Effectiveness and Safety of Transcatheter Closure of Perimembranous Ventricular Septal Defects in Adults

Wang, Jianming; Zuo, Junli; Yu, Shiqiang; Yang, Xiangdong; Xianyang, Zhu; Li, Jun; Yang, Lifang; Xiong, Lize; Ge, Shuping; Ren, Jun; Yang, Jian

doi:10.1016/j.amjcard.2015.12.036

Cited by 14 publications

(7 citation statements)

References 22 publications

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“…In the present study, the procedure time from the femoral artery puncture to sheath removal was 44.9±7.3 minutes (range, 29.0-65.0 minutes)，and was shorter in later cases than in the initial cases, suggesting that an experienced team would facilitate this procedure. The reported mean procedure time of transcatheter pm-VSD closure under fluoroscopic guidance varies between 44 and 122 minutes (22)(23)(24)(25), and seems to be somewhat longer than that in the present study. Without regard for different occluder systems, the procedure time in our series indicated that the feasibility of device implantation under TTE guidance was not worse than that reported in other series.…”

Section: Discussioncontrasting

confidence: 67%

Transcatheter perimembranous ventricular septal defect closure under transthoracic echocardiographic guidance without fluoroscopy

et al. 2018

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Background: Transcatheter device closure has become an alternative therapy for ventricular septal defect (VSD). This study aimed to investigate the feasibility and safety of transcatheter perimembranous VSD (pm-VSD) closure under transthoracic echocardiography (TTE) guidance alone. Methods: Between October 2012 and July 2016, 118 patients with pm-VSD underwent an attempt of transcatheter device closure for pm-VSD through the femoral artery under TTE guidance alone. Patients were followed-up at 1, 3, 6, and 12 months after the procedure and yearly after discharge. Results: The mean age was 11.7±12.5 years (range, 1.0-53.0 years) and the mean body weight was 32.2±21.6 kg (range, 11.5-102.0 kg). The mean diameter of the VSD was 4.0±1.1 mm (range, 3.0-8.0 mm). Transcatheter device closure under TTE guidance alone was successful in 111 patients. The average procedural time was 44.9±7.3 minutes (range, 29.0-65.0 minutes). All 111 patients were followed-up for 3.4±2.3 years. At the last follow-up, two patients had a residual shunt smaller than 2 mm, seven patients had right bundle branch block (RBBB) including one patient with complete RBBB, six patients had mild or less tricuspid regurgitation, and two patients still had trivial aortic regurgitation including one patient that had it before the procedure. Occluder malposition, complete atrioventricular block, or other complications were not observed. Conclusions: Transcatheter pm-VSD closure can be successfully performed under TTE guidance alone with outcomes similar to those achieved with fluoroscopic guidance in selected patients with weight more than 10 kg and VSD smaller than 8 mm. However, long-term follow-up in a large number of patients would be necessary.

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Section: Discussioncontrasting

confidence: 67%

Transcatheter perimembranous ventricular septal defect closure under transthoracic echocardiographic guidance without fluoroscopy

et al. 2018

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“…[ 9 ] According to previous opinion, the asymmetric Amplatzer occluder is invented to expanded the indication for transcatheter closure of pmVSD. [ 10 , 11 ] So that the asymmetric occluder has been used as an alternation for the failure closure of systematic Amplatzer occluder. Due to the specific structure characteristics of pmVSD, failure of device closure is usually considered with the causes of large defect, aortic valvar prolapse, and severe complications.…”

Section: Discussionmentioning

confidence: 99%

Re-evaluation of the criteria for asymmetric amplatzer occluders in the closure of perimembranous ventricular septal defects

Liao

et al. 2020

Medicine

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Rationale: To discuss suitable criteria for the application of asymmetric Amplatzer occluders for perimembranous ventricular septal defects (pmVSDs). Patients concerns and diagnoses: We retrospectively studied 18 children with perimembranous VSDs who underwent attempted asymmetric occluder closure between January 2015 and December 2018 in our center. Interventions: Asymmetric Amplatzer occluders were attempted to be placed to all the enrolled patients. We analyzed the diameter of the defects with the receiver operating characteristic curve (ROC) values, the size of the occluders attempted, the presence of aneurysm and the presence of aortic valve prolapse for each patient. Then, for patients who experienced successful device implantation, the therapeutic efficiency was evaluated by follow-up. Outcomes: Only 5 out of a total of 18 patients completed successful device implantation. Compared with failed cases, successful cases demonstrated a significantly smaller VSD size (5.46 ± 1.03 mm vs. 8.73 ± 2.33 mm, P = 0.012) and had a low ratio of aortic valvar prolapse (20% vs. 76.92%, P = 0.026). Four out of 5 successful cases involved arrhythmia complications, but the rhythm of the heart recovered after drug treatment. According to the ROC and Youden analyses, the cut-off value of the defect size for successful asymmetric Amplatzer occluder implantation was no larger than 5.7 mm. Lessons: The application of an asymmetric Amplatzer occluder expands the range of indications for patients with superior localized VSD but is largely limited in cases with aortic valvar prolapse and large VSD sizes. All successful cases recovered from arrhythmia postprocedure.

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“…Ventricular septal defects (VSDs) are the most common type of CHD with an incidence in 30% of all cases, including up to 10% of those diagnosed in adults [33]. In adults, VSD closure is indicated for hemodynamically significant left to right shunts (Qp:Qs > 1.5:1) [34] in cases of worsening aortic regurgitation (AR) [35] or with recurrent infective endocarditis [36]. Defects can occur anywhere along the septum, and more than 80% are perimembranous VSD (pmVSD) [36].…”

Section: Vsd Closurementioning

confidence: 99%

Update on Transcatheter Interventions in Adults with Congenital Heart Disease

Li,

Aboulhosn

2024

JCM

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The field of adult congenital interventions is unique in the world of cardiac catheterization, combining the structural concepts commonly employed in pediatric heart disease and applying them to adult patients, who are more amenable to device intervention as they no longer experience somatic growth. Rapid advances in the field have been made to match the growing population of adult patients with congenital heart disease, which currently surpasses the number of pediatric patients born with congenital heart disease. Many congenital defects, which once required surgical intervention or reoperation, can now be addressed via the transcatheter approach, minimizing the morbidity and mortality often encountered within adult congenital surgeries. In this paper, we aim to provide a focused review of the more common procedures that are utilized for the treatment of adult congenital heart disease patients in the catheterization laboratory, as examples of current practices in the United States, as well as emerging concepts and devices awaiting approval in the future.

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Effectiveness and Safety of Transcatheter Closure of Perimembranous Ventricular Septal Defects in Adults

Cited by 14 publications

References 22 publications

Transcatheter perimembranous ventricular septal defect closure under transthoracic echocardiographic guidance without fluoroscopy

Transcatheter perimembranous ventricular septal defect closure under transthoracic echocardiographic guidance without fluoroscopy

Re-evaluation of the criteria for asymmetric amplatzer occluders in the closure of perimembranous ventricular septal defects

Update on Transcatheter Interventions in Adults with Congenital Heart Disease

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