Huang JIANG-SHAN, Sun KAI- PENG, Xu NING, Zhang GUI- CAN, Chen QIANG

Transözofageal ekokardiyografi eşliğinde ventriküler septal defektlerin transtorasik olarak kapatılması

Amaç: Bu çalışmada tamamen transözofageal ekokardiyografi eşliğinde ventriküler septal defektlerin transtorasik olarak kapatılmasının etkinliği ve güvenliliği değerlendirildi. Çalışma planı: Nisan 2017 - Kasım 2018 tarihleri arasında merkezimizde ventriküler septal defektlerin transtorasik olarak kapatıldığı toplam 119 hasta (62 erkek, 57 kadın; ort. yaş 2.1±5.2 yıl; dağılım, 11 ay-50 yıl) çalışmaya alındı. Hastaların tümü ventriküler septal defektlerin çapı ve morfolojik özellikleri açısından transtorasik ekokardiyografi ile değerlendirildi. İşlem sırasında transtorasik ekokardiyografi oklüder yerleştirilmesi için kullanılan tek kılavuz araç idi. Bulgular: Hastaların 116’sında transtorasik cihaz kapama işlemi başarılı idi. Bir hastada yeni başlangıçlı aort yetmezliği ve bir diğer hastada cihaz yerleştirildikten sonra şiddetli aritmiler nedeniyle olmak üzere, iki hastada cerrahi onarıma geçildi. Bir hastaya hastane yatışı sırasında oklüder migrasyonu nedeniyle ikinci bir ameliyat yapıldı. İlk girişimde 106 ventriküler septal defekt oklüderi doğru bir şekilde yerleştirildi. On hastada transtorasik ekokardiyografide güvenli olmayan yerleşim veya önemli düzeyde rezidüel şant izlendi. İlk takılan cihaz asimetrik cihaz veya daha kapsamlı bir oklüder ile değiştirildi ve nihayetinde memnun edici sonuçlar alındı. Takip sırasında yeni başlangıçlı aort yetmezliği, rezidüel şant, tam kalp bloku veya cihazın yerinden çıkması gibi komplikasyonlar gözlenmedi. Sonuç: Ventriküler septal defektlerin tamamen transtorasik ekokardiyografi eşliğinde transtorasik olarak kapatılması güvenli ve etkili bir yöntemdir.

Transthoracic closure of ventricular septal defects guided by transesophageal echocardiography

Background: This study aims to investigate the effectiveness andsafety of transthoracic closure of ventricular septal defects totallyguided by transesophageal echocardiography.Methods: A total of 119 patients (62 males, 57 females; meanage 2.1±5.2 years; range, 11 months to 50 years) who underwenttransthoracic closure of ventricular septal defects in our centerbetween April 2017 and November 2018 were included. All patientswere evaluated in terms of the diameter and morphological featuresof ventricular septal defects via transesophageal echocardiography.During the procedure, transthoracic echocardiography was used asthe only guiding tool for occluder implantation.Results: Of the patients, 116 underwent successful transthoracicdevice closure procedure. Two patients were switched to surgicalrepair due to new-onset aortic regurgitation in one patient andsevere arrhythmias after device release in the other patient. Onepatient underwent a second operation for occluder migration duringthe hospital stay. In the first attempt, 106 ventricular septal defectoccluders were correctly positioned. Transthoracic echocardiographyrevealed the insecure position or significant residual shunting in10 patients. The original device was replaced with an asymmetricdevice or a more extensive occluder, and satisfactory resultswere finally obtained. No complications such as new-onset aorticregurgitation, residual shunt, complete heart block, or devicedislodgement occurred during follow-up.Conclusion: Transthoracic closure of ventricular septal defectsunder the total guidance of transthoracic echocardiography is a safeand effective method.

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