Perimembranous Ventricular Septal Defect Device Closure: Choosing Between Amplatzer Duct Occluder I and II

Abstract

Transcatheter closure of perimembranous ventricular septal defects (pmVSDs) is a well-established procedure. Recently, Amplatzer duct occluders (ADO) I and II have been reported to close large series of pmVSDs successfully (off-label use). ADOs are economical compared with the standard Amplatzer VSD occluders, a major consideration in developing countries with low-budget programs. We report closure of symptomatic, hemodynamically significant pmVSDs using the ADOI and ADOII devices. Although there are no set criteria for choosing between ADOI and ADOII, the former's price tag includes snare and long sheath. Thus, we aim to predetermine device usage based on transthoracic echocardiography (TTE) findings. Between March 2013 and November 2014, 30 patients had transcatheter closure of pmVSDs using the ADO devices. The median age was 4 years (range 1.1-13 years) and median weight was 15 kg (range 6.5-85 kg). ADOII could not be used in VSDs larger than 6 mm and/or with a large aneurysm. The median VSD size as assessed by echocardiography was 5.5 mm while the mean was 5.5 mm (range 3-12 mm); while by angiography it was 5 mm & the mean was 4.75 mm (range 3-9 mm). The median fluoroscopy time (FT) was 8 min (range 5-38 min). We inserted ADOI in 13 patients and ADOII in 17 patients (no significant difference between median age and weight in each group). VSD size was significantly larger and FT was longer in ADOI patients; the device type matched what was decided from TTE data in 84% of cases. Follow-up ranged from 2 to 24 months (median 12 months). The mean LVEDD z-score of the patients was 1.1 before VSD closure, while it was 0.63, 0.35, and 0.23 at the 1-, 3 months, and last follow-up, respectively. Complete closure rates immediately, at 24 h, and at last follow-up were 87, 90, and 94% respectively. No patient developed heart block or any other complication. ADOI and ADOII are equally safe and effective in pmVSD closure. ADOII use, although cheaper than ADOI, is limited to smaller VSDs. The choice between ADOI and ADOII can be decided by TTE prior to procedure which is convenient in low economic programs.

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

“…Dilawar et al [20] informed that VSD closure rate was 100% (7/7) using ADO immediately after the procedure, and medium term follow-up of 6/7 patients revealed no residual VSD with 100% success. 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%.…”

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

“…In this study, the procedure success rate was high in both groups (95.6% in the DO group vs. 97.2%in the Coil group, P 5 .53) and comparable to other studies using conventional, off-label use or new devices for percutaneous pmVSD closure. [8][9][10][11][12][13][14][26][27][28][29] In contrast, the clo- [30][31][32][33] Thus, percutaneous VSD closure has been largely abandoned in many countries, and surgical closure is still accepted as the standard therapy for pmVSD. Patients in whom CHB was first detected after percutaneous VSD closure in our centers were treated with intense medication, including corticosteroids, temporary pacemaker and continuously followed for two weeks.…”

Transcatheter closure of congenital perimembranous ventricular septal defect using the Amplatzer duct occluder 2

“…2 Nowadays, transcatheter device closure for perimembranous ventricular septal defect has become a widely accepted alternative to openheart surgery. [3][4][5][6] Since the development of occluders and intervention technique, the spectrum of indications has been widened. Recently, several studies on the transcatheter device of ventricular septal defect using Amplatzer duct occluder 2 have been reported.…”

“…Recently, several studies on the transcatheter device of ventricular septal defect using Amplatzer duct occluder 2 have been reported. [6][7][8][9] However, most of the reports were based on small samples without a long-term follow-up. The appropriate time of usage and ventricular septal defect size capable of closure, the accurate indications, and long-term results of Amplatzer duct occluder 2 were not yet clarified.…”