Perventricular device closure of congenital muscular ventricular septal defects

Abstract

Muscular ventricular septal defects (MVSDs) account for approximately 20% of all congenital ventricular septal defects. Large defects in infants result in early heart failure, failure to thrive and pulmonary hypertension. Although percutaneous closure of MVSDs has been employed safely and effectively in children, adolescents and adults, its application in the small infant (weight <6 kg) carries a higher risk for complications including arrhythmias, hemodynamic compromise, cardiac perforation, tamponade and death. Perventricular closure of such defects, introduced by Amin and coworkers in the late 1990s, has become an attractive treatment modality for these small and high-risk patients. Experience worldwide has shown that the procedure is feasible, reproducible, safe and effective. In this article, the authors review the indications, the step-by-step technique and the results of perventricular closure of MVSDs using the AMPLATZER mVSD device (AGA Medical, MN, USA).

Mid‐term follow up of perventricular device closure of muscular ventricular septal defects

“…In our patient cohort, only one patient had a long-term complication that could be avoided by exercising additional care when manipulating wires, sheaths, and devices in the left ventricle. Following a specific procedural technique refined by experience as described by Pedra et al [22] will help decrease complications. As its long-term safety is confirmed, perventricular MVSD closure presents a superior approach to surgical MVSD closure in infants by avoiding two stages and allowing repair without CPB.…”

Effects of transthoracic device closure on ventricular septal defects and reasons for conversion to open-heart surgery: A meta-analysis

“…Among all the selected articles, 146 trials were conducted primarily in China 4–6,12,25–34,36–53,55–59,61,63,65–160,162,167,168,171–175,180,185,186 , 3 articles were conducted in other Asian countries (one each in India, South Korea and Turkey) 166,169,184 , 10 studies were conducted in the United States 11,62,64,163,170,176,178,179,181,182 , 5 studies were performed in European countries (one each in Austria, France, Germany, Poland, Russian Federation) 35,54,161,165,183 , 2 articles were conducted in South American countries (1 Brazil and 1 Chile) 164,177 , and 1 case-control study was performed in Australia 60 . A total of 108 articles were written in Chinese 5,12,26–29,31,32,36–43,46,70–132,134–159,174,175 , whereas 58 articles were written in English 4,6,11,25,30,33–35,44,45,47–69,133,160–163,165–173,176–186 , and the remaining article was written in Portuguese 164 .…”

“…A total of 108 articles were written in Chinese 5,12,26–29,31,32,36–43,46,70–132,134–159,174,175 , whereas 58 articles were written in English 4,6,11,25,30,33–35,44,45,47–69,133,160–163,165–173,176–186 , and the remaining article was written in Portuguese 164 . All trials were published between 1998 and 2016.…”

“…Two case-control studies did not mention the comparability of cases and controls, and one only controlled for age. Of the 129 identified case series, 56 studies (43.42%) were considered to be of acceptable quality according to the 18-item, validated quality appraisal tool 47–50,52,54,56,58,60,61,64,66,68–70,72–74,76,81,89,92,95,98,103–105,113,115,117,125,128,129,131,135,136,138,140,141,145,146,149,152,153,155,156,158,160,162,164–166,168,171–173 (Supplemental Table 4). Four series did not clearly elucidate the study objective in the abstract, introduction or methods section; five did not account for the characteristics of the included participants; 121 case series collected cases at a single centre; 85 did not apply the criteria for inclusion; two recruited participants inconsecutively; four did not clearly describe the primary or additional interventions; 20 did not clearly defined the outcome measures in the introduction or methods section; 116 did not use appropriate statistical tests to assess the relevant outcome; 17 did not report the length of follow-up; 59 did not report the loss of follow-up; 53 did not estimate the random variability of the outcomes; 1 did not report the adverse events; most of the series (n = 128) did not report the source of support for the study.…”

Hybrid approach for closure of muscular ventricular septal defects

“…With regard to periventricular technique used for mVSD closure, the aid of an experienced echocardiographer is crucial to provide perfect imaging during procedure of implant placement, as well as for safe catheter manipulation, device delivery and deployment, and post-release position in the septum [14]. All hybrid procedures were performed under TEE guidance, but we also used an epicardial probe that was helpful in precise assessment of mVSD position and shape (Figure 3).…”