Transcatheter Closure of Congenital Perimembranous Ventricular Septal Defect in Children Using Symmetric Occluders: An 8-Year Multiinstitutional Experience
Transcatheter Closure of Congenital Perimembranous Ventricular Septal Defect in Children Using Symmetric Occluders: An 8-Year Multiinstitutional Experience
复制标题
使用对称封堵器经导管封堵儿童先天性膜周室间隔缺损：8 年多机构经验
DOI：
10.1016/j.athoracsur.2012.03.067
复制
发表时间：
2012-08-01
影响因子：
4.6
通讯作者：
Yang, Jian
中科院分区：
文献类型：
--
作者：
Wang, Lei;Cao, Sancheng;Yang, Jian
背景资料。膜周室间隔缺陷(PmVSD)是儿童最常见的先天性心脏畸形之一。经导管pmVSD封堵术的结果仍然存在争议，提示有必要对该方法的安全性和有效性进行进一步评估。本研究的目的是分析使用对称性封堵器封堵儿童pmVSD的安全性、有效性和长期随访数据。2002年12月至2011年10月，在中国西北部的三个主要心脏中心，应用对称性pmVSD封堵器对525例2~12岁的pmVSD患儿进行了经导管封堵。所有患者均接受心电图和经胸超声心动图检查，随访至2011年10月。对不良事件进行记录和评价。男252例，女273例，平均体重21.5 kg。介入治疗时的平均年龄为5.6岁，平均肺血流量与全身血流量之比为2.5。经导管介入治疗成功502例(95.6%)。植入装置大小中位数为6.5 mm(4~18 mm)。在中位数45个月的随访期内，没有发生死亡。总共报告了三起主要不良事件(0.6%)；其中两起与瓣膜有关。与此同时，在整个随访期内，检测到104例轻微不良事件。所有经历重大不良事件的患者年龄均在3岁以下。3岁以下儿童的主要不良事件发生率显著高于3岁以上儿童(3.75%比0.00%；Fisher‘s Exact检验p=0.004)。目前的研究数据显示，使用对称性封堵器的经导管PMVSD封堵术显示出极好的成功率和长期随访结果。经导管方法为开放手术提供了一种侵入性较小的替代方法，在治疗某些患者群体的pmVSD方面显示出一定的前景。(Ann Thorac Surg 2012；94：592-8)(C)2012年，胸外科学会
Background. Perimembranous ventricular septal defects (pmVSDs) are one of the most common forms of congenital cardiac malformation in children. Results of transcatheter pmVSD closure remain debatable, prompting the need for further evaluation with regard to the safety and efficacy of this procedure. The aim of the study was to analyze the safety, efficacy, and long-term follow-up data associated with transcatheter closure of pmVSDs in children using symmetric occluders.Methods. From December 2002 to October 2011, 525 children with pmVSDs between 2 and 12 years of age underwent transcatheter closure at three major heart centers in northwest China with symmetric pmVSD occluders. All patients were followed up until October 2011 with electrocardiogram and transthoracic echocardiography. Adverse events were recorded and evaluated.Results. There were 252 male and 273 female patients with an average weight of 21.5 kg. The mean age at the time of transcatheter closure was 5.6 years, and the average ratio of pulmonic to systemic blood flow was 2.5. Transcatheter intervention was successfully performed in 502 patients (95.6%). The median device size implanted was 6.5 mm (range, 4 to 18 mm). During a median 45-month follow-up period, no mortality occurred. A total of three major adverse events (0.6%) were reported; two were valve-related. Meanwhile, 104 minor adverse events were detected during the entire follow-up period. All individuals experiencing major adverse events were younger than 3 years of age. The incidence of major adverse events in patients younger than 3 years old was significantly higher than that of patients older than 3 years old (3.75% versus 0.00%; Fisher's exact test p = 0.004).Conclusions. Data from the current study suggest that transcatheter pmVSD closure using symmetric occluders displayed an excellent success rate and long-term follow-up results. The transcatheter approach provides a less-invasive alternative to open surgery and displays some promise in the treatment of pmVSDs in certain patient populations. (Ann Thorac Surg 2012;94:592-8) (c) 2012 by The Society of Thoracic Surgeons