Efficacy and Safety of Using Amplatzer Ductal Occluder for Transcatheter Closure of Perimembranous Ventricular Septal Defect in Pediatrics

Abstract

Background:Perimembranous Ventricular Septal Defect (PMVSD) is the most common subtype of ventricular septal defects. Transcatheter closure of PMVSD is a challenging procedure in management of moderate or large defects.Objectives:The purpose of this study was to show that transcatheter closure of perimembranous ventricular septal defect with Amplatzer Ductal Occluder (ADO) is an effective and safe method.Patients and Methods:Between April 2012 and April 2013, 28 patients underwent percutaneous closure of PMVSD using ADO. After obtaining the size of VSD from the ventriculogram a device at least 2 mm larger than the narrowest diameter of VSD at right ventricular side was chosen. The device deployed after confirmation of its good position by echocardiography and left ventriculography. Follow up evaluations were done 1 month, 6 months, 12 months and yearly after discharge with transthoracic echocardiography and 12 lead electrocardiography.Results:The mean age of patients at procedure was 4.7 ± 6.3 (range 2 to 14) years, mean weight 14.7 ± 10.5 (range 10 to 40) kg. The mean defect size of the right ventricular side was 4.5 ± 1.6 mm. The average device size used was 7.3 ± 3.2mm (range 4 to 12 mm). The ADOs were successfully implanted in all patients. The VSD occlusion rate was 65.7% at completion of the procedure, rising up to 79.5% at discharge and 96.4% during follow-up. Small residual shunts were seen at completion of the procedure, but they disappeared during follow-up in all but one patient. The mean follow-up period was 8.3 ± 3.6 months (range 1 to 18 months). Complete atrioventricular block (CAVB), major complication or death was not observed in our study.Conclusions:Transcatheter closure of PMVSD with ADO in children is a safe and effective treatment associated with excellent success and closure rates, but long-term follow-up in a large number of patients would be warranted.

Nit-Occlud Lê VSD coil versus Duct Occluders for percutaneous perimembranous ventricular septal defect closure

“…Generally, pmVSD closure using either the Duct Occluders or the VSD Coil does not eliminate the risk of CHB as well as other major complications. However, the rate of this complication in our study was low and comparable to the CHB rate of surgical closure documented in the literate …”

Transcatheter Closure of Perimembranous Ventricular Septal Defects Using Different Generations of Amplatzer Devices: Multicenter Experience

“…El Said et al [23] proposed three different locations for measurement of the defect: at the left ventricular opening of the VSD; at the largest diameter of the aneurysm, usually in the midsegment of the aneurysm; and at the right ventricular opening of the VSD aneurysm, usually the smallest diameter of the defect, where they proposed the use of a device 2 mm larger than this last measurement. Ghaderian et al [25] proposed to select an ADO device at least 2 mm larger than the narrowest of the measured VSD diameter in right side by ventriculogram. As mentioned previously, we measured the narrowest portion of the VSD on the left ventricular side during the diastolic left ventricular angiogram, and the devices were chosen not to exceed this diameter by 2 mm in case of using ADO device; and in case of using ADO II, the central disc was chosen not to exceed this measure by 1 mm.…”

“…El-Sisi et al [26] in a prospective observational single center study of 30 patients reported a 100% success using ADO devices (I and II). Ghaderian et al [25] used an ADO device in 28 patients with a successful rate of 96.4%. Hua et al [27] published a 100% successful closure of PmVSD in 16 patients using AVP II.…”

Early Experiences Using Cocoon Occluders for Closure of a Ventricular Septal Defect

“… 8) 9) 10) As a result, there are important modifications for the prevention of CAVB, and various positive clinical experiences have since been reported with those devices. 11) 12) In Korea, there was a report about transcatheter closure of perimembranous VSD with an Amplatzer duct occluder I, 1) but it was an off-label use of the device. Recently, various types of Cocoon occluders (Vascular Innovations Co., Nonthaburi, Thailand) for VSD were developed.…”