Clinical application of eccentric nitinol occluder in transcatheter closure of intracristal ventricular septal defects and its medium-term therapeutic efficacy

Abstract

Objective To investigate the security and medium-term therapeutic efficacy of domesticmade eccentric nitinol occluder in transcatheter closure of intracristal ventricular septal defects(VSD).Methods From January 2005 to July 2008,transcatheter closure was attempted in 26 patients with intracristal VSD.The diameter of VSD ranged 3 to 9 mm average(4.7 ± 4.5)mm and the distance of VSD to pulmonary valve over 2 mm,to aortic valve over 1 mm.Follow-up was made with transthoracic echocardiography and echocardiography at the 1st week,1st,3rd,6th and 12th months after operation.Results The devices were deployed successfully in 21 patients,the successful rate was 80.8%(21/26).After the operation immediately,left ventricular radiography showed tiny(< 2 mm)residual shunt in 2 patients and trace residual shunt in 3 patients.The residual shunt all disappeared within 1 day to 3 months.Complete left bundle branch block(LBBB)was found on electrocardiogram immediately in 1 patient,and there were no other severe complications.All patients were followed up 12 to 48 months,8 cases combined with right bundle branch block(RBBB),and 3 cases combined with LBBB before operation,5 cases returned to normal after operation 2-14 days,average(7.25 ± 2.46)d,6 cases no returned to normal,included 4 RBBB,2 LBBB.One RBBB returned to normal 1 month after operation,1 RBBB returned to normal 3 months after operation,and the others continued in follow-up period.Conclusion Intracristal VSD may be closed with domestic-made eccentric nitinol occluder safely and effectively,and medium-term effect is good,long-term outcome still needs'more large-scale clinical observation. Key words: Heart septal defects,ventricular,intracristal; Radiography,interventional; Eccentric nitinol occluder