Safety and efficacy of amplatzer duct occluder for percutaneous closure of ventricular septal defects with tunnel shape aneurysm: Medium term follow up

Abstract

Objectives: Different devices including Amplatzer duct occluder has been used for percutaneous closure of ventricular septal defects. This study reports our medium term follow up of perimembranous and muscular ventricular septal defects with tunnel shape aneurysm closure using the Amplatzer duct occluder. Materials and Methods: From May 2006-December 2012, we used Amplatzer duct occluder in seven ventricular septal defect patients here at Hamad General Hospital, Doha, Qatar. There were 4 male and 3 female patients with an age range of 4 -32 years with a median of 8 years and weight range of 16 -63 kg with a median of 33 kg. In this group, 6 were perimembranous and 1 muscular and all these ventricular septal defects had a tunnel shape aneurysm. Transesophageal echocardiographic diameter ranged from 4 -8 mm and Qp/Qs was 1 -1.6. Angiographically, the diameter on the left ventricular side measured 3.5 -10 mm and on right ventricular side 2.4 -5 mm. 8/6 mm Amplatzer duct occluder was used to close these ventricular septal defects. Results: There were no major complications and immediately after the procedure there was no residual shunt in any of these patients and all the patients remained in normal sinus rhythm. One patient was expatriate and no further follow up was available. The rest of the 6 patients had 1 -80 months with a median of 54 months follow up and none of these patients had any residual shunt and all remained in normal sinus rhythm. Two patients developed trivial aortic valve regurgitation immediate post procedure, one remained unchanged and the 2 nd has progressed to mild at this latest follow up. Conclusion: Amplatzer duct occluder is feasible and a safe device for percutaneous closure of selective tunnel shape aneurysmal perimembranous and muscular ventricular septal defects.

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

“…By example, they used an ADO 6/4 for a tunnel-like VSD in a small 4.4 kg baby successfully at a time when the membranous VSD devices were not available. In a study period of 79 months, Dilawar and Ahmad [20] published a total of 7 cases (6 perimembranous and 1 muscular) with tunnel-type aneurysmal tissue closed using 8/6 mm ADO. Diab et al [21] recommended using the ADO in those patients where significant crowding at the right ventricle apex by muscle bundles prohibits the full expansion of the RV disc of the approved VSD occluders.…”

“…Percutaneous closure of PmVSD remains a real challenge; however, with the use of softer and smaller devices, we think that VSD closure can be more safe and effective. 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).…”

“…However, using these softer Amplatzer devices, only eventual and minor complications have been reported in regard to aortic, tricuspid, or mitral regurgitation. Dilawar [20] informed one patient who had progression of aortic valve regurgitation from trivial immediately after procedure to mild in a median of 54 months of follow-up. In the study of El Said et al [23], new tricuspid regurgitation occurred in only 1 of 18 patients and was trivial.…”

Current outlook after 4 years since the beginning of interventional cardiology in congenital heart disease in Chiapas State

“…Undoubtedly, interventional cardiology in the field of congenital heart diseases has developed less invasive solutions for congenital heart defects in an attempt to minimize the need for open heart surgery and thus optimize patient prognosis 10 . Within the experience we have developed over these four years after the introduction of hemodynamics into the treatment of congenital heart diseases in Chiapas, we specifically started a study in patients diagnosed with perimembranous ventricular septal defect who were candidates for closure by cardiac catheterization and, taking into account the interest in the incidence of complete atrioventricular block published in the literature, we decided to carry it out using devices not specifically designed for the closure of these defects (off-label use), backed by previous reports with good results of closure of these defects not using usual devices [11][12][13][14][15] .…”

Panorama actual a 4 años del inicio de la cardiología intervencionista en cardiopatías congénitas en el Estado de Chiapas

“…Sin duda, la cardiología intervencionista en cardiopatías congénitas ha desarrollado soluciones menos invasivas para los defectos cardiacos congénitos con la intención de minimizar la necesidad de cirugía cardiaca abierta y así optimizar el pronóstico de los pacientes 10 . Dentro de la experiencia que hemos desarrollado a lo largo de estos cuatro años después del inicio de la hemodinamia en cardiopatías congénitas en Chiapas, precisamente iniciamos un protocolo en pacientes con diagnóstico de comunicación interventricular perimembranosa y que eran candidatos a ser llevados a cierre por cateterismo cardiaco, esto tomando en cuenta el interés por la incidencia de bloqueo atrioventricular completo publicado en la literatura, por lo que decidimos llevarlo a cabo utilizando dispositivos no específicamente diseñados para cierre de estos defectos (off-label), teniendo como respaldo reportes previos con buenos resultados de cierre de estos defectos con dispositivos no habituales [11][12][13][14][15] .…”