. Tricuspid valvuloplasty was also performed and the following course was uneventful.Lessons:For non-significant residual shunt after device closure of PmVSD, implantation of a second device or surgical repair may be a better and more satisfactory alternative compared with lifelong antibiotic prophylaxis or no interventions, since associated IE can indeed occur despite its rarity and the risk of antibiotic-associated adverse events may outweigh the benefits.