Catheter therapy of Swiss cheese ventricular septal defects using the Amplatzer muscular VSD occluder

Abstract

The medical and surgical management of patients with multiple muscular ventricular septal defects (VSDs) is associated with morbidity and mortality. Three children with Swiss cheese VSDs were treated with transcatheter occlusion of their multiple defects using the Amplatzer muscular VSD occluder. Seventeen defects were closed in five catheterization procedures. One patient had three devices placed in two procedures, the second had five defects closed in one procedure, and the third had nine defects closed in two procedures. Two patients had previously been treated with pulmonary artery banding and required subsequent surgical band removal. There was immediate reduction in the left-to-right shunting and clinical improvement in all patients. Complications included the need for blood transfusion during the two longest procedures and tricuspid valve regurgitation in one. Transcatheter occlusion of multiple VSDs is an acceptable alternative or adjunct to surgical therapy for these complex patients.

Catheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: Initial clinical experience

“…The appropriate device size was chosen to be 1-2 mm larger than the VSD size as assessed by TEE or same as the TTE size (patient 6). The next step in the closure sequence was placing a long sheath (7)(8) across the VSD into the LV apex (Figs. 3C and 4D).…”

Perventricular device closure of isolated muscular ventricular septal defect in infants: A single centre experience

“…4 The percutaneous closure of mVSD is an alternative technique with encouraging results in children. 8,9 However, its application in infants is limited due to relatively large size of the device-delivery-apparatus, which may cause hemodynamic instability and rhythm disturbances. 10 This underscores the need for a hybrid approach where the access obtained by sternotomy or epigastric incision allows deployment of closure device into the beating-heart under echocardiographic and/or fluoroscopic guidance.…”

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

“…Percutaneous device closure of MVSDs offers the advantage of avoiding the surgical risks associated with cardiopulmonary bypass (CPB) and ventriculotomy. Nevertheless, percutaneous MVSD closure has demonstrated risks in patients with low weight or poor vascular access [6,7]. The passage of large delivery catheters can cause rhythm disturbances and hemodynamic compromise in small patients.…”