Initial results of primary device closure of large muscular ventricular septal defects in early infancy using perventricular access

Abstract

Objectives: To report our experience with the use of the Amplatzer muscular ventricular septal defect (VSD) occluder, using direct right ventricle free wall puncture for primary closure of muscular VSDs in infants. Background: Young infants with heart failure due to large or multiple muscular VSDs often require intervention at a stage when percutaneous device closure is impractical due to delivery system limitations. There are considerable benefits to avoiding bypass in these infants. Methods: Patients with suitable muscular VSDs, considered too small for transvenous closure, underwent perventricular muscular VSD closure under transesophageal echo (TEE) guidance. Results: Eight infants underwent the procedure. The median age was 14 weeks (2-41) with median weight of 4 kg (3-6.6). Four patients had additional VSDs and one patient had previous repair of coarctation. One patient had dextrocardia and severe left ventricular impairment due to an associated cardiomyopathy. The median VSD size was 8 mm (range, 4-10 mm). A single device (6-12 mm) was deployed in each patient, the size chosen being 1-2 mm larger than the TEE measurement. Two patients had subsequent pulmonary artery banding, with absorbable bands, because of moderate residual shunting through additional VSDs. The latest echo study at a median of 7.2 weeks (0.5-66) post device implantation revealed no patients with a hemodynamically significant shunt. Conclusion: Perventricular muscular VSD closure can be safely and effectively undertaken in small infants with suitable muscular defects, and this strategy can avoid the need for bypass. '

Perventricular device closure of isolated muscular ventricular septal defect in infants: A single centre experience

“…Crossland et al confirmed that perventricular device closure of isolated large mVSD is safe and effective in 8 infants (median age e 14 (2e41) weeks; median weight e 4 (3e6.6) kg) at short-term followup. 13 Gan et al reported similar results in 8 patients (mean age 2.5 AE 3.6 years, mean weight of 10.9 AE 7.6 kg) with postprocedural hospital stay of 7.9 AE 2.2 days. 14 In their experience on mVSD device closure, Karim et al undertook successful perventricular device closure in 8 out of 20 infants.…”

Miniinvasive hybrid closure of multiple muscular ventricular septal defects in a premature infant with novel use of Amplatzer Duct Occluder II – a case report

“…Coexistence of congenital heart defects and additional muscular septal defects leading to oversized systemic-to-pulmonary blood flow increases the risk of pulmonary hypertension and heart failure [4]. In this specific group the decision of challenging surgical correction is questionable with regard to morphology of basic defects, patients' weight and age, as well as additional problems.…”

“…Different hybrid approaches have been reported in small groups, but there are several limitations of hybrid procedures in borderline children that are related to technological development of miniaturized implants and delivery systems [4]. After a hybrid approach with artificial elements implanted on the beating heart, heparin is recommended in the early postoperative period, with antiplatelet agents finally administered orally.…”

A Minimally Invasive Technique for Occluding Large Muscular Ventricular Septal Defects in Infants

“…The avoidance of open-heart surgery in infants has been investigated with some success by other groups [10,11,12,13]. Since 2010, we have treated infants with large muscular VSDs measuring between 7 and 15 mm via transthoracic closure without cardiopulmonary bypass with good outcomes.…”