Pediatric cardiology Transcatheter closure of ventricular septal defects with nitinol wire occluders of type patent ductus arteriosus

Abstract

Ventricular septal defects closure (VSD) depending on the anatomy and clinical setting can be performed surgically or by a hybrid and transcatheter approach. Two cases of children with VSD will be presented. Patients’ defects were closed with various types of occluders made of nitinol wire mesh occluder, patent ductus arteriosus (PDA) type. The first case was a 2.5-year-old boy after cardiosurgical correction of tetralogy of Fallot (TOF). After the procedure, a significant haemodynamic residual VSD was observed, which was not successfully closed during the subsequent reoperation. Despite pharmacological treatment, symptoms of heart failure were observed in this patient. In echocardiographic images the residual VSD was presented as a tunnel-like dissection of the ventricular septum (length 6 mm and diameter 3.4 mm). The defect was closed via arterial access with an Amplatzer Duct Occluder II (ADO II). The procedure was successfully performed without any medical complications. In this child, a significant shunt reduction and a noticeable improvement in the patient's clinical status and diminished symptoms of heart failure were noticed. The second patient was a 4-year-old girl suffering from a multi-perforated perimembranous VSD accompanied by a ventricular septal defect with aneurysm. The defect was closed by a venous approach with a PDA Cardio-O-Fix occluder (very similar to ADO I). No short-term or long-term complications were visible during or after the procedure. Only a mild residual shunt through the VSD was observed 6 months afterwards. Transcatheter VSD closure with a proper morphology, with occluders of type Amplatzer Duct Occluder ADO I or ADO II, constitutes a safe and effective therapeutic alternative.

Complete heart block following transcatheter closure of perimembranous VSD using amplatzer duct occluder II

“…Occurrence of CAVB has not been reported following VSD closure using ADO‐II device. Possible explanations as proposed in literatures are: longer central waist of ADO‐II device might avoid the compression on perinodal tissue and ADO‐II device being very soft and devoid of fabric patch, chance of device‐induced inflammation and fibrous tissue formation is less .…”

“…ADO-II device being very soft and devoid of fabric patch, chance of device-induced inflammation and fibrous tissue formation is less [5].…”

Transcatheter Trans-aortic Retrograde Approach for the Closure of Perimembranous Ventricular Septal Defects using Cocoon [Amplatzer Duct Cccluder I Like] Device – An Initial Experience from a Single Centre

“…ADO I or its chinese counterparts were used in a few case reports by antegrade approach for the closure of residual post-surgical VSDs [13,14] and for the closure of multi-perforated perimembranous VSD with aneurysm [15]. Recently, Nguyen et al published a multicenter case series of antegrade transvenous closure of PMVSD using ADO I with 95% success rate and with complications in 1.7% of cases.…”

Transcatheter closure of ventricular septal defects using the Amplatzer Duct Occluder II device: a single-center experience

“…Theoretically, lower risk of TAVB is connected with a gentle construction of ADO II, namely thinner structure of the nitinol wire and lack of patches inside the occluder [6]. Ventricular septal defects larger than 6.5 mm and a distance less than 3 mm between the upper margin of the VSD and aortic valve are reported as two major limitations [7].…”