Objective Assessment of the efficacy of transcatheter interventional treatment for intracristal ventricular septal defect (IVSD) and mid-to-long term follow-up evaluation of complications.
Methods Retrospective analysis of 39 patients of intracristal ventricular septal defect (IVSD) diagnosed between January 2012 and December 2020 at the Structural Heart Disease Center, First Affiliated Hospital of Xi'an Jiaotong University, with mean IVSD defect of 4.9±1.6 mm(2～8 mm) measured by transthoracic echography (TTE). Among all patients, 36 patients (92.3%) were successfully occluded, with Symmetrical VSD occlude (20/36, 55.6%) or zero side eccentric type VSD occluder (16/36, 44.4%) (Shanghai). Among the other 3 patients (7.7%), 2 patients received surgical intervention, 1 patient had small left to right shunt to terminate the operation. After the procedure, to assess mid-to-long term the efficacy of interventional occlusion and common post-procedure complications, patients were followed up with Electrocardiogram (ECG) and/or 24-hr Holter, Transthoracic echocardiography (TTE), Chest radiograph, etc., at 1, 3, 6, 12 months and annually thereafter for a total minimum 5 years of observation period.
Results During perioperative and follow-up period, there was no cases of death or requirement of permanent pacemaker or severe valve regurgitation surgery or other severe complications. There was no mild increase of aortic valve and pulmonary valve regurgitation, infective endocarditis, pericardial tamponade or other secondary complications. 36 patients were successfully occluded (success rate 92.3%). There were 1 case of occlude displacement (2.6%), 1 case of residual shunt (2.6%), and 1 case of acute hemolysis (2.6%). There were 10 cases of perioperative mild aortic regurgitation (25.6%), In 2 cases (5.1%), the aortic regurgitation flow increased from mild to moderate after the occluder was placed during the operation, and surgical repair was performed after the intervention was terminated. There were 8 cases of Arrhythmia (20.5%). 2 cases of severe aortic valve prolapse with large defects requiring surgical intervention were found during intraoperative left ventricular angiography (5.1%). 7 cases (17.9%) of combined mild aortic regurgitation were found during follow-up, among which there were 2 cases (5.1%) were new-onset mild aortic regurgitation, and 2 cases (5.1%) of arrhythmia with incomplete right bundle branch block and premature atrial contractions. Post interventional occlusion treatment, the mid-to-long term follow-up showed no significant increase in aortic regurgitation , and the occurrence of arrhythmia was significantly reduced compared to the perioperative period (P<0.05).
Conclusion Transcatheter interventional treatment of IVSD<8 mm features small incision, high success rate, low complication rate post treatment and during mid-to-long term follow-up, especially the incidence of increased aortic regurgitation and severe arrhythmia are low, mid-to-long term follow-up observation showed good patient outcome.
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