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Per-ventricular closure of perimembranous Ventricular septal defect in pediatric patient - Long-term result
Qi An, Da Zhu.
West China hospital of Sichuan University, Chengdu, China.

OBJECTIVE: Perventricular closure of pm-VSD is a novel technique which been reported in the literature, however follow-up data is still limited. We sought to analyze safety, efficacy and long term follow-up results of perventricular closure of pm-VSD in selected pediatric patient.
METHODS: Between January 2007 and June 2008, 42 pediatric patients underwent per-ventricular closure of pm-VSD at our institution. A domestic made VSD device (concentric or eccentric - SHAMA Corp, Shanghai, China) was used during the procedure. 24h- Holter EKG as well as Echocardiogram were used to detect the complication during hospital stay and follow-up.
RESULTS: Mean age at closure was 3.2 ± 1.0 years (range from 1.5 - 6 years), per-ventricular closure was successfully done in 34 patients (81%). Among these patients, the mean VSD size was 5.9± 2.7mm with mean device size 7.3±2.0. No deaths occurred. Total occlusion rate was 82% at completion of the procedure, rising 91% to at discharge and 100% during follow-up. A total of 7 early complication occurred, mainly due to transit device induced aortic (2 patients) and tricuspid valve (4 patients) regurgitation, transit complete right bundle branch block (CRBBB) (1 patient). The median follow-up time was 4.5 years (range 4 to 5.5). The most significant long-term complication was complete atrioventricular block (c-AVB) which required pacemaker implantation in 1 subject (2.9%). Bundle branch block was also noted in 6 patients (17%) through Holter EKG during follow-up (2-CRBBB, 2 incomplete right bundle block and 2 left posterior fascicular block). Device induced valve regurgitation was noted in 4 patients during follow-up (2 aortic and 2 tricuspid ) with all in trivial grade
CONCLUSIONS: In the current era and in experienced hands, perventricular closure of pm-VSD can be performed safely in selected pediatric patient with good long term outcome.


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