Abstract
Objectives To observe and analyze the long-term change of different types of arrhythmias after transcatheter closure of perimembranous ventricular septal defect (pmVSD). Methods We retrospectively collected the data of patients who underwent pmVSD closure in our institution from March 2002 to December 2010. Results One hundred thirty-nine patients met the inclusion criteria, of which 265 (25.5%) had early arrhythmia. They were classified into two categories: conduction abnormality (191/1039; 18.4%) and origin abnormality (94/1039; 9.0%), including 20 patients with both types of arrhythmias. The median follow-up time was 84.5 months, and 103 patients (103/191; 53.9%) with early conduction block got permanent arrhythmias, while only three patients (3/94; 3.2%) with early anomalous origin arrhythmias still had an abnormal electrocardiogram. Serious arrhythmias (28/1039; 2.7%), including II° atrioventricular block (AVB), III° AVB, and complete left bundle branch block (CLBBB), can appear immediately in the early postoperative period (21 patients) or in the late outset (seven patients) after several months or even years (6 months to 8.3 years). Twenty patients (20/21; 95.2%) with serious arrhythmia in the early postoperative period improved after early treatment, but six patients relapsed or worsened during follow-up. At the endpoint, severe arrhythmia persisted in 13 patients, of which four patients got permanent pacemaker implanted, and one patient with recurrent CLBBB died from heart failure. Conclusions The probability of delayed CAVB or bundle branch block after VSD closure is low but often occurs several years after surgery. Therefore, long-term ECG follow-up should last for several years or even decades. Serious arrhythmias that appear early after transcatheter pmVSD closure may impose a risk of recurrence although they have been cured already. Close attention should be paid to the changes of cardiac function in patients with CLBBB after VSD closure, and the severity of such arrhythmia should be taken seriously and reexamined.
Highlights
Ventricular septal defect (VSD) is one of the most common congenital heart malformations, accounting for 40% of all congenital heart diseases [1,2,3], of which the majority is perimembranous VSD [4]
In order to demonstrate the safety and performance of VSD occluders in the long run, we focused on patients with at least one-year follow-up after the procedure, since many
We divided the perimembranous VSD (pmVSD) into three components according to the defect location in the parasternal short-axis echo views. e inlet septum is toward between 9 and 10 o’clock, the membranous one between 10 and 11 o’clock, and the outlet one between 11 and 12 o’clock
Summary
Ventricular septal defect (VSD) is one of the most common congenital heart malformations, accounting for 40% of all congenital heart diseases [1,2,3], of which the majority is perimembranous VSD (pmVSD) [4]. The treatments of pmVSD mainly include interventional occluder closure and surgical repair. E initial application of Amplatzer Membranous VSD Occluder was not satisfactory in the clinical practice, which prevented the promotion and application of this technology in the United States [6]. Kinds of VSD occluders have been widely used clinically in other countries afterwards, including China [7, 8]. Cardiology Research and Practice publications only include short- or middle-term follow-up data [6, 9, 10]. Previous research has shown that the group with the AmplatzerTM Membranous and Muscular VSD occluder in child showed the highest closure rate of 93–95%, perhaps due to a better correlation between the diameter of the VSD and height of the child [11]
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