Percutaneous Ventricular Septal Defect Closure in Patients Under 1 Year of Age

Abstract

Untreated ventricular septal defect (VSD) is an important cause of congestive heart failure in early infancy. Growth is impaired in this population, and surgical closure is challenging because of congestion in the lungs, making infants prone to respiratory infection, and because of their poor nutritional status. The aim of this study is to share our experience with percutaneous VSD closure in patients under 1 year of age. Patients with hemodynamically significant left-to-right shunt, less than 1 year of age, and with VSD diameter ≤ 6 mm were retrospectively included in the study between December 2014 and January 2017. The median length of follow-up was 8.5 (4-14.2) months. Twelve patients from 2 to 12 months of age, with a median weight of 6.75 (5.4-8) kg, were included. The mean VSD diameter as measured by angiography from the left ventricle side was 4.7 ± 0.25 mm, and from the right ventricle side was 3.4 ± 1.1 mm. All were of a perimembranous type except three, which were muscular. All defects were closed with the Amplatzer Duct Occluder II (ADO II) or the ADO II-additional size. The mean fluoroscopy duration and total radiation dose were 22.6 ± 18.7 min and 1674 ± 851 cGy/min, respectively. No aortic regurgitation associated with device closure was seen in any of the patients. Complete atrioventricular block occurred in one patient 6 months after the procedure, and was treated with a permanent pacemaker. VSD closure is challenging, regardless of whether a surgical or percutaneous procedure is used. The risks are higher for children younger than 1 year with low body weight. Percutaneous closure, which carries similar risks but is less invasive than surgery, may be the preferred alternative in early infancy.

Device Closure of Perimembranous Ventricular Septal Defect: Choosing Between Amplatzer Occluders

“…Previously cited reports showed a variety of devices that have been used to treat pmVSD with promising results (4, 5). Despite that, percutaneous VSD closure is still not currently approved in the United States because of unacceptably high rates of post-procedural and late-onset heart block (HB) (10, 13–15).…”

Percutaneous closure of perimembranous ventricular septal defect using patent ductus arteriosus occluders

“…The huge cornerstone that makes the widespread use of percutaneous VSD closure with devices has been limited is the unacceptable high rate of CHB in the literature [ 11 , 20 , 24 , 33 , 34 ]. This complication may happen very early or very late after the procedure [ 24 , 35 , 36 ], may be reversible with medication, or may become persistent and require permanent pacemaker insertion [ 37 , 38 ].…”

Percutaneous closure of perimembranous and postsurgical ventricular septal defects with Amplatzer Duct Occluder II Additional Sizes in paediatric patients – case series

“…During the same procedure, residual postsurgical PDA was closed with another ADO II AS [6]. Narin et al [7] presented their experience with percutaneous VSD closure in children under 1 year of age. There were 12 patients – ADOII was applied in 8 patients (complete AV block occurred in 1 of 8 patients after 6 months), while ADO II AS was used in 4 patients (no rhythm disturbances in the follow-up).…”

“…The main issues are the risk of embolization, early and late conduction disturbances, damage to the tricuspid valve apparatus or aortic insufficiency [4]. Numerous devices have been proposed for percutaneous pmVSD closure, including the off-label use of Amplatzer muscular VSD occluders, Amplatzer duct occluders type I and II (ADO I, II) or ADOII Additional Sizes (ADO II AS) [2, 5–7]. To the best of our knowledge, there have been only two previous publications from this and the previous year regarding this application of ADO II AS in children – 1 case report [6] and 1 presentation of a series of 4 cases [7].…”