Abstract:

OBJECTIVE: To investigate the feasibility, safety and efficacy of domestic small waist big edge-type occluder for patients with multiple outlets sac-type membranous ventricular septal defection (VSD), and summarize its technical problems and the choice of treatment strategies.

METHODS: A total of 20 patients with sac-type membranous VSD, underwent left ventricular angiography at left anterior oblique 45°-60° plus CAOD 20°-25°; the left ventricular entrance diameters were 7-21 (10.9 ± 5.2) mm, more than 2 outlets in the right ventricular surfaces, and the largest outlet diameters were 3-10 (4.8 ± 2.9) mm. According to the result from transthoracic echocardiography (TTE) and angiography, the sac-bag size, shape, location, extent of tissue adhesion, and stability were determined. Different types of small waist big edge-type occluder were implanted, and the occluder diameter was 5-14 (4.6±   2.8) mm. Following 15 minutes of blocking, the immediate effects of occlusion were observed through repeating left ventricular angiography and TTE. All patients rechecked ultrasonic cardiography and electrocardiogram at 5-7 days of hospital stay, and 1, 3, 6 and 12 months following surgery. All patients took aspirin tablets for 6 months.

RESULTS: Of 20 patients, 17 cases underwent domestic small waist big edge occluder, blocked successfully through left ventricular entrance, 2 cases were successful using symmetry block, and 1 case was failed. Intraoperative occlusion did not affect the aortic valve and tricuspid valve function. There were 1 case with left bundle branch block and 1 case with right bundle branch block during the operation, and all recovered within a week by using hormone therapy. After 6 months, the cardiac sizes were reduced to different degrees.

CONCLUSION: It is safe and effective to treat multiple outlets sac-shaped membranous VSD with domestic small waist big edge-type occluder. The key technology, according to the sac size, shape, firmness, outlet orientation, import size, and the size of aortic stump, is to determine the block site and to select a suitable occluder.