Hacettepe Üniversitesi Ihsan Doğramacı Çocuk Hastanesinde Perimembranöz ve Musküler Ventriküler Kapatılmaları ve Komplikasyonları

Abstract

During the last years, “amplatzer septal occluder” devices are being used in many centres in the transcatheter and perventricular closure of perimembranous and muscular ventricular septal defects (VSD). Even though the success rate of closure defects with these devices has reached 97,4%, major complications such as full AV block, severe tricuspid insufficiency, severe aortic insufficiency, and severe residual shunt are still encountered in many centres with changing rates due to the difficulty of the procedure, devices being big in size, and localisation of the defects. In this study, files of 82 cases from the Division of Pediatric Cardiology whose VSD's were planned to be shutdown with transcatheter and perventricular methods were retrospectively analyzed. From 82 cases 69 were chosen for the shutdown procedure. Of 69 cases 50,7% were females, 49,3% males, and their treatment age was 10,6 (3 months-34 years). The complications of the cases were divided according to the time of the complication as early (24-48 hours after or during the process) or later; and according to severity of complications seen as major and minor. From sixty nine cases, 63 (41 perimembranous, 22 muscular) were successful (91.3%). Defects of thirteen cases (15.9%) were not suitable for closing. And in six cases it was not achieved (8,6%). In our study 15,94% major complications of which 7,25% early and 8,7% late were seen. 5.8% of the complications in the late period caused cases which need replacement due to severe tricuspid insufficiency. 10.1% of major complications underwent a surgical treatment. From late period cases, in 27,5% minimal tricuspid insufficiency, in 10,1% minimal aortic insufficiency, and in 5,8% mild residual shunt were detected. As a result, most of the complications seen in this study, both in the late period and during the process, are associated with tricuspid valve. While complications encountered in the early period (4.35%) can be fully fixed with surgical operations, those seen in the late period (5.8%) require tricuspid valve replacement. Therefore, we believe transcatheter shutdowns of VSDs and / or the use of these devices should be re-considered.