title: Transcatheter closure of postoperative residual ventricular septal defects using Amplatzer-type perimembranous VSD occluders.
abstract: OBJECTIVE
  The reoperations of postoperative residual ventricular septal defects (VSDs) are associated with higher risks. Our aim is to assess the efficacy and safety of transcatheter closure of postoperative residual VSDs using perimembranous VSD occluders.
  
  
  METHODS
  Twenty-one patients with residual VSDs underwent transcatheter closure in our center from January 2005 to January 2012. The study population consisted of 9 males and 12 females whose ages ranged from 1.9 to 54 years (median age, 8.7 years). Eighteen cases had perimembranous VSD repair previously, 3 cases had tetralogy of Fallot surgical treatment. All patients had signs of left ventricle volume overload (Qp/Qs ≥ 1.5). Two types of perimembranous VSD occluders, symmetric and asymmetric, were used in 14 and 7 cases, respectively. The diameter of residual VSDs ranged from 4-16 mm (mean, 7.8 mm). The waist size of occluders ranged from 6-18 mm.
  
  
  RESULTS
  There were 0 deaths and 1 serious adverse event. Intravascular hemolysis occurred in 1 patient (4.8%), lasted for 7 days, and recovered with therapy. A trivial intraprosthetic residual shunt was observed in 2 patients (9.5%) after the procedure and 1 patient (4.8%) at 6 months. Two patients (9.5%) had transient left anterior hemiblock and recovered within the first week after the procedure. At the latest follow-up, no atrioventricular block and new-onset aortic regurgitation occurred.
  
  
  CONCLUSIONS
  Transcatheter closure is a feasible and safe management option for patients with postoperative residual VSDs and obviates the need for a second surgery and cardiopulmonary bypass.
authors.affiliation: Department of Cardiovascular Surgery, The General Hospital of Jinan Military District, Jinan, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.forename: Jiali
authors.initials: J
authors.lastname: Liang
authors.forename: Xiaozhou
authors.initials: X
authors.lastname: Zheng
authors.forename: Guanhua
authors.initials: G
authors.lastname: Jiang
authors.forename: Zhe
authors.initials: Z
authors.lastname: Yang
authors.forename: Luying
authors.initials: L
authors.lastname: Zhang
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhang
authors.forename: Haofeng
authors.initials: H
authors.lastname: Sun
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000628:therapy; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D055989:Septal Occluder Device; D013771:Tetralogy of Fallot / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult