Transcatheter closure of postoperative residual perimembranous ventricular septal defects.
BACKGROUND
The presence of postoperative residual perimembranous ventricular septal defect (PmVSD) is relatively uncommon. However, reoperation might be associated with an increased surgical risk. Transcatheter device closure is an alternative strategy for management of postoperative residual defects.


METHODS
Between July 2002 and November 2008, transcatheter closure of postoperative residual PmVSDs was attempted in 26 patients (11 male, 15 female). Symmetric and asymmetric PmVSD occluders were used.


RESULTS
The diameter of residual defects was from 3 mm to 10 mm (mean 6.3 +/- 2.3 mm) on transthoracic echocardiography. In 24 of 26 patients, the residual defects were successfully closed. No direct residual defect was found on left ventriculography after the procedure. Total occlusion rate was 62% (15 of 24) at completion of the procedure, rising to 71% (19 of 24) at one week and 96% (23 of 24) during the follow-up. Twenty patients had only one device implanted, whereas 4 patients had two devices implanted. The waist size of occluders used ranged from 5 mm to 12 mm (mean 8.6 +/- 2.5 mm). One patient presented with complete atrioventricular block 3 days after the procedure and recovered 2 weeks later. Hemolysis occurred in 3 patients after the procedure within 12 hours. These patients recovered 4 weeks, 4 days, and 8 days later, respectively. During follow-up, the devices were in a stable position with optimal shapes. No late complications were observed.


CONCLUSIONS
Transcatheter closure of postoperative residual PmVSDs is possible without the need for reoperation. The early and midterm prognosis of patients with transcatheter closure is good.
Gu
Ming-Biao
MB
Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Bai
Yuan
Y
Zhao
Xian-Xian
XX
Zheng
Xing
X
Li
Wei-Ping
WP
Qin
Yong-Wen
YW
D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult