Use of muscular VSD Amplatzer occluder for closing right ventricular free wall perforation after hybrid procedure?

Abstract

In some patients, so cold hybrid cardiologic procedures are performed whereas a heart is exposed surgically to puncture directly the heart cavity. After performing the interventional procedure, the opening in ventricular wall is closed surgically. We present our initial experience with closing the right ventricular (RV) cavity opening with the muscular ventricular septal defect Amplatzer occluder (A-MVSDO). In four sheep, heart was exposed surgically and punctured under direct vision by needle and guide wire, 14F and 26F sheath were introduced into right ventricle and the A-MVSDO was introduced causing closure of the RV opening. In all four cases, the occluder was successfully placed closing the opening in RV. No major bleeding after occlusion was observed. Following complications were observed: pneumothorax in two animals, rhythm disturbances and thrombus suspected in one. A-MVSDO occluder seems to be a useful device to close RV opening after hybrid interventional cardiologic procedure.

Closure of left ventricle perforation with the use of muscular VSD occluder

“…The bleeding stopped within the first 2 min and did not continue. This observation is different from our experience with application of occluder for the closure of right ventricular perforation [8]. The difference in the amount of bleeding is possibly caused by higher LV pressure and might explain the smaller bleeding amounts in one animal with lower blood pressure.…”

Is device closure for direct access valved stent implantation safe?

“…Nothing is known about their use for sealing a hole in a ventricle against outer world. In recent studies we have proven that it is possible to use the AMuscVSDO to close the perforation made in the free wall of right and left ventricles as a preparation for stented valve implantation [3,4]. However, nothing is known about the healing process and the histology that take place after the implantation of Amplatzer Occluder into the free wall of the heart.…”

Transapical transcatheter aortic valve implantation

“…Interestingly, there are already reports about device closure of the left or even right ventricular apex after valved stent implantation [11][12][13][14].…”