Aortic regurgitation after closure of ventricular septal defect by transcatheter device: the long-term complication

Han, Yuehu; Li, Hongling; Zhu, Hailong; Sun, Guocheng; Yin, Qiang; Gu, Chengxiong

doi:10.1017/s1047951120000414

Cited by 6 publications

(10 citation statements)

References 10 publications

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“…AR is one of the most common complications after transcatheter occlusion and may be caused by aortic valve injury resulting from a guidewire or occluder-related injury [15][16][17]. At the end of follow-up in this study, 2 patients (1.5%) aggravated to moderate AR, and 3 patients (2.2%) had new-onset mild AR.…”

Section: Discussionmentioning

confidence: 58%

“…e reason may be that the shape of the prolapsed right coronary valve gradually returns to normal [7]. Although Topcuoglu et al have reported late severe AR and right aortic valve perforation during long-term follow-up, surgical removal of the occluder and repair of VSD are needed [16,17]. It is worth noting that late AR also occurs during surgical repair of VSD.…”

Section: Discussionmentioning

confidence: 99%

“…It is worth noting that late AR also occurs during surgical repair of VSD. Aortic valve deformation, AR, and postprocedural residual shunt are risk factors for the occurrence or progression of AR [16].…”

Section: Discussionmentioning

confidence: 99%

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Safety and Efficacy of Transcatheter Occlusion of Perimembranous Ventricular Septal Defect with Aortic Valve Prolapse: A Six-Year Follow-Up Study

Zhang

Wang

Liu

et al. 2021

Journal of Interventional Cardiology

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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.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

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Safety and Efficacy of Transcatheter Occlusion of Perimembranous Ventricular Septal Defect with Aortic Valve Prolapse: A Six-Year Follow-Up Study

Zhang

Wang

Liu

et al. 2021

Journal of Interventional Cardiology

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“…Aortic regurgitation implies aortic valve incompetence with a risk of developing left ventricular dysfunction, heart failure, and even death ( 12 ). Aortic regurgitation is one of the major considerations in the transcatheter closure of VSD ( 13 ). Surgery performed because of aortic regurgitation that occurred during or after the transcatheter procedure has been reported ( 13 , 14 ).…”

Section: Discussionmentioning

confidence: 99%

Unplanned Surgery After Transcatheter Closure of Ventricular Septal Defect in Children: Causes and Risk Factors

Yang

Wu²,

Zhiyuan

et al. 2021

Front. Pediatr.

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Objectives: To evaluate the causes and risk factors of unplanned surgery after transcatheter closure of ventricular septal defect (VSD) in children.Methods: A total of 773 patients with VSD who had the devices transcatheter released between January 2013 and December 2018 in our institution were retrospectively reviewed. Univariate and multivariate analyses were used to identify the risk factors for unplanned surgery.Results: Twenty four patients (3.1%) underwent unplanned surgery after transcatheter closure of VSD. The most common cause for unplanned surgery was new-onset or worsening aortic regurgitation (14/24; 58.3%), followed by occluder migration (4/24; 16.7%), complete atrioventricular block (2/24; 8.3%), severe hemolysis (2/24; 8.3%), residual shunt (1/24; 4.2%), and occluder edge near the tricuspid valve chordae (1/24; 4.2%). Logistic regression analysis revealed that primary aortic valve prolapse (OR: 5.507, 95%CI: 1.673–18.123, P = 0.005); intracristal VSD (OR: 8.731, 95%CI: 2.274–33.527, P = 0.002); eccentric occluder (OR: 4.191, 95%CI: 1.233–14.246, P = 0.022); larger occluder size (OR: 1.645, 95%CI: 1.331–2.033, P < 0.001); and pulmonary artery systolic pressure ≥45 mmHg (OR: 4.003, 95%CI: 1.073–14.941, P = 0.039) were risk factors for unplanned surgery.Conclusions: New-onset or worsening aortic regurgitation was the primary cause for unplanned surgery after transcatheter closure of VSD in children. Primary aortic valve prolapse, intracristal VSD, eccentric occluder, larger occluder size, pulmonary artery systolic pressure ≥45 mmHg could increase the risk of unplanned surgery.

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“…The asymmetric Amplatzer occluder was designed to solve the problem of superior localized VSD dealing with the dilemma of aortic valvar prolapse. [ 9 ] According to previous opinion, the asymmetric Amplatzer occluder is invented to expanded the indication for transcatheter closure of pmVSD. [ 10 , 11 ] So that the asymmetric occluder has been used as an alternation for the failure closure of systematic Amplatzer occluder.…”

Section: Discussionmentioning

confidence: 99%

Re-evaluation of the criteria for asymmetric amplatzer occluders in the closure of perimembranous ventricular septal defects

Liao

et al. 2020

Medicine

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Rationale: To discuss suitable criteria for the application of asymmetric Amplatzer occluders for perimembranous ventricular septal defects (pmVSDs). Patients concerns and diagnoses: We retrospectively studied 18 children with perimembranous VSDs who underwent attempted asymmetric occluder closure between January 2015 and December 2018 in our center. Interventions: Asymmetric Amplatzer occluders were attempted to be placed to all the enrolled patients. We analyzed the diameter of the defects with the receiver operating characteristic curve (ROC) values, the size of the occluders attempted, the presence of aneurysm and the presence of aortic valve prolapse for each patient. Then, for patients who experienced successful device implantation, the therapeutic efficiency was evaluated by follow-up. Outcomes: Only 5 out of a total of 18 patients completed successful device implantation. Compared with failed cases, successful cases demonstrated a significantly smaller VSD size (5.46 ± 1.03 mm vs. 8.73 ± 2.33 mm, P = 0.012) and had a low ratio of aortic valvar prolapse (20% vs. 76.92%, P = 0.026). Four out of 5 successful cases involved arrhythmia complications, but the rhythm of the heart recovered after drug treatment. According to the ROC and Youden analyses, the cut-off value of the defect size for successful asymmetric Amplatzer occluder implantation was no larger than 5.7 mm. Lessons: The application of an asymmetric Amplatzer occluder expands the range of indications for patients with superior localized VSD but is largely limited in cases with aortic valvar prolapse and large VSD sizes. All successful cases recovered from arrhythmia postprocedure.

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Aortic regurgitation after closure of ventricular septal defect by transcatheter device: the long-term complication

Cited by 6 publications

References 10 publications

Safety and Efficacy of Transcatheter Occlusion of Perimembranous Ventricular Septal Defect with Aortic Valve Prolapse: A Six-Year Follow-Up Study

Safety and Efficacy of Transcatheter Occlusion of Perimembranous Ventricular Septal Defect with Aortic Valve Prolapse: A Six-Year Follow-Up Study

Unplanned Surgery After Transcatheter Closure of Ventricular Septal Defect in Children: Causes and Risk Factors

Re-evaluation of the criteria for asymmetric amplatzer occluders in the closure of perimembranous ventricular septal defects

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