Congenital Heart Disease
Vol.16, No.5, 2021, pp.519-528, doi:10.32604/CHD.2021.015527
Wenqian Zhang, Chaojie Wang, Lingmei Zhou, Junjie Li, Jijun Shi, Yumei Xie, Mingyang Qian, Shushui Wang, Zhiwei Zhang
This study aims to evaluate the morphology and function of the aortic valve after transcatheter closure of ventricular septal defect (VSD) with aortic valve prolapse (AVP) abased on clinical and radiological outcomes.
From January 2013 to November 2014, 164 consecutive patients (97 males, 59.1%) with VSD and AVP were treated by transcatheter closure. The patients were divided into the mild AVP group (n = 63), moderate AVP group (n = 89) and severe AVP group (n = 12). The clinical and radiological outcomes of these patients were analyzed retrospectively.
In total, 146 (89.0%) patients were successfully treated with VSD occluders, including 59/63 (93.7%) with mild AVP, 80/89 (89.9%) with moderate AVP and 7/12 (58.3%) with severe AVP. The degree of AVP was ameliorated or disappeared in 39 (26.7%) patients, and remained unchanged in 103 (70.5%) patients after the intervention. In the 35 patients who initially had trivial-to-moderate aortic regurgitation (AR), the degree of AR was ameliorated or disappeared in 25 (71.4%) patients, aggravated from trivial to mild AR in 1 (2.9%) patient, and remained unchanged in 9 (25.7%) patients. In 111 patients without AR, 1 (0.9%) patient had mild AR and 24 (21.6%) patients had trivial AR after intervention. The depth and width of the prolapsed aortic valve decreased after transcatheter closure of VSD in all three groups. During the 70-month (range, 54–77) follow-up period, no patients with AVP and AR needed an aortic valve intervention.
Transcatheter closure of VSD with AVP is feasible. The morphology and function of the prolapsed aortic valve improved and remained stable for a long period after intervention.
Established therapies for ventricular septal defects (VSD) include transcatheter or surgical closure. An appealing minimal invasive strategy of a transcatheter procedure is preferred if feasible. Hence, the fundamental decision deals with exactly the question: is this VSD suitable for transcatheter closure? Zhang et al dealt with the topic of transcatheter closure of a VSD in patients with aortic valve prolaps (AVP) in their article “Morphology and Function of the Aortic Valve after Transcatheter Closure of Ventricular Septal Defect with Aortic Valve Prolaps”. Of 164 patients, 146 (89%) were successfully treated with VSD occluders. The authors describe the interventional procedure technique, devices, and clearly show preinterventional patient characteristics, including size of VSD, degree of aortic regurgitation, degree of tricuspid regurgitation, mean pulmonary artery pressure and ratio of pulmonary and systemic blood flow (QP/QS). The degree of AVP was ameliorated or disappeared in 39 (26.7%) patients, and remained unchanged in 103 (70.5%) patients. Subgroup analysis according to the preoperative degree of aortic regurgitation was performed and gives a deeper insight. During a 70-month follow-up period, no patient needed an aortic valve intervention. This article is a must read for specialist in centers offering transcatheter and surgical VSD closure.