Transcatheter Closure of Perimembranous Ventricular Septal Defects Using Different Generations of Amplatzer Devices: Multicenter Experience

Abstract

Objectives. To demonstrate safety and efficacy of using different generations of softer Amplatzer ™ devices for ventricular septal defect (VSD) closure to avoid serious complications at follow-up. Background. Transcatheter closure of perimembranous ventricular septal defects (PmVSD) is a well-established procedure; however, it is associated with unacceptable incidence of complete heart block. Great advantages have been achieved by using softer devices for VSD transcatheter closure. e first and second generation of Amplatzer ™ occluders (AVP II, ADO, and ADO II) seem to offer a safe and attractive alternative for this procedure. ese devices can be delivered using either an arterial (retrograde) or venous (prograde) approach. Methods and Results. Patients with congenital PmVSD who underwent transcatheter closure using ADO, ADO II, and AVP II devices were included. Primary end point was to determine efficacy and safety of these generations of devices and to determine the incidence of complications at follow-up (complete AV block and aortic/tricuspid/mitral regurgitation). One hundred and nineteen patients underwent VSD closure at a median age of 5 years (8 months-54 years). During the catheterization, there were only minor complications and at follow-up of 36 ± 25.7 months (up to 99 months), the closure rate was high of 98.3% and freedom from AV block was 100%. Conclusions. e use of softer Amplatzer ™ devices is a good alternative to achieve PmVSD closure safely with no risk of AVB during the procedure or at midterm follow-up.

The Long-Term Change of Arrhythmias after Transcatheter Closure of Perimembranous Ventricular Septal Defects

“…So far, the underlying mechanism of arrhythmias after transcatheter pmVSD closure is still unclear. The risk factors may include age, weight, operation duration time, operation technique, anatomy location of the pmVSD, size of the occluder, morphological characteristics of the occluder, and so on, but the conclusions about risk factor were different in various researches [ 5 , 12 , 15 , 39 ]. In this study, younger patients with large size occluder, asymmetrical concentric or eccentric occluder, and undergoing the operation on an early time might easily get arrhythmias.…”

“…Currently, the treatments of pmVSD mainly include interventional occluder closure and surgical repair. Compared with the surgical repair, up to now, the interventional treatments are still controversial [5].…”

“…Currently, the treatments of pmVSD mainly include interventional occluder closure and surgical repair. Compared with the surgical repair, up to now, the interventional treatments are still controversial [ 5 ]. The initial application of Amplatzer Membranous VSD Occluder was not satisfactory in the clinical practice, which prevented the promotion and application of this technology in the United States [ 6 ].…”

Use of ASD closure device for the sealing of false lumen entry in the ascending aorta after dissection Type A surgical repair

“… 13–16 A retrospective study involving 119 patients found that Amplatzer vascular plug and Amplatzer duct occluder I and II seem to be safe for the closure of VSD and they can be used off-label with good mid-term results. 17 …”

Panorama actual a 4 años del inicio de la cardiología intervencionista en cardiopatías congénitas en el Estado de Chiapas

“…Hasta la fecha hemos realizado un total de 36 procedimientos con buenos resultados, con un índice de cierre del 100% y, lo más importante, libre de complicaciones. Recientemente publicamos en un estudio multicéntrico la experiencia de nuestro país y del grupo cardiovascular de Egipto en los últimos nueve años en donde se reportaron un total de 119 pacientes con una mediana de edad de 5 años y peso de 18 kg que fueron llevados a cierre de comunicación interventricular perimembranosa utilizando dispositivos ADO de primera y segunda generación, así como dispositivos AVP II, en donde se reportó un índice de cierre del 98.3% y no se reportó ningún caso de bloqueo atrioventricular a un seguimiento a 36 ± 25.7 meses 17 . También reportamos el cierre de un defecto ventrículo-atrial (Gerbode) con un dispositivo AVP II  en un paciente de sexo masculino de 10 años de edad con antecedente de corrección de conexión anómala parcial de venas pulmonares derechas al atrio derecho 18 .…”