Comparative outcomes of two competitive devices for retrograde closure of perimembranous ventricular septal defects

Abstract

BackgroundRetrograde closure of perimembranous ventricular septal defects (pmVSDs) is a well-established procedure. However, interventionists are still looking for the best closure device.MethodsWe performed a single-center retrospective review of 5-year-experience (from July 2015 to July 2020) with retrograde closure of pmVSDs using AmplatzerTM Duct Occluder II (ADOII) and KONAR-MF™ VSD occluder (MFO). Deficient sub-aortic rim (SAR) (≤2.5 mm for MFO and ≤3 mm for ADOII) was an exclusion criterion in defects with a diameter ratio (right-side exit/left-side entry) > 0.5.ResultsWe identified 77 patients (57.1% males) with a median age of 4.3 years (IQR, 2.2–8.3) and a median weight of 16 kg (IQR, 11.2–24.5). 44 (57.1%) defects (22.7% with deficient SARs) with a median left-side defect diameter of 8.7 mm (IQR, 5.7–10) were closed with ADOIIs. 33 (42.9%) defects (51.5% with deficient SARs) with a median left-side defect diameter of 10.8 mm (IQR, 8.8–13.5) were closed with MFOs. One 7/5 MFO was removed before release and upsized to a 12/10 MFO. Implantation success rate was 100% with ADOII and 90.9% with MFO devices. Two MFOs were snare-recaptured after embolization, and one 9/7 MFO was snare-retrieved for a new onset of grade-2 aortic regurgitation that persisted afterward. Median follow-up was 3.3 years (IQR, 2.1–4.2) for ADOII and 2.3 years (IQR, 1.7–2.5) for MFO. No permanent heart block or death occurred. Freedom from left ventricular dilation was 94.62% at 36 months of follow-up. Freedom from residual shunt was 90.62% for MFO and 89.61% for ADOII at 24 months of follow-up. One 2.6-year-old patient with baseline mild aortic valve prolapse and trivial aortic regurgitation developed a grade-2 aortic regurgitation after 9/7 MFO implantation. He was treated surgically after two years without device extraction. One new grade-2 asymptomatic tricuspid regurgitation persisted at the last follow-up in the ADOII group.ConclusionsADOII and MFO are complementary devices for effective retrograde closure of pmVSDs in children, including defects with absent or deficient SAR. ADOII is limited to smaller defects but offers a lower profile and a flexible left-side disk for better maneuverability over the aortic valve during retrograde implantation.

Safety and efficacy of Amplatzer duct occluder II and konar-MF™ VSD occluder in the closure of perimembranous ventricular septal defects in children weighing less than 10 kg

“…In cases where an ADOII device is used to prevent the development of AR and ensure a safe zone, it is recommended to have a SAR of ≥3 mm ( 20 ). In our study, we excluded defects with deficient SAR, even though it has been reported as feasible by other operators ( 31 ). The attachment point of the MFO device is flexible, allowing for the placement of the RV and LV discs at different angles.…”

Transcatheter Closure of Perimembranous Ventricular Septal Defects Including Multifenestrated and Gerbode-Type Defects Using the Lifetech Konar Device

“…Due to the plug softness and its design on the left side, the occluder fits very well within the aneurysm reducing the risk of residual shunt. It also seems really appropriate in cases of multiple exits on the right side or multifenestrated defects including the Gerbode-type VSD [1,[3][4][5][6][7][8][9][10], which is not a limitation although only one exit is crossed by the device. In this setting, to obtain full occlusion was more complex but possible, and this was noticed in half of our patients, even if two patients received a second occluder, as already reported [9].…”

“…In fact, both the whole plug on the left side covering the LV entry and the retention disk on the right side could achieve full occlusion of the defect. Haddad has suggested that device undersizing may be associated with a persistent shunt in patients with a multifenestrated defect and should be avoided [3,10]. In addition, the possibility of connecting the device to the delivery cable from either the left or the right side is also a real advantage.…”

Comparison of perventricular and percutaneous ultrasound-guided device closure of perimembranous ventricular septal defects

“…Not all cases used eccentric occluders, as symmetrically concentric VSD occluder could close the infundibular or aneurysmal structure without affecting the aortic valve. Despite previous encouraging results by other operators using mixed guidance, VSD closure was avoided in cases without an aneurysmal structure and when the subaortic rim was less than 1 mm (25).…”