Objective: To look at the presentation, treatment and outcome of patients who developed atrioventricular block after transcatheter closure of a perimembranous ventricular septal defect (PMVSD) with the Amplatzer PMVSD device. Setting: Three tertiary referral centres for paediatric cardiology in two countries. Results: All three patients presented within 10 days of the procedure. All three patients were treated with intravenous steroids. A permanent pacemaker was inserted in all patients but no pacemaker required activation after two months. Conclusion: Complete atrioventricular block occurring in the weeks after device occlusion of a PMVSD appears to resolve quickly. Continued involvement in multicentre device databases is required to monitor safety.

No abstract

Cardiac operations were preformed in 499 children from January 1998 through December 1999. Their median age was 263 days. A positive culture from blood, bronchoalveolar lavage, wound, or central catheter was obtained in 110 patients (22%). Age, sex, presence of pulmonary hypertension, body surface area, ratio of body surface area to oxygenator surface area, whether heart surgery was open or closed, and the duration of the operation, cardiopulmonary bypass, intubation, and intensive care were analyzed. Patients who developed infections were significantly younger, with smaller body surface areas and disparity with the oxygenator surface area, longer operative and bypass times, extended intubation, and prolonged intensive care. There was a significant correlation between infection and pulmonary hypertension. Sex and type of operation were not predictors of infection.

In some patients, so cold hybrid cardiologic procedures are performed whereas a heart is exposed surgically to puncture directly the heart cavity. After performing the interventional procedure, the opening in ventricular wall is closed surgically. We present our initial experience with closing the right ventricular (RV) cavity opening with the muscular ventricular septal defect Amplatzer occluder (A-MVSDO). In four sheep, heart was exposed surgically and punctured under direct vision by needle and guide wire, 14F and 26F sheath were introduced into right ventricle and the A-MVSDO was introduced causing closure of the RV opening. In all four cases, the occluder was successfully placed closing the opening in RV. No major bleeding after occlusion was observed. Following complications were observed: pneumothorax in two animals, rhythm disturbances and thrombus suspected in one. A-MVSDO occluder seems to be a useful device to close RV opening after hybrid interventional cardiologic procedure.

Growing experience in interventional cardiology leads to the use of large diameter of vascular equipment. In some instances, the so-called hybrid procedures are performed. After performing the interventional procedure, the opening in ventricular wall is closed surgically. Our intention was to check if the MVSDO can be used to close the perforation in the heart after the interventional cardiology procedure performed through the left ventricular (LV) free wall. In three pigs under general anesthesia, the heart was exposed through a small substernal incision. The LV was punctured and an 18F sheath was introduced into the LV. A 14 mm MVSDO was inserted through the 10F Delivery System. Using both the echocardiographic and angiographic guidance, the MVSDO was placed on the LV wall to close the opening in the LV. Time and volume of bleeding was recorded. In all cases the occluder was successfully placed closing the opening, bleeding observed after deployment of occluder lasted for approximately 2 min. We think MVSD occluder can be used to close the LV free wall perforation after hybrid interventional cardiac procedure. Early bleeding through MVSDO might be resolved by the manufacturing of new occluder with better sealing properties.