Transcatheter Closure of Perimembranous and Intracristal Ventricular Septal Defects Using Amplatzer Duct Occluder II in Children

Abstract

Background. Transcatheter closure of aneurysmal perimembranous ventricular septal defect (pmVSD), pmVSD near the aortic valve, and intracristal VSD (icVSD) with symmetrical or asymmetrical ventricular septal defect occluders still presents significant challenges. We report our experience with transcatheter closure of pmVSD and icVSD using Amplatzer duct occluder II (ADO II) in children. Method. We retrospectively analyzed all children, who presented to our hospital consecutively between March 2014 and June 2020 for attempted transcatheter closure of pmVSD or icVSD with the ADO II device. Standard safety and last-follow-up outcomes were assessed and compared. Results. In total, 41 patients underwent transcatheter closure of VSD with the ADO II (28 in pmVSD and 13 in icVSD groups) with a median age of 3.5 years (total range: 0.9 to 12 years) and median weight of 15.0 kg (total range: 10.0 to 43.0 kg). Implantation was successful in 40/41 patients (97.5%, 27/28 in pmVSD group, 13/13 in icVSD group). One patient with mild aortic valve prolapse in pmVSD group developed new-onset moderate aortic regurgitation after a 4/4 mm ADO II was deployed; however, this resolved after the device was retrieved and successfully replaced with a 5 mm zero eccentric VSD occluder. There was no procedure-related mortality. After a median follow-up of six months (total range: 6 to 72 months), complete closure rates were 85.1% and 76.9% among pmVSD and icVSD groups, respectively. In the pmVSD group, one case of new-onset moderate tricuspid regurgitation was observed at six months, and there was one case of severe tricuspid regurgitation that had progressed from mild tricuspid regurgitation at 12 months. No serious complications were noted in the icVSD group. Conclusion. ADO II provides a safe and reproducible alternative for the closure of perimembranous and intracristal ventricular septal defects with a diameter less than 5 mm in young children.

Progression of aortic regurgitation following transcatheter closure of intracristal ventricular septal defects in children: a mid- to long-term follow-up study

“…Recently, Tang et al reported using ADO II to close small doubly committed subarterial VSDs (1.5–3.5 mm) ( 28 ). In their short-term study (1–45 months), only 1/24 developed new-onset mild AR, which was similar to our recent report (1/13) ( 28 , 29 ). Therefore, ADO II may be one of the options for small icVSD because its material is softer than other occluders, which may preclude sustained damage to the aortic valve.…”

Aortic Regurgitation Requiring Unplanned Surgery following Transcatheter Closure of Ventricular Septal Defect in Children: Incidence and Risk Factors

“…Occluder type was considered to be different in the comparison of general characteristics. Adjusted multivariate analysis did not suggest that occluder-related factors were the possible risk factors for AR requiring unplanned surgery, surprisingly, while according to our understanding and experience from other studies occluder-related factors should be associated with the occurrence of AR [15, 25, 27, 28]. This may result from the small number in AR group in our study.…”

Progress of biodegradable polymer application in cardiac occluders

“…A milestone and the top level of the nonbiodegradable occluder so far is the nanocoated occluder of the left atrial appendage with a modified surface to achieve appropriate cell responses, which has been pioneered and developed by the Ding team from the Orient 16 . The next‐generation occluder is expected to be biodegradable, because the permanent presence in the human body may probably cause various adverse reactions, like hemolysis, thrombosis, metal allergy, toxic reaction, valve damage, heart perforation, and even severe arrhythmia 17–24 . Furthermore, implantation of metal ASD or PFO occluders will obstruct the transseptal access to the left atrial.…”

“…16 The next-generation occluder is expected to be biodegradable, because the permanent presence in the human body may probably cause various adverse reactions, like hemolysis, thrombosis, metal allergy, toxic reaction, valve damage, heart perforation, and even severe arrhythmia. [17][18][19][20][21][22][23][24] Furthermore, implantation of metal ASD or PFO occluders will obstruct the transseptal access to the left atrial. It may impede the future transcatheter operation for acquired heart disease, such as mitral valvuloplasty, left atrial appendage occlusion, pulmonary vein angioplasty, and radiofrequency ablation for atrial arrhythmia.…”