The clinical value of imaging analysis in transcatheter closure of ventricular septal defect by using the occluder

Objective: To discuss the clinical value of left ventriculography and aortography in performing transcatheter closure of ventricular septal defect (VSD) by using the occluder. Methods: During the period from January 2009 to February 2011, a total of 106 patients with VSD were encountered in the hospital. Transcatheter closure by using the occluder was carried out in all patients. Left ventriculography and aortography (LAO 45°-55° + CRA 25°) were performed before and after the closure procedure. Larger angle projection (LAO 75° + CRA 35°) was also employed in order to distinguish the intracristal VSD from infracristal VSD, while RAO 35° was adopted for angiography of subpulmonic VSD. The size of left ventricular defect shunt and the distance from the defect to the aortic valve were measured. The transcatheter closure procedure was performed. The preoperative and postoperative imaging findings of left ventriculography and aortography were analyzed. Results: VSD was successfully occluded in a total of 97 cases and no complications occurred. Among these cases, small intracristal VSD was seen in 7 and infracristal VSD in 12, and all of them were successfully occluded by using the nitinol asymmetric occluder. One case was affected with muscular VSD and the remaining 77 cases suffered from perimembranous VSD. In two cases, echocardiographic diagnosis was infracristal VSD but left ventriculographic diagnosis was perimembranous VSD. In other 8 cases, the diagnosis made by echocardiography was perimembranous VSD, while the diagnosis made by left ventriculography was infracristal VSD. The procedure was unsuccessful in 9 patients, and all of them were intracristal VSD which were confirmed by left ventriculography, but echocardiography diagnosed infracristal VSD in only 2 and perimembranous VSD in one of these 9 cases. Statistically significant difference in diagnosing infracristal and intracristal VSD existed between left ventriculography and echocardiography (P<0.05), while no significant difference in diagnosing perimembranous and muscular VSD existed between the two examination methods (P>0.05). Conclusion: The imaging determination of VSD type, including ventriculography and aortography, is very important for successful performing the transcatheter closure procedure. (authors)