Background. With the rapid development of transcatheter techniques and instruments, transcatheter occlusion for patients with perimembranous ventricular septal defect (pVSD) and aortic valve prolapse (AVP) was constantly being tried, while the efficacy and safety of pVSD with AVP remain controversial. Objective. The aim of this study was to evaluate long-term efficacy and safety of transcatheter occlusion of pVSD with AVP. Methods. We retrospectively analyzed 164 children with pVSD and AVP who underwent transcatheter occlusion between January 2013 and November 2014. AVP was divided into 3 degrees according to right coronary leaflet morphology at end-diastole during aortic root angiography. Patient demographic and clinical data were collected. Results. There were 97 males and 67 females (median age, 40.0 (30.0–62.7) months; average weight, 16.94 ± 9.02 kg). Mild (n = 63), moderate (n = 89), and severe (n = 12) AVP success rates were 93.7%, 89.9%, and 58.3%, respectively. Immediately after procedure, there was no new-onset aortic regurgitation (AR) above trivial degree, residual shunt above mild degree, or complications requiring medication or operation, except for 1 patient who developed transient complete atrioventricular block. During follow-up, 1 mild AVP patient aggravated from mild to moderate AR and 1 moderate AVP patient aggravated from trivial to moderate AR. The new-onset AR in mild, moderate, and severe AVP was 2%, 1.8%, and 20%, respectively. AR disappeared in 17 patients. Residual shunt occurred in 9 patients after procedure, 4 of which disappeared during the follow-up period. No serious complications occurred in any patient during follow-up. Five-year cardiovascular event-free survival rates for mild, moderate, and severe AVP were 89.6%, 94.5%, and 80.0%, respectively. Conclusion. Transcatheter occlusion of pVSD with mild and moderate AVP has a high success rate and few complications, which is safe and effective in long-term follow-up. Transcatheter occlusion of pVSD with severe AVP has low success rates and high AR incidence. Therefore, transcatheter occlusion of pVSD with AVP is recommended for mild to moderate, but not severe, AVP.

中文翻译：

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主动脉瓣脱垂的膜周室间隔缺损经导管封堵的安全性和有效性：一项为期六年的随访研究

背景。随着经导管技术和器械的快速发展，膜周室间隔缺损（pVSD）和主动脉瓣脱垂（AVP）患者的经导管封堵不断被尝试，而pVSD联合AVP的疗效和安全性仍存在争议。客观。本研究的目的是评估经导管封堵 pVSD 与 AVP 的长期疗效和安全性。方法。我们回顾性分析了2013年1月至2014年11月期间接受经导管封堵术的164例pVSD合并AVP患儿。在主动脉根部血管造影期间，根据右冠状动脉瓣叶形态在舒张末期将AVP分为3度。收集患者人口统计学和临床​​数据。结果. 男性 97 例，女性 67 例（中位年龄 40.0（30.0-62.7）个月；平均体重 16.94 ± 9.02 kg）。轻度 ( n  = 63)、中度 ( n  = 89) 和重度 ( n = 12) AVP 成功率分别为 93.7%、89.9% 和 58.3%。术后即刻，除1例患者出现短暂性完全性房室传导阻滞外，均无轻度以上新发主动脉瓣关闭不全（AR）、轻度以上残余分流或需要药物或手术的并发症。随访期间，1 名轻度 AVP 患者从轻度至中度 AR 加重，1 名中度 AVP 患者从轻微至中度 AR 加重。轻度、中度和重度 AVP 的新发 AR 分别为 2%、1.8% 和 20%。17 名患者 AR 消失。9例患者术后出现残余分流，其中4例在随访期间消失。随访期间所有患者均未出现严重并发症。轻度、中度和重度 AVP 的 5 年无心血管事件生存率为 89。结论。轻、中度AVP经导管封堵pVSD成功率高，并发症少，长期随访安全有效。严重 AVP 的 pVSD 经导管闭塞成功率低且 AR 发生率高。因此，对于轻度至中度但不严重的 AVP，建议使用 AVP 经导管封堵 pVSD。