Catheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: Initial clinical experience

Abstract

The surgical closure of membranous ventricular septal defects (VSDs) is associated with morbidity and low mortality. Six patients with VSDs located in the membranous part of the ventricular septum underwent an attempt of catheter closure using a new device specifically designed for the membranous septum. Patients ranged in age from 3.5 to 19 years (median, 10.5 years) and in weight from 15 to 45 kg (median, 29 kg). One patient with associated pulmonary valve stenosis had shortness of breath. The median Qp/Qs ratio was 1.6 (range, 1.1-3) and the median left ventricle end-diastolic dimension (LVEDD) was 44 mm (range, 38-52 mm). The devices were deployed via the femoral vein using 7-8 Fr sheaths. There was immediate complete closure in all patients. One patient developed trivial aortic regurgitation. There were no other complications. The median fluoroscopy time was 15.5 min (range, 10.3-53.4 min). At 24 hr, all patients were doing well. The median LVEDD decreased to 38 mm (range, 34-47 mm). One patient continued to have trace aortic regurgitation. All patients were discharged home after 24 hr. Transcatheter occlusion of membranous VSDs is safe and effective. Further clinical trials are underway to assess the long-term safety and results.

Atrioventricular Block: A Serious Complication in and After Transcatheter Closure of Perimembranous Ventricular Septal Defects

“…1 -4 Preliminary results following the use of this device were encouraging, and the incidence of complications such as aortic and tricuspid regurgitation was low. 1,2,5 However, the complication of atrioventricular block (AVB) emerged due to the close proximity of a PMVSD to the conduction system. 6,7 In this article, we report the incidence of AVBs during and after transcatheter closure of PMVSD with the Amplazter eccentric PMVSD occluder, and the outcome of the complication in our center.…”

Transcatheter Device Closure of Congenital and Postoperative Residual Ventricular Septal Defects

“…8 -10 To date, published reports of this approach are limited to small series with relatively limited follow-up. [11][12][13][14][15][16][17][18][19] Since 1989, 168 patients with unrepaired congenital VSDs and postoperative residual VSDs have undergone transcatheter closure with successive generations of STARFlex-type devices as a part of approved regulatory trials. A subset of this experience was used to obtain FDA approval of the second-generation CardioSEAL device for closure of specific VSDs (NMT Medical Inc).…”

Percutaneous Closure of Perimembranous Ventricular Septal Defect with Amplatzer Device

“…The device is simple, requires a relatively low profile sheath for implantation, while the short waist of the device obviates protrusion into both ventricles and allows recapturing and repositioning if required [9][10][11][12][13]. The eccentric configuration of the device especially on the superior surface imparts a safety from impinging on aortic valve and its function.…”