AIM To evaluate the application value of transthoracic echocardiography (TTE) in interventional treatment and mid-long-term follow-up of perimembranous ventricular septal defect (pmVSD).
METHODS A total of 302 patients were diagnosed with pmVSD using TTE, including 129 (42.7%) males and 173 (57.3%) females, with an average age of (19±16) years. The size of the heart cavity, size, shape and peripheral structure of the defect were observed by multi-view TTE before operation. A suitable domestic occluder was selected according to the results of TTE before operation and angiography during the operation. Follow-up was performed on the second day, 6 months and ≥12 months after the operation using TTE to observe the closure effect. All patients completed a follow-up of more than 12 months, and 178 (58.9%) patients completed a follow-up of more than 3 years.
RESULTS TTE identified that pmVSD left ventricular surface size defect was 10.7 ± 4.6 (2.5～26) mm and right ventricular surface size of the main hole 3.3 ± 1.5 (1.5～11) mm before operation. TTE detected 121 (40.1%) cases of funnel type, 134 (44.3%) cases of capsular porous type, 39 (12.9%) cases of capsular single-hole type and 8 (2.6%) cases of window type. There were 17 (5.6%) cases of right coronary valve prolapsed, 12 (3.9%) cases of non coronary valve prolapsed and 34 (11.3%) cases of abnormal attachment of tricuspid chordae tendineae. There were 34 (11.3%) cases with abnormal tricuspid chordal attachment and 11 cases (3.6%) had a distance of 0 mm from the anterior valve attachment point to the edge of the defect. There were 116 cases (38.4%) with enlarged left atrium and ventricle. All patients were successfully occluded and the waist diameters of the occluder used were (7.3±3)4 mm. After operation, there were 31 (10.3%) cases of residual shunt on the second day, which decreased to 9 (3.0%) cases at 6 months, 7 (2.3%) cases in 1～3 years and 4 (2.2%, n = 178) cases≥3 years. Eleven cases had new onset of aortic regurgitation after operation, all of which were small and there was no change in the medium and long-term follow-up. Two patients with tricuspid regurgitation increased from small regurgitation before operation to moderate regurgitation after operation, and there was no significant increase when they were followed up for more than 1 year and their heart cavity size was normal. Ninety-three (30.7%) patients presented normal cardiac cavity size on the second day after operation, and all patients had normal cardiac cavity size 6 months after operation.
CONCLUSION TTE has important clinical value in the interventional treatment and long-term follow-up of pmVSD. Transcatheter closure of pmVSD is safe and effective, with favorable results in mid-long-term follow-up.
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