经食管超声心动图在微创室间隔缺损封堵治疗中的应用

目的 评价经食管超声心动图(transoesophageal echocardiography,TEE)在微创外科室间隔缺损封堵治疗中的临床价值.方法 经胸超声心动图检查粗筛27例室间隔缺损(VSD)患者,拟行微创外科非体外循环下封堵治疗.术前行TEE,根据VSD位置、类型、大小选择合适的封堵器;术中TEE引导封堵器放置,评价即刻封堵效果;术后1周内复查.结果 3例患者术前TEE剔除,20例患者封堵成功,TEE显示19例无残余分流,1例微量残余分流;4例患者转体外循环进行VSD修补,其中2例有残余分流,2例出现主动脉瓣反流;20例微创封堵成功患者术后1周内超声随访,均见封堵器位置正常,无残余分流,左心室重构改善,三尖瓣反流程度减轻,肺动脉压力下降.结论 TEE对选择适合行微创封堵的VSD患者、选择封堵器大小、协助封堵器的释放、评价疗效均有重要作用.微创VSD封堵安全、有效.     

国产对称双盘状封堵器经导管治疗室间隔缺损21例

目的:分析国产对称双盘状封堵器经导管治疗室间隔缺损（VSD）的疗效。方法:21例,全部为膜部室间隔缺损,年龄3.035.0（7.6±8.4）岁。VSD左室面直径为2.212.0（6.2±4.2）mm。经6F-10F传送鞘置入国产对称双盘状封堵器,封堵后即刻行左心室造影,术后1 d、1、6及12月行超声心动图检查观察有无残余分流。结果:封堵器植入成功20例,植入技术成功率95%。术后即刻左心室造影示4例（20%）存在微少量残余分流,16例（80%）封堵完全无残余分流。术后2448 h超声心动图示分流完全消失19（95%）、微少量残余分流1例（5%）。1例封堵术后3 d发生一过性Ⅲ度房室传导阻滞,经过410 d内科保守治疗治愈。1月超声心动图所有病例未见残余分流。结论:应用国产双盘状封堵器治疗VSD是一种安全有效的介入方法,操作简便,成功率高,近期疗效可靠。     

国产封堵器介入治疗巨大动脉导管未闭的临床评价

目的应用国产封堵器经导管治疗巨大动脉导管未闭（PDA）并对其疗效进行评价。方法全组27（男8,女19）例,年龄6～54（24±15）岁,主动脉造影示PDA最窄径为13～28（16±4）mm。封堵后即刻和30min行侧位降主动脉造影,术后2d,1、3、6个月分别行超声心动图及X线平片检查。结果24例成功,3例PDA封堵后判断为有阻力性肺动脉高压,放弃治疗。成功的患者中,14例选用国产PDA封堵器,10例选用国产ASD封堵器。术后即刻降主动脉造影检查示,使用ASD封堵器中,有2例微量残余分流,5例少量残余分流,1例少～中量残余分流;PDA封堵器中,有4例微量残余分流,2例少量残余分流。术后30min,ASD封堵器4例微～少量残余分流,1例仍为少～中量残余分流;PDA封堵器仅2例微量残余分流。1例ASD封堵器治疗术后7h发生溶血,治疗72h溶血无减轻迹象,外科开胸取出封堵器并行PDA结扎术。术后2d,超声心动图示PDA封堵器1例微量残余分流,ASD封堵器5例微量残余分流。随访1～6个月,所有左心内径增大的患者均明显回缩,未发现残余分流和导管再通。结论应用国产封堵器经导管治疗直径≥13mm的PDA是一种安全有效地介入方法。     

国产双盘状封堵器经导管治疗膜部室间隔缺损疗效的初步评价

目的 :应用国产双盘状封堵器经导管治疗膜部室间隔缺损并对其疗效进行初步评价。方法 :全组 2 0例 ,年龄8± 6 （2～ 17）岁。室间隔缺损直径为 7.2± 2 .3（2 .0～ 14 .0 ） mm。经 7F或 8F传送鞘置入双盘状封堵器 ,封堵后即刻行左心室造影 ,术后 1d及 1月行超声心动图检查观察有无残余分流及再通。结果 :全组技术成功率 10 0 % ,术后左心室造影显示 ,6例存在微量～少量残余分流 ,14例封堵完全无残余分流。术后 2 4 h、术后 1月超声心动图未见残余分流及再通。结论 :应用双盘状封堵器治疗膜部室间隔缺损是一种安全有效的介入方法 ,成功率高 ,近期疗效可靠 ,中远期疗效尚需进一步观察     

室间隔缺损介入治疗五年临床随访分析

目的 总结分析室间隔缺损(VSD)介入治疗后的随访结果,重点分析其并发症发生情况.方法 2002年11月至2007年11月,共有445例膜周部VSD患者接受了介入封堵术,其中男性203例,女性242例,年龄2.5～58(14.2±6.8)岁.所有患者均经股静脉途径放置封堵器,采用的VSD封堵器包括进口偏心伞及国产对称伞.所有患者术后1、3、6、12个月(其后相隔1年)进行门诊随访,复查超声心动图、X线胸片、心电图.结果 共有417例患者封堵成功,总技术成功率93.7%(417/445),未发生与手术相关的死亡.至2008年2月,平均随访25.6个月(3个月～5年),严重并发症发生率为2.2%(10/445),其中包括三度房室传导阻滞安装永久起搏器2例、左束支传导阻滞伴左心室增大2例、中-大量主动脉瓣反流2例、中量三尖瓣反流2例、中量二尖瓣反流1例、溶血1例.术后5年有7例患者仍存在少量残余分流,总完全封堵率为98.3%(410/417).结论 VSD介入治疗总体上安全有效.应注意适应证的选择和术后严格随访,以减少严重并发症及晚期并发症的发生.     

国产动脉导管封堵器闭合膜周部室间隔缺损的疗效评价

目的评价国产动脉导管（PDA）封堵器闭合膜周部室间隔缺损（VSD）的可行性、安全性及疗效。方法2004年5月至2008年7月,21例先天性膜周部VSD患者[男性10例,女性11例,年龄5～40（21．3±10．2）岁]成功接受了封堵治疗。膜周部VSD的直径均先经经胸心脏彩超检查（TTE）测量,并经左心室造影进一步明确。封堵操作完成10min后再次予TTE及左心室造影评估封堵效果。术后心电监护1周,出院前及出院后1、3、6个月随访复查TTE及心电图。结果21例患者均全部封堵成功,国产PDA封堵器尺寸为6／8～18／20mm。封堵后,2例新出现微量主动脉瓣反流,1例出现少量的三尖瓣反流;3例出现完全性或不完全性右束支传导阻滞,1例出现完全性左束支传导阻滞,1例出现不完全右束支合并间歇性完全性左束支传导阻滞,除2例完全性或不完全性右束支传导阻滞在6个月内随访时未恢复外,其他3例均在出院前恢复正常;4例存在微量残余分流,其中3例在7d后复查超声时消失,另1例在1个月随访时消失。术前TTE估测肺动脉压力为28．0～46．7（33．4±9．2）mmHg,术后肺动脉压力为16．0-30．2（19．2±7．6）mmHg,6个月随访时肺动脉压力进一步下降为15．3-26．7（17．3±6．9）mmHg。结论对部分膜周部室间隔缺损的患者应用PDA封堵器进行封堵是可行的、安全的及有效的。     

室间隔缺损介入封堵326例经验总结及随访分析

目的 总结经皮导管室间隔缺损介入封堵术的临床经验,并对326例患者的中期随访结果进行回顾性分析.方法 326例室间隔缺损患者均经临床和经胸超声心动图（TTE）确诊,排除干下型室间隔缺损,采取经皮导管室间隔缺损介入封堵术,术后即刻左心室造影和经胸超声心动图检查观察疗效,术后1d、1个月、3个月、6个月、1年、2年、3年、4年、5年行经胸超声心动图、X线胸片和超声心动图检查随访观察.结果 经皮导管室间隔缺损介入封堵成功率为98.3％（320/326）,失败原因为室间隔缺损过大或过小、位置特殊、合并主动脉瓣脱垂及反流、损伤三尖瓣或主动脉瓣、房室传导阻滞等.术后并发症：1例术后1d封堵器移位,急诊心脏外科手术处理;2例8 kg患儿术后股动脉血栓形成,尿激酶溶栓后治愈;12例新出现三尖瓣轻度反流或原有三尖瓣反流增多;1例损伤主动脉瓣致中度反流,急诊外科手术处理;56例出现非阵发性交界性心动过速,经激素、人体白蛋白、营养心肌等治疗后恢复窦性心律;17例不完全性束支传导阻滞;5例完全性左束支传导阻滞.1例术后10个月出现二度Ⅱ型房室传导阻滞,治疗后恢复至二度Ⅰ型房室传导阻滞.1例术后8d出现脑出血,开颅发现脑血管畸形,外科处理后治愈.术后患者左心室舒张末内径、心胸比例较术前改善.结论 经皮导管室间隔缺损介入封堵术具有创伤小、并发症少、无需体外循环、成功率高等特点,值得推广,但应规范选择患者和长期随访.     

室间隔缺损介入治疗并发症及防治对策

对50例室间隔缺损(VSD)患者行介入封堵术治疗后的并发症进行回顾性分析,结果术中封堵器脱落、Ⅲ°房室传导阻滞各1例;术后左前分支传导阻滞、主动脉轻度关闭不全、少量残余分流各2例,封堵器脱落、溶血各1例;3个月后仅2例主动脉关闭不全.认为术前依靠超声心动图严格筛选适应证,术中选择适当封堵器,术后严密随访是成功行VSD介入治疗、减少严重并发症的关键.     

应用国产对称双盘状封堵器经导管治疗小儿室间隔缺损的疗效评价

目的应用国产对称双盘状封堵器经导管治疗小儿室间隔缺损（VSD）并对其疗效进行初步评价。方法全组446例,其中443例为膜部VSD,3例为肌部室VSD,年龄7±8（2～12）岁。VSD左室面直径为6.8±3.9（2.0～12.0）mm。经6F～10F传送鞘置入对称双盘状封堵器,封堵后即刻行左心室造影,术后1d、1个月、6个月及行超声心动图检查观察有无残余分流。结果全组446例封堵器植入成功,植入技术成功率100%。术后即刻左心室造影示81例（18.2%）存在微～少量残余分流,365例（81.8%）封堵完全无残余分流。术后24～48h超声心动图示分流完全消失410例（91.9%）、微～少量残余分流36例（8.1%）。1例封堵术后24h发生溶血,经过7d内科保守治疗治愈。8例封堵术后3d发生一过性Ⅲ度房室传导阻滞,经过4～10d内科保守治疗治愈。1个月超声心动图发现2例残余分流（0.9%）。结论应用国产双盘状封堵器治疗小儿室间隔缺损是一种安全有效的介入方法,操作简便,成功率高,近期疗效可靠,中远期疗效尚需进一步观察。     

应用改良的动脉导管未闭封堵器经导管闭合三尖瓣腱索附着异常的膜周部室间隔缺损

目的 探讨应用改良的国产动脉导管未闭（patent ductus arteriosus,PDA）封堵器经导管闭合三尖瓣腱索附着异常的膜周部室间隔缺损（perimembranous ventricular septal defect,pmVSD）的安全性和可行性。 方法 选择2011年12月～2019年12月在西安交通大学第一附属医院结构性心脏病科诊断为pmVSD并伴有三尖瓣腱索附着异常的患者（n = 35）,应用改良的国产PDA封堵器介入治疗,对其基线特征、经导管操作和随访数据进行回顾性分析。 结果 所有患者（100%）手术成功,术中无传导阻滞发生。1例（2.9%）于术后48 h内发生一过性完全右束支传导阻滞,静脉推注地塞米松3 d后心电图恢复正常。35例（100%）患者经胸超声心动图（transthoracic echocardiography,TTE）检查均未观察到残余分流。在平均（4.4 ± 2.3）年的随访期内,1例（2.9%）三尖瓣返流（tricuspid regurgitation,TR）较术前增加,为中量TR,其余患者未观察到严重的TR或TR加重。 结论 使用改良的PDA封堵器经导管闭合三尖瓣腱索附着异常的pmVSD是一种安全、有效的治疗选择,未发现严重的TR及其它并发症。     

Transcatheter closure of perimembranous and intracristal ventricular septal defects with the SHSMA occluder

Objectives : The objective of this study was to evaluate the safety and efficacy of transcatheter closure of perimembranous ventricular septal defect (pmVSD) and intracristal VSD (icVSD) using the Shanghai Shape Memory Alloy (SHSMA) pmVSD occluder. Background : There is still limited experience with transcatheter closure of pmVSD and icVSD. Methods : Between January 2003 and September 2010, 348 patients with pmVSD and 47 patients with icVSD underwent transcatheter closure using a SHSMA pmVSD occluder. Results : The total successful closure rate in pmVSD and icVSD subjects was 97.4 and 78.7%, respectively. During the perioperative period, no death, major bleeding or hemolysis occurred in both groups. In pmVSD group, one case of occluder dislodgement, one case of pericardial tamponade, and two cases of thromboembolism occurred. None in icVSD group had these complications. During a median of 3.2 years of follow‐up, there was no evidence of significant residual shunt and device‐related valve regurgitation. None in icVSD group and 10 patients (2.9%) in pmVSD group had a persistent arrhythmia. Overall, only one patient (0.3%) with pmVSD acquired complete atrioventricular block requiring implantation of a permanent pacemaker. The rim from the tricuspid valve to the defect < 4 mm was the only predictor of arrhythmic complications after procedure (OR = 4.24; P = 0.021). Conclusions : Transcatheter closure of pmVSD in selected patients using the SHSMA occluder is effective and safe. Transcatheter closure of icVSD in experienced hands using this device is also feasible and safe. © 2011 Wiley Periodicals, Inc.     

Arrhythmias after transcatheter closure of perimembranous ventricular septal defects with a modified double-disk occluder: early and long-term results

With the development of interventional techniques and devices, transcatheter closure of perimembranous ventricular septal defect has been widely performed. However, there has been a lack of long-term follow-up results about postoperative ECG changes of PmVSD patients. We report our experience of early and late arrhythmias after transcatheter closure of PmVSD with a modified double-disk occluder (MDVO). We performed a retrospective review of 79 patients (47 males, 32 females) between September 2002 and May 2007 who underwent transcatheter closure of perimembranous ventricular septal defect. Symmetric and asymmetric PmVSD occluders were used. The diameter of the evaluated defects ranged from 3 to 12?mm, as measured by TTE and 3 to 15?mm by left ventriculography. Most cases of PmVSD were treated successfully with a single procedure, resulting in a successful closure rate of 97% (77/79 patients). There was no death in any of the patients. After the operation, 79 patients were followed-up for a range of 10–76?months (35.3?±?17.4?months). In this series, 11 cases of incomplete right bundle branch block and five cases of complete right bundle branch block occurred during the early period after operation. During long-term follow-up, these issues declined in prevalence to five and four cases, respectively. Moreover, reversible third-degree AVB occurred during closure or after the procedure, and two of the three patients with reversible AVB received a temporary heart pacemaker implantation. These patients recovered 1?h, 6?days, and 9?days later, respectively. During 10–76?months of follow-up, no complications occurred in any of the patients, including residual shunt, severe aortic valve, or tricuspid valve regurgitation. Device closure of perimembranous ventricular septal defects with a modified double-disk occluder (MDVO) resulted in excellent closure rates and acceptably low arrhythmia rates.     

Percutaneous closure of ventricular septal defects in children aged <12: early and mid-term results

AIMS: The aim of the article is to study the safety, efficacy, and follow-up of percutaneous closure of muscular ventricular septal defect (mVSD) and perimembranous ventricular septal defect (pmVSD) in children. METHODS AND RESULTS: Between January 2000 and June 2005, among 140 patients who underwent percutaneous closure of an mVSD or a pmVSD, 88 were aged lt;12. Two different Amplatzer devices were used: the mVSD occluder and the pmVSD occluder. Mean age and weight at procedure were 4.5+/-3.3 years and 18.7+/-11.2 kg, respectively. Percutaneous closure was successfully achieved in 83 subjects (94%). No deaths occurred. Thirteen patients (14.7%) had early complications: device embolization (n=4), vascular complications (n=3), and rhythm abnormalities (n=6). These were transient complications in all but one case [1.1% complete atrioventricular block (cAVB) needing pacemaker implantation]. During a median follow-up of 24 months, three subjects treated for a pmVSD needed pacemaker implantation due to the occurrence of cAVB. Multivariable analysis using Cox's proportional hazard regression showed that age was the only risk factor associated with the occurrence of cAVB (P=0.028; relative risk: 0.25). CONCLUSION: Percutaneous closure of mVSD and pmVSD in children can be performed safely and successfully. The occurrence of cAVB is a major concern in young children with pmVSD.     

Transcatheter closure of perimembranous ventricular septal defects using amplatzer asymmetric ventricular septal defect occluder: preliminary experience with 18-month follow up.

BACKGROUND: This study reports our experience in the nonsurgical closure of perimembranous ventricular septal defects in children and adolescents with the Amplatzer asymmetric ventricular septal defect occluder and the outcome of an 18-month follow up. METHODS AND RESULTS: Twenty patients (median age:10 years; median weight:32 kg) with perimembranous ventricular septal defect were selected for transcatheter closure with the Amplatzer device. The prosthesis diameter chosen was 1-2 mm larger than the largest measured diameter of the defect on transesophageal echo (TEE). All patients were put on oral aspirin (5 mg/kg/day in children and 150 mg/day in adults) five days prior to and for six months after closure. Follow-up evaluation at 48 hr and 1, 6, 12 and 18 months included clinical examination, electrocardiogram, and a transthoracic echocardiogram. The mean defect diameter on color flow mapping on TEE was 7.1 +/- 2.3 mm. The device diameter ranged from 6-14 mm (median = 8 mm). One patient developed an anaphylactic reaction to contrast. The procedure was successful in 17 out of 19 patients where it was attempted (89.4%). In two patients with associated significant aortic valve prolapse and mild aortic regurgitation the device could not be successfully deployed. A trivial residual shunt observed during postdeployment left ventricular angiogram in 7 of 17 patients (41.2%) completely disappeared at one month follow-up. Three patients had right bundle branch block (2 complete and 1 incomplete) whereas one developed junctional escape rhythm with a right bundle branch block morphology. One patient had clinically silent thromboembolism to the left vertebral artery and another patient had hemolysis which resolved spontaneously within 48 hr. Follow-up at 13.5 +/- 5.3 months (range 1-18 months) revealed no residual shunt. The left ventricular internal dimension in diastole decreased significantly from 45 +/- 6 mm to 40 +/- 6 mm (P < 0.01) at the time of the last follow up. The baseline tricuspid regurgitation (n = 4) and aortic regurgitation (n = 3) remained unchanged during the follow up period. None of the patients developed left ventricular outflow tract obstruction or new aortic or tricuspid regurgitation. There were no other device related complications such as device migration, systemic thromboembolism, infective endocarditis, pericardial effusion or delayed conduction disturbances. CONCLUSIONS: In carefully selected children and young adults, the Amplatzer asymmetric ventricular septal defect occluder is a promising device for transcatheter closure of perimembranous ventricular septal defect with encouraging results on short term follow up.     

婴幼儿室间隔缺损介入治疗的可行性及远期疗效

目的：探讨经导管介入治疗婴幼儿先天性心脏病室间隔缺损的可行性及远期疗效。方法研究总结海南省人民医院心内科2002年12月至2013年10月间经导管介入治疗的173例婴幼儿先天性室间隔缺损的临床资料。结果患儿年龄11个月～3岁[（2.1±0.7）岁],其中男81例,女92例,体重6～15 kg[（10.2±3.6）kg];室间隔缺损直径2.5～9.0 mm[（5.1±1.7）mm],其中单纯膜周部缺损88例（50.9%）,膜周部缺损并膜部瘤形成52例（30.1%）,膜周部缺损并主动脉瓣脱垂13例（7.5%）,嵴内型室间隔缺损20例（11.6%）,置入封堵器直径4～12 mm[（6.3±2.2）mm]。随访1个月～10年[（6.2±1.3）年]。173例患者中168例成功封堵,成功率97.1%,未成功的5例患者中,3例封堵器置入后出现中度主动脉瓣反流,2例导管通过缺损即多次出现完全性房室传导阻滞（CAVB）。随访过程中,1例患儿术后第3天发生CAVB,经地塞米松治疗4 d后恢复。3例患儿在术后即刻出现完全性左束支传导阻滞,随访中仅1例患儿发展为持续性完全性左束支传导阻滞,该患儿随访的5年中未发现心功能异常,1例患儿在随访的第4年发现完全性左束支传导阻滞,之后随访的3年中未发现心功能异常。术后第1天复查心脏彩超发现4例新发的主动脉瓣轻度反流和8例残余分流（宽约1～2 mm）,发现主动脉瓣轻度反流患儿在分别随访的6个月、2年、3.5年和8.5年中未发现进行性加重,发现残余分流患儿有4例在1个月后恢复,3例在6个月后恢复,1例在1年后恢复。随访的1个月～10年间无溶血、封堵器移位或脱落、迟发性房室传导阻滞等并发症。结论经导管介入治疗婴幼儿室间隔缺损是一项安全可行的技术,远期疗效良好。     

Perimembranous ventricular septal defect with aneurysm: two options for transcatheter closure

We present our experience with 2 options for device closure of perimembranous ventricular septal defect with aneurysm. Thirty-four patients with perimembranous ventricular septal defect with aneurysm, aged from 14 to 42 years, underwent transcatheter closure with modified double-disk occluders. A sheath was used to deliver the occluder after establishment of a stable "arteriovenous loop" under fluoroscopy. Electrocardiography and transthoracic echocardiography were used for follow-up. All but 1 patient experienced successful transcatheter closure of perimembranous ventricular septal defect with aneurysm, when occluders were used in 2 different positions. There were 19 patients whose perimembranous ventricular septal defects were closed at the inlet of the aneurysm and 15 patients whose defects were closed at the outlet. Eight patients had a residual shunt immediately after the procedure, which disappeared during follow-up. One patient developed minor aortic regurgitation. Four patients who manifested different types of conductive block were all in the group that underwent closure at the inlet of the aneurysm. No other complications were observed during follow-up.We infer that perimembranous ventricular septal defect with aneurysm can be successfully closed with modified double-disk occluders. Each of the 2 options that we have presented for transcatheter closure of perimembranous ventricular septal defect with aneurysm has its advantages and disadvantages. Ultimately, the configuration of the lesion should decide the type and position of the device.     

Transcatheter closure of perimembranous ventricular septal defect using an Amplatzer occluder--early results

BACKGROUND: Transcatheter closure of perimembranous ventricular septal defect with the use of an Amplatzer occluder was introduced in 1999, however, clinical experience with this method remains limited. AIM: To assess short-term safety and efficacy of this technique in children. METHODS: Since 2001, nine children underwent transcatheter closure of perimembranous ventricular septal defect in the cardiac centre in Bratislava (Slovak Republic) or in our centre. Patients were selected for the procedure based on the results of transesophageal echocardiography (TEE). Transcatheter closure using the Amplatzer occluder was guided by both TEE and angiography. The follow-up duration ranged from 3 to 22 months, mean 11.5 months. Control angiography was performed in order to detect any leakage through the aortic valve. The end-diastolic left ventricular diameter before and after the procedure as well as the function of the aortic, tricuspid and mitral valves were also assessed. RESULTS: The procedure was effective in all patients. No damage to atrio-ventricular nor aortic valves was observed. Tricuspid regurgitation, present prior to the procedure, markedly decreased following the closure of the defect. The left ventricular end-diastolic diameter significantly (p=0.001) decreased after the procedure. CONCLUSIONS: (1) Perimembranous ventricular septal defect can be safely and effectively closed using a transcatheter Amplatzer occluder. (2) Appropriate selection for the procedure as well as TEE and angiographic guidance during the procedure enable the avoidance of complications. (3) Tricuspid regurgitation is not an absolute contraindication to perform this procedure.     

Transcatheter closure of perimembranous ventricular septal defect with amplatzer membranous occluder

BACKGROUND: Use of trancatheter device closure for membranous ventricular septal defect is still in evolving phase. We report the early and mid-term results of our experience with the new asymmetric Amplatzer membranous ventricular septal defect occluder. METHODS AND RESULTS: We attempted, transcatheter closure of perimembranous ventricular septal defect using asymmetric Amplatzer occluder in 26 patients. The patients were selected on the basis of transthoracic and transesophageal echocardiographic assessment of the ventricular septal defect. The procedure was successful in 21 (81%) patients. The age ranged from 3 to 23 years, weight from 10 to 59 kg and defect size ranged from 3 to 9 mm (mean: 5 +/- 1.8 mm). One patient had situs inversus with dextrocardia: 11 had aneurysmal tissue partly occluding the defect and the device was deployed either across (n=6) or within the aneurysmal sac (n=5). Three patients developed high degree atrioventricular block on attempts to cross the defect with the sheath and the procedure was discontinued. In two patients it was not possible to place the sheath in left ventricle despite repeated attempts. There was a residual flow in 4 (19%) patients at 24 hours. Two patients developed bundle branch block and none had complete heart block. At follow-up (1-9 months, n=20), residual flow was seen in two patients. None developed late conduction defect, aortic regurgitation, infective endocarditis or hemolysis. CONCLUSIONS: Transcatheter closure of perimembranous ventricular septal defect can be performed safely and effectively with the new asymmetric Amplatzer occluder device in selected patients with good short- and midterm results. These devices can be deployed safely in and across and the aneurysmal sacs. In selected cases, this procedure is a satisfactory alternative to surgery.     

应用第二代Amplatzer动脉导管未闭封堵器治疗成人膜周部室间隔缺损疗效分析及中长期随访

目的 分析应用第二代Amplatzer动脉导管未闭封堵器（Amplatzer duct occluderⅡ,ADOⅡ）治疗成人膜周部室间隔缺损（perimembranous ventricular septal defect, pmVSD）的安全性、有效性及中长期随访结果。方法 根据纳入标准筛选自2013年6月～2021年6月成人pmVSD患者44例，应用ADOⅡ封堵器行室缺封堵术，应用心电图和经胸超声心动图（transthoracic echocardiography, TTE）评价术后即刻、术后1日、1月、3月、6月以及每年随访的封堵疗效及并发症发生情况。结果 共纳入44例pmVSD患者，年龄（38±13）岁，其中膜部膨出瘤型24例，管型13例，漏斗型4例，pmVSD外科修补术后残余瘘3例。应用ADOⅡ封堵器行pmVSD封堵术，造影下平均缺损出口大小（3.4±1.1）mm，封堵器腰部平均直径（4.8±1.5）mm，封堵器平均长度（4.3±0.7）mm，即刻封堵成功率100%，完全封堵率为75.0%。23例患者随访时间为（38±24）个月，中位随访时间为36个月。与术前相比较，术后6...     

Transcatheter Closure of Perimembranous Ventricular Septal Defect Using the Amplatzer Duct Occluder II

Objective: To evaluate the efficacy of Amplatzer duct occluder II (ADO II) in the treatment of perimembranous ventricular septal defect (pmVSD) in children. Methods: Between June 2017 and June 2020, 13 patients with pmVSD had attempted transcatheter closure using ADO II, seven of patients were used antegrade approach and six of them were used retrograde approach. Results: There were 8 males and 5 females, age from 1 to 7 years, weight from 10.5 to 31.0 kg, and VSD size from 2.0 to 4.0 mm. Procedure was successful in all cases with the outer diameter of the occluders ranging from 4 to 6 mm. No aortic, tricuspid regurgitation or residual shunt was found in the immediate ultrasound assessment. No arrhythmia was observed in the Holter monitoring 3 days after the intervention. Discharge echocardiography indicated complete shunt closure. No evidence of occluder prolapse, malignant arrhythmia, or intensed valve regurgitation was seen on a median follow-up of 18 months (range, 6 to 36 months). Conclusions: Based on our experience, ADO II showed good efficacy in the early and middle stages of pediatric pmVSD closures.