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The purpose of comparative analysis of the transcatheter the interventional transcatheter therapy and surgical treatment of children with efficacy and complications of ventricular septal defect (ventricular septal defect, VSD), to provide the basis for clinical choose the best treatment. Methods retrospective study, analysis of the May 2004 to April 2010 in our hospital medical intervention therapy treatment and surgical thoracotomy VSD patients, the two groups were compared the efficacy and complications. Results intervention group 408 (male 198, female 210) cases, using transcatheter ventricular septal defect closure; surgical group for patients with concomitant surgical VSD 440 (male 243, female 197) were using cardiopulmonary bypass under direct vision repair the VSD. Intervention group and the average age of the surgical group (5.14 ± 3.23) years and (2.14 ± 2.85) (P lt; 0.001); the average VSD size were (5.27 ± 3.04) mm and (13.24 ± 5.00) mm (P lt; 0.001). The intervention group and the success rate of the surgery group were 99.26% and 97.73% (P = 0.123). Complications of transcatheter closure: closure of postoperative residual shunt in 46 cases (11.27%), new-onset valvular regurgitation in 51 cases (12.47%), which aortic regurgitation in 35 cases (8.58%), tricuspid regurgitation 2 cases (0.49%), mitral regurgitation in 2 cases (0.49%), pulmonary regurgitation in 12 cases (2.94%), various arrhythmias in 125 cases (30.63%), including one case after transcatheter closure 2d appear The paroxysmal III degree atrioventricular block (AVB) after conservative treatment Ⅰ degree AVB; 1 case of plugging 3d concurrency - Adams syndrome, ECG paroxysmal III degree AVB prompted install a temporary pacemaker 6d medical treatment 10d discharged after recovery. Eight cases after closure of hemolytic (1.96%), of which seven were cured by 5 ~ 7d conservative treatment, and one cases conservative treatment fails to turn surgical treatment. Patients 1d found the occluders off turn surgical treatment. After closure puncture site hematoma, improved and discharged by local pressure dressing. Surgical complications: post-surgical residual shunt in 92 cases (21.40%), the new hair valvular regurgitation in 140 cases (32.56%), which aortic regurgitation in 84 cases (19.53%), 2 cases of tricuspid regurgitation ( 0.47%), mitral regurgitation in 43 cases (10%), pulmonary valve regurgitation in 60 cases (13.95%), arrhythmia in 208 cases (61.00%), 20 patients Ⅲ ° AVB (4.65%), all temporary pacemaker installed, of which six cases occurred a transient the Ш-degree AVB, 11 patients recovered after conservative treatment, 3 patients required to install permanent cardiac pacemaker therapy. Pulmonary complications in 100 cases (23.26%), including pneumonia, 62 cases, 38 cases of atelectasis. Postoperative low cardiac output syndrome (LCOS) 25 cases, 6 cases of pericardial effusion in 30 cases of pulmonary hypertension crisis, a small amount of the hemopericardium gas nine cases, a small amount of pleural effusion in 18 cases, a small amount of pneumomediastinum 14 cases 12 cases of pneumothorax, subcutaneous emphysema 4 cases, 4 cases of laryngeal edema, hoarseness. Seven cases of fungal infection, antifungal therapy cure. Septicemia, anti-infection treatment for two weeks to cure. The postoperative bleeding immediately line mediastinal exploration hemostasis. One cases of postoperative the 5d stress ulcer after medical treatment improved and discharged. Patients the 13d line B-ultrasound found the left femoral vein thrombosis, brain injury cases, subarachnoid hemorrhage patients, pulmonary hemorrhage patients cured by medical treatment. The average amount of blood transfusion for the surgical group (409.35 ± 251.97) ml, intervention group 1 patients need a blood transfusion; postoperative hospital stay for the intervention group and the surgical treatment group (5.27 ± 0.79) d and (11.17 ± 4.94, respectively) d (P lt; 0.001). Interventional the residual shunt treatment group, new hair valvular regurgitation, arrhythmias were significantly lower than the surgical group (P lt; 0.001). Transcatheter closure of VSD Conclusion Transcatheter efficacy and surgery under cardiopulmonary bypass thoracotomy quite, fewer complications, catheter interventional treatment alternative to surgery to become the preferred method of treatment part perimembranous VSD.
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