title: Transcatheter closure of congenital perimembranous ventricular septal defect in children using symmetric occluders: an 8-year multiinstitutional experience.
abstract: BACKGROUND
  Perimembranous ventricular septal defects (pmVSDs) are one of the most common forms of congenital cardiac malformation in children. Results of transcatheter pmVSD closure remain debatable, prompting the need for further evaluation with regard to the safety and efficacy of this procedure. The aim of the study was to analyze the safety, efficacy, and long-term follow-up data associated with transcatheter closure of pmVSDs in children using symmetric occluders.
  
  
  METHODS
  From December 2002 to October 2011, 525 children with pmVSDs between 2 and 12 years of age underwent transcatheter closure at three major heart centers in northwest China with symmetric pmVSD occluders. All patients were followed up until October 2011 with electrocardiogram and transthoracic echocardiography. Adverse events were recorded and evaluated.
  
  
  RESULTS
  There were 252 male and 273 female patients with an average weight of 21.5 kg. The mean age at the time of transcatheter closure was 5.6 years, and the average ratio of pulmonic to systemic blood flow was 2.5. Transcatheter intervention was successfully performed in 502 patients (95.6%). The median device size implanted was 6.5 mm (range, 4 to 18 mm). During a median 45-month follow-up period, no mortality occurred. A total of three major adverse events (0.6%) were reported; two were valve-related. Meanwhile, 104 minor adverse events were detected during the entire follow-up period. All individuals experiencing major adverse events were younger than 3 years of age. The incidence of major adverse events in patients younger than 3 years old was significantly higher than that of patients older than 3 years old (3.75% versus 0.00%; Fisher's exact test p=0.004).
  
  
  CONCLUSIONS
  Data from the current study suggest that transcatheter pmVSD closure using symmetric occluders displayed an excellent success rate and long-term follow-up results. The transcatheter approach provides a less-invasive alternative to open surgery and displays some promise in the treatment of pmVSDs in certain patient populations.
authors.affiliation: Department of Cardiology, Xi'an Children Hospital, Fourth Military Medical University, Xi'an, People's Republic of China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.forename: Sancheng
authors.initials: S
authors.lastname: Cao
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.forename: Lifang
authors.initials: L
authors.lastname: Yang
authors.forename: Yin
authors.initials: Y
authors.lastname: Liu
authors.forename: Jun
authors.initials: J
authors.lastname: Ren
authors.forename: Qiaomei
authors.initials: Q
authors.lastname: Ma
authors.forename: Haijian
authors.initials: H
authors.lastname: Xing
authors.forename: Dan
authors.initials: D
authors.lastname: Li
authors.forename: Danqiu
authors.initials: D
authors.lastname: Tian
authors.forename: Yi
authors.initials: Y
authors.lastname: Wan
authors.forename: Shiqiang
authors.initials: S
authors.lastname: Yu
authors.forename: Tao
authors.initials: T
authors.lastname: Chen
authors.forename: Xiuling
authors.initials: X
authors.lastname: Yang
authors.forename: Jian
authors.initials: J
authors.lastname: Yang
mesh_terms: D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D055989:Septal Occluder Device; D013997:Time Factors