Effectiveness and Safety of Transcatheter Closure of Perimembranous Ventricular Septal Defects in Adults
Effectiveness and Safety of Transcatheter Closure of Perimembranous Ventricular Septal Defects in Adults
复制标题
成人膜周室间隔缺损经导管封堵术的有效性和安全性
DOI：
10.1016/j.amjcard.2015.12.036
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发表时间：
2016
影响因子：
2.8
通讯作者：
Yang Jian
中科院分区：
文献类型：
--
作者：
Wang Jianming;Zuo Jian;Yu Shiqiang;Yi Dinghua;Yang Xiuling;Zhu Xianyang;Li Jun;Yang Lifang;Xiong Lize;Ge Shuping;Ren Jun;Yang Jian
本研究旨在确定使用改良双盘封堵器封堵成人膜周部室间隔缺损（pmVSD）的长期安全性和有效性。从2004年1月至2014年12月，337例成人pmVSD患者使用2种类型的双盘封堵器进行了经导管介入治疗; 302例患者接受了对称同心pmVSD封堵器，35例患者接受了不对称同心pmVSD封堵器。所有患者均通过心电图和经胸超声心动图随访至2015年6月。两种手术的成功率均为100%。在中位71个月的随访期间，没有感染性心内膜炎、脑血管意外、心力衰竭或死亡病例发生。记录了2例主要不良事件（0.6%）：1例患者发生需要手术治疗的完全性房室传导阻滞，另1例患者发生需要手术修复的重度三尖瓣返流。心脏传导阻滞是最常见的轻微不良事件。平均左心室（LV）舒张末期容积从干预前的96.6 ± 23.2 ml降至6个月随访时的86.0 ± 22.0 ml（p <0.05）。在随访期间，先前扩大的LV腔室减小至正常大小。总之，使用改良双盘封堵器经导管封堵pmVSD安全有效，在成人中获得了良好的长期结果。这种干预的潜在益处包括心脏重塑、感染性心内膜炎的发生率降低和预防LV容量超负荷。
This study was designed to determine the long-term safety and efficacy of using modified double-disk occluders for perimembranous ventricular septal defect (pmVSD) closure in adults. From January 2004 to December 2014, 337 adults with pmVSDs were treated through transcatheter intervention using 2 types of double-disk occluders; 302 patients received a symmetrical concentric pmVSD occluder, and 35 patients received an asymmetrical concentric pmVSD occluder. All patients were followed up through electrocardiography and transthoracic echocardiography until June 2015. The success rate was 100% for both procedures. During the median 71-month follow-up period, no cases of infective endocarditis, cerebrovascular accidents, heart failure, or death occurred. Two major adverse events (0.6%) were recorded: complete atrioventricular block requiring surgical treatment in one patient and severe tricuspid valvular regurgitation requiring surgical repair in another patient. Cardiac conduction block was the most common minor adverse event. The mean left ventricular (LV) end-diastolic volume decreased from 96.6 ± 23.2 ml before intervention to 86.0 ± 22.0 ml (p <0.05) at the 6-month follow-up visit. Previously enlarged LV chambers decreased to normal sizes during the follow-up period. In conclusion, transcatheter closure of pmVSDs using modified double-disk occluders was both safe and effective and yielded excellent long-term results in adults. The potential benefits of this intervention included remodeling of the heart, a reduced incidence of infective endocarditis and prevention of LV volume overload.