Three centers experience with device closure of congenital Gerbode‐type perimembranous ventricular septal defects

Abstract

Objectives: We aim to evaluate our experience with interventional closure of Gerbode-type perimembranous ventricular septal defects (pmVSDs). Methods: We performed three-center retrospective data review of patients with congenital indirect Gerbode-type pmVSDs treated percutaneously between August 2017 and May 2021. Standard safety and latest follow-up outcomes were assessed. Results: Ten patients (six females) were identified with a median age of 6.8 years (range: 2.5-54) and a median weight of 26.5 kg (range: 12-88). The median left ventricular defect size was 10 mm (range: 3-15.5). On baseline ultrasound, 6 patients had absent subaortic rim , 6 patients had trivial aortic regurgitation, and 3 patients had tear-drop-type (small) aortic cusp prolapse. The tricuspid regurgitation was graded II (n = 5) and III (n = 5). Five Lifetech Konar-Multifunctional occluders, four Amplatzer duct occluders II and one Amplatzer duct occluder I were implanted. The median fluoroscopy time was 10.4 min (range: 4.3-20.2). Preexisting aortic regurgitations remained identical. One new aortic regurgitation was identified before discharge and remained trivial after 48 months of follow-up. No heart block or tricuspid stenosis was observed on a median follow-up of 17 months (range: 3-48). All patients are symptom-free with complete shunt closure and significant regression or resolution of tricuspid regurgitation. Conclusions: Despite anatomical challenges, interventional closure of congenital indirect Gerbode-type pmVSD appears to be feasible, safe, and most importantly clinically effective using different commercially available devices. Amplatzer duct occluder II and Lifetech Konar-Multifunctional occluder offer interesting specifications to retrogradely target this specific defect with success.

Percutaneous device closure of Gerbode‐type ventricular septal defects

“…reported the first transcatheter closure of an acquired Gerbode defect. There are few published case reports and small series reports of immediate and short-term results following transcatheter closure of the Gerbode defect.Haddad et al9 in a retrospective multicenter study contribute their experience on percutaneous closure of the indirect Gerbode type pmVSD. Transcatheter closure was performed on 10 patients from three centers from August 2017 to May 2021.…”

“…Haddad et al 9 in a retrospective multicenter study contribute their experience on percutaneous closure of the indirect Gerbode type pmVSD. Transcatheter closure was performed on 10 patients from three centers from August 2017 to May 2021.…”

“…The authors then go on to comprehensively detail the risks and considerations of closing Gerbode‐type defects, listing current literature available while aptly pointing out the lack of homogenized guidelines available when considering this type of pmVSD for transcatheter closure. Haddad et al 9 have effectively demonstrated that percutaneous closure of Gerbode type pmVSD's is a safe and effective alternative to surgical repair and is a valuable addition to the currently available literature available on this type of procedure.…”

Percutaneous Device Closure of Gerbode-type Ventricular Septal Defects

“…Haddad et al (9) in a retrospective multicenter study contribute their experience on percutaneous closure of the indirect Gerbode type pmVSD. Transcatheter closure was performed on 10 patients from 3 centers from Aug 2017-May 2021.…”

“…The authors then go on to comprehensively detail the risks and considerations of closing Gerbode-type defects, listing current literature available while aptly pointing out the lack of homogenized guidelines available when considering this type of pmVSD for transcatheter closure. Haddad et al (9) have effectively demonstrated that percutaneous closure of Gerbode type pmVSD's is a safe and effective alternative to surgical repair and is a valuable addition to the currently available literature available on this type of procedure Advances in echocardiography have allowed for accurate diagnosis and intra-procedure feedback with regards to optimal device size and device placement to prevent interference with the valves or the conduction system. Vijayalakshmi et al (10) in a series of 12 patients describe successful closure of their pmVSD with one patient developing transient complete heart block that resolved within 48 hours after administration of steroids.…”