Update of Transcatheter Closure of Ventricular Septal Defect in China

1. Update of Transcatheter Closure of Ventricular Septal Defect in China Yong-wen Qin Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai

2. 1、The number and quality of VSD intervention improved during past ten years

3. The first cases of VSD intervention in our center The first pmVSD patients treated with symmetric occluder (2001.12，21) The first post-MI VSD patient treated with symmetric occluder (2001.10)

4. Patient number * year Development of CHD intervention from 1990s-2011 in China

5. VSD intervention in last 3 years in China（394 hospitals）

6. 2、Three kind of VSD devices invented and clinical use in China

7. Modified VSD device in China symmetric occluder thin waist occluder asymmetric occluder

8. Schematic diagram of ventricular septal defect occluder

9. The classification of VSD by ventriculography Individualization choice of the occluder according to anatomy of VSD • A tubular • B window-like • C aneurysmal • D infundibular

10. Infundibular VSD symmetric occluder

11. How to choose the occluder according to VSD Intracristal VSD asymmetric occluder

12. Intracristal VSD

13. Intracristal VSD Symmetric device ---Aortic valve regurgitation asymmetric device ---no aortic valve regurgitation

14. Intracristal VSD

15. Intracristal VSD

16. Intracristal VSD Aortic valve regurgitation--- device inclined to one side The direction of left disk marker should be apex

17. Intracristal VSD When the marker turn to apex, aortic valve regurgitation became trace

18. Intracristal VSD No aortic valve regurgitation-- long rim direction pointed to cardiac apex

19. VSD PV Echo: subpulmonary VSD---near PV

20. VSD complicared with aortic valve prolapse

21. VSD 5mm ----- 0 rim device (10mm)

22. Postoperation, no aortic regurgitation However, occluder maybe oversized

24. VSD 7mm, near aortic valve

26. Echo: subpulmonary VSD---near PV

27. Device 9mm (L), change to Device 11mm (R)

28. no aortic valve regurgitation

30. Multi-hole VSD---device choice multi-hole VSD thin waist occluder

31. One device close three holes

32. VSD with two holes VSD1 VSD1 VSD2 device For VSD2

33. Two device for two holes

34. Large VSD -1

35. Large VSD -2 14mm A6B2 device

36. Large VSD -3 No aoric valve regurgitation ,no TVR

37. PDA device for large VSD

38. PDA device for large VSD 20mm PDA device

39. PDA device for large VSD

40. Post-myocardial infarction VSD

41. Postoperative residual perimembranous VSD Transcatheter closure of postoperative residual perimembranous VSD

42. PS and large VSD VSD 17mm, device 24mm

43. 3、Conduction Block complicated with VSD Intervention: experience in china

44. Past Literature Review in China

45. Clinial trial data of Amplatzer VSD device Catheter Cardiovasc Interv. 2006, 68(4):620-8. (n=100) J Am Coll Cardiol. 2006, 47(2): 319-25. (n=35) Eur Heart J. 2007, 28: 2361. (n=430)

46. The data on VSD occluder in China from 21 centers (N=9311, 2007) • Success rate 96.45% • Death 0.05% (5) • Transient cAVB 0.63% (59) • PPM 0.09% (8)

47. 2011 registry data in China • 5474 cases with vsd in 394 hospital in china • PPM 1case

48. The data from Changhai hospital (2001-2012) • 2001-2002, 196 cases underwent percutaneous procedure (using symmetry device), no cAVB • 2003-2006, among 300 cases (Symmetry , Eccentric、thin waist devices), 11 cases complicated transient 3rd degree AVB, permanent pacemaker occur in 1 case • 2007-2012, sequence 550 cases with Symmetry , Eccentric,thin waist devices, cAVB occur 1 patient

49. The possible reason of increase AVB from 2003 to 2006 ? • Patients: patients non-selected, consecutive patients admitted • Doctors: personnel stability, and operation technology maturity • Indication: increased intracristal multi-holes and aneurysm type VSD • Devices: Application of asymmetric occluder

50. Device waist length and AVB • 2001--2003---more than 3.5 mm---no case with AVB • 2003--2006---less than 2.5mm---12/300 with AVB • 2007--2012---more than 3.5mm---no case with AVB