Transcatheter closure of doubly committed subarterial ventricular septal defects with the Amplatzer ductal occluder: initial experience

Abstract

Background:There is limited experience about transcatheter closure of doubly committed subarterial ventricular septal defects with Amplatzer ductal occluder.Methods:Between March, 2015 and July, 2017, a total of 22 patients with doubly committed subarterial ventricular septal defects received transcatheter closure using Amplatzer ductal occluder and underwent clinical follow-up for at least 6 months.Results:Device implantation was finally successful in 21 (95.4%) patients despite failed occlusion in one patient and intra-procedural replacement of unsuitable occluders in four (19.0%) patients. In mean 12.3 months of follow-up, there were no major complications (death, aortic valve or sinus rupture, device dislocation or embolisation, grade 2 new-onset aortic regurgitation, etc.), resulting in clinical occlusion success of 95.4%. Mechanical haemolysis occurred in one patient and resolved with medication. Residual shunt was observed in 11 (52.4%) patients (9 mild, 2 moderate-severe) post-procedurally, 14 (66.7%) patients (12 mild, 2 moderate-severe) in hospital stay, and 2 (9.5%) patients (2 mild, 0 moderate-severe) at the last follow-up. Device-induced new-onset aortic regurgitation was found in nine (42.8%) patients (9 mild, 0 moderate-severe) post-procedurally and in hospital stay, which was resolved in two (9.5%) patients and unchanged in seven (33.3%) patients at the last follow-up. Another four (19.0%) patients newly developed mild aortic regurgitation during follow-up.Conclusions:Transcatheter closure of doubly committed subarterial ventricular septal defects with Amplatzer ductal occluder is technically feasible in the selected patients. However, further study is needed to confirm its long-term clinical outcomes.

Recent achievements in transcatheter closure of ventricular septal defects: a systematic review of literature and a meta-analysis

“…The highest reported incidence of TR in the early period was 25.49% (26/102 patients) [29]. However, it was 40.91% (9/22 patients) for AR [18]. A review of reports showed a decrease in the incidence of these lesions over time, involving more tricuspid valve.…”

Doubly committed subarterial ventricular septal defect closure through tricuspid approach: a clinical analysis

“…18 With the accumulation of interventional experience, some studies proved perventricular closure of DCVSD with occluder was technically feasible and safe in the selected patients, and perventricular occlusion was the preferred approach because it showed a higher success rate than transfemoral occlusion. 19,20 No acute complications or severe adverse events (death, valve injury, complete atrioventricular block, and embolism) occurred either in the early period or during the follow-up in their research. 19,20 Even though interventional occlusion had been extensively applied in the treatment of peri-membranous and muscular ventricular septal defect, its application to DCVSD to some extent had been limited due to the complexity and its potential damages to the aortic valve.…”

“…19,20 No acute complications or severe adverse events (death, valve injury, complete atrioventricular block, and embolism) occurred either in the early period or during the follow-up in their research. 19,20 Even though interventional occlusion had been extensively applied in the treatment of peri-membranous and muscular ventricular septal defect, its application to DCVSD to some extent had been limited due to the complexity and its potential damages to the aortic valve. 21 Liu et al reported the incidence of early and late complications of interventional occlusion for DCVSD was up to 19.2% and 3.8%, respectively.…”

Predictors of transcatheter closure cancellation in children with ventricular septal defect

“…The incidence of cancellation due to heart conduction disturbances was smaller than that of the VSD PMO type. 9,10 Another study revealed that aortic valve disorders occur in 5-8% of the PMO-type VSD and 30% of the DCSA type, because the DCSA VSD is located just below the aortic valve. In the case of DCSA VSD, the aortic valve disorder occurs initially in the diastolic phase due to the venturi effect produced by the left-to-right shunt, then prolapse can occur during the systolic phase because the damaged aortic valve is no longer able to withstand high aortic pressure.…”