Percutaneous closure of perimembranous ventricular septal defects with the Amplatzer device: Technical and morphological considerations

Abstract

Percutaneous closure of perimembranous ventricular septal defects (VSDs) has been feasible, safe, and effective with the new Amplatzer membranous septal occluder. We report further experience with this device with emphasis on morphological aspects of the VSDs and technical issues. Ten patients (median age and weight, 14 years and 34.5 kg, respectively) with volume-overloaded left ventricles underwent closure under general anesthesia and transesophageal guidance (TEE). The VSD diameter was 7.1 +/- 4.0 mm by angiography and 7.8 +/- 3.7 mm by TEE. Three patients had defects associated with aneurysm-like formations (two with multiple exit holes), four had defects shrouded by extensive tricuspid valve tissue, two had defects with little or no tricuspid valve involvement, and one had a right aortic cusp prolapse with trivial aortic regurgitation. Implantation was successful in all patients, although in two the initial device had to be changed for a larger one. Kinkings in the delivery sheath, inability to position the sheath near the left ventricular apex, and device prolapse through the VSD prompted modifications in the standard technique of implantation. Device orientation was excellent except in one case. Nine patients had complete occlusion within 1-3 months. Device-related aortic or tricuspid insufficiency, arrhythmias, and embolization were not observed. Two patients had slight gradients across the left ventricular outflow tract, normalizing after 3 months. The Amplatzer membranous septal occluder was suitable to close a wide range of perimembranous VSD sizes and morphologies with good short-term outcomes. Longer follow-up is required.

Atrioventricular Block: A Serious Complication in and After Transcatheter Closure of Perimembranous Ventricular Septal Defects

“…1 -4 Preliminary results following the use of this device were encouraging, and the incidence of complications such as aortic and tricuspid regurgitation was low. 1,2,5 However, the complication of atrioventricular block (AVB) emerged due to the close proximity of a PMVSD to the conduction system. 6,7 In this article, we report the incidence of AVBs during and after transcatheter closure of PMVSD with the Amplazter eccentric PMVSD occluder, and the outcome of the complication in our center.…”

Low Incidence of Rhythm Disturbance following Percutaneous Closure of Ventricular Septal Defects using the Amplatzer Device at Immediate-to-Long-Term Follow Up

“…The Amplatzer muscular occluder has been successfully used to close muscular VSDs [6,7] and a specially designed Amplatzer ventricular septal occluder has been used in perimembranous defects [8,10,14]. The Amplatzer duct occluder has been used successfully for the closure of tunnel-type VSDs with aneurysmal tissue [11,12]; recently, ADO -II has been tried with good success rates and minimal rhythm disturbances [13].…”

“…Approximately two-thirds of VSDs are in the perimembranous (pmVSD) location, and there have been growing concerns about complete heart block at late follow up of percutaneous membranous VSD closure. A special Amplatzer membranous VSD device with an eccentric left ventricular disc was designed for the closure of pmVSDs with good initial results [8][9][10]. Occasionally, pmVSD with aneurysmal tissue can be closed with an Amplatzer duct occluder (ADO) [11,12].…”

Percutaneous Closure of Perimembranous Ventricular Septal Defect with Amplatzer Device

“…The rate of immediate and complete closure in this series was 92% and 100 % after three months. Ongoing endothelialisation of the device is responsible for the decline in the rate of residual shunting with time, which is comparable to surgical repair [14][15].…”

“…This mandates constant vigilance and perhaps revision of the advocated protocol of patient discharge on the next day of the procedure. Experience is now emerging with the use of this device in ventricular septal aneurysms, PMVSDs undergoing closure by the septal tricuspid leaflet and with prolapse of the aortic cusps [14].…”