Document Detail

Closure of perimembranous ventricular septal defect using transcatheter technique versus surgical repair.
MedLine Citation:
PMID:  16380857     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Since the Membr VSD occluders have been introduced into clinical practice it is now possible to compare two treatment methods -- surgical and percutaneous. AIM: Assessment of the effectiveness and risk of complications in patients with perimembranous ventricular septal defect (VSD) treated with the Membr VSD occluder or surgery as well as comparison of postprocedural left and right ventricular systolic functions. METHODS: The study involved 11 children with perimembranous VSD treated with occluder implantation (Group A) and 12 children with surgical repair (Group C). Groups A and C differed slightly in terms of age of patients (p=0.026), but had similar mean weights (p=0.103), pulmonary to systemic flow ratios (Qp: Qs, p=0.929) and follow-up duration after the procedure. No significant differences were observed between the two groups in terms of left ventricular systolic function [left ventricular ejection fraction (EF, p=0.567)], diastolic function [mitral flow E/A ratio (p=0.975)], E deceleration time (DCT, p=0.346), isovolumetric relaxation time (IVRT, p=0.606), heart rate (HR, p=0.133) or left ventricular diameter (LV) on transthoracic echocardiography (TTE) before VSD closure. TEE was performed in all patients and the parameters listed above were measured within 3 to 16 months after the procedure, and then intra- and inter-group comparisons were carried out. Additionally, mitral (MV), tricuspid (TV) and aortic (Ao) valve regurgitations were evaluated. RESULTS: Tricuspid (TR, p=0.028) and mitral regurgitation (MR, p=0.043) decreased significantly after closure of VSD with the Membr VSDO. MR was significantly smaller in patients treated with the occluder than in those after surgery (p=0.026). Postprocedural TR (p=0.486) and aortic regurgitation (AR, 0.607) did not differ significantly between the two groups. Left ventricular EF was significantly (p=0.004) lower and HR higher (0.043) after surgery than in children treated with the occluder. No significant differences of the diastolic function were found - E/A (p=0.88), DCT (p=0.413), IVRT (p=0.09). CONCLUSIONS: 1. During the mid-term follow-up left ventricular EF was higher in patients after Membr VSDO occluder implantation than after surgical repair of VSD. 2. Higher EF and reduction of the left ventricular diameter after closure of perimembranous VSD with the occluder may result in a lower incidence and degree of MR in comparison to the subjects operated on.
Małgorzata Pawelec-Wojtalik; Michał Wojtalik; Wojciech Mrówczyński; Rafał Surmacz
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Kardiologia polska     Volume:  63     ISSN:  0022-9032     ISO Abbreviation:  Kardiol Pol     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-28     Completed Date:  2006-07-26     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376352     Medline TA:  Kardiol Pol     Country:  Poland    
Other Details:
Languages:  eng     Pagination:  595-602; discussion 603-4     Citation Subset:  IM    
Pracownia Angiografii i Hemodynamiki SPSK nr 5, ul. Szpitalna 27/33, 60-572 Poznań.
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MeSH Terms
Cardiac Surgical Procedures / methods*
Follow-Up Studies
Heart Catheterization / methods*
Heart Septal Defects, Ventricular / complications,  surgery*
Mitral Valve Insufficiency / diagnosis,  etiology
Severity of Illness Index

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