[Transcatheter closure of perimembranous ventricular septal defects: a clinical application in children].

OBJECTIVE

To evaluate the safety and efficacy of transcatheter closure of perimembranous ventricular septal defects (TCVSD) in children.

METHODS

From November 2002 to July 2004, fifty children (26 males and 24 females) with perimembranous (ventricular septal defect, VSD) underwent an attempt of transcatheter closure using the amplatzer occluder specially designed for perimembranous VSD. Among the 50 children, one of them was diagnosed with aneurysm of aortic sinus, one with dextrocardia, and two with leakage after the surgical repair of VSD. The mean age of patients was (9.1 +/- 4.8) years (ranged from 2 to 17 years). The mean body weight of patients was (33.5 +/- 19.7) kg (ranged from 9 to 81 kg). The mean diameter of VSD measured by transthoracic echocardiography (TTE) was (4.8 +/- 0.9) mm (ranged from 3 to 7 mm). The mean rate of quantity of pulmonary flow/quantity of systemic flow (Qp/Qs) was 1.3 +/- 0.3 (ranged from 1.1 to 2.0), the moderate shunt from left to right was found in 4 patients and the small shunt from left to right in the rest. Occluder was released through the right heart system. All patients were followed up in 1, 3, 6 and 12 months after procedures of TTE, X-ray and electrocardiography.

RESULTS

The devices were deployed successfully in 47 patients, the rate of success was 94%. There was a tiny (< 3 mm) residual shunt in 2 patients after closure. During the follow-up of 6 months, only one patient had a tiny residual shunt. Complete left bundle branch block (LBBB) was found in one child who was examined with electrocardiograph 2 weeks later. There was no other severe complication. After 1 to 18 months (mean 7 months) follow-up, all patients demonstrated a great decrease (from 38.5 +/- 4.6 mm pre-closure to 35.2 +/- 5.1 mm post-closure) in their left ventricle end-diastolic dimension (LVEDD, P < 0.05).

CONCLUSION

This study demonstrated that transcatheter closure of membranous VSD using occluder would be safe and effective for children, and the results of short-term was satisfied. Further clinical trials are underway to assess the long-term result.