[Effects of transcatheter closure of perimembranous ventricular septal defects: intermediate and long-term follow-up of 68 cases].

Objective: To evaluate the curative effects of transcatheter closure on perimembranous ventricular septal defects (PMVSDs) using unbalanced Amplatzer asymmetric ventricular septal defect occluder (AAVSDO).

Methods: The data of 68 patients of PMVSDs with a diameter of 6.7 mm (3 to 12 mm) and the diameter of ventricular septal rim below the aortic valve of 2.7 +/- 1.1 mm (1-5 mm), 27 males and 41 females, aged 15.6 +/- 11.5 (1.5-44), weighing 42.8 +/- 15.2 kg (10-72 kg), treated with AAVSDO, the diameter of which was 1-2 mm larger than the largest diameter of the defects determined by angled left ventriculography, from September 2002 to January 2005 were prospectively analyzed. The patients were followed up for 221 +/- 130 days (90 to 750 days).

Results: Seventy-one procedures were performed. The device was implanted successfully in 65 of the 68 patients (95.6%). The selected device diameter was 8.4 mm (4 to 14 mm). Device was lost in one patient during the procedure, which was successfully managed by recapturing the device with a snare device and redeploying it. During the procedure, transient complete left bundle branch block and right bundle branch block occurred in 6 and 5 patients respectively. On follow-up evaluation, transient junctional rhythm occurred in one patient, and accelerated ventricular rhythm in 1. After deployment of the device, the immediate complete closure rate was 43% (28/68), increased to 81.5% (53/68) on the day next to the procedure, and reached 100% 6 months after. One patient adopted surgical reparation because hemolysis occurred after the device implanted. The hospitalization time was 4.5 +/- 3.6 days (2-8 days). The X-ray exposure time was 14.8 +/- 10.7 min (6-48 min). The procedure time 72.6 +/- 38.7 min (35-186 min). One patient was diagnosed as with deep vein thrombosis because of right leg swelling at the seventh day after the procedure. The symptoms disappeared after anticoagulation treatment with low molecule weight heparin. During the scheduled long-term follow-up all patients were doing well. No episode of endocarditis, procedure-related death, or wire disruption was recorded.

Conclusion: The initial and long-term follow-up results of transcatheter closure of PMVSDs are promising with high success and occlusion rates. Transcatheter closure of PMVSDs using AAVSDO appears to be the first line choice for suitable patients with such defects.