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

Abstract

IntroductionOff-label use of different devices has been described for percutaneous closure of ventricular septal defects (VSD) because of the unacceptable rate of post-procedure heart block associated with special VSD devices.AimTo describe the early single-center clinical experience with closure of a VSD using the Amplatzer Duct Occluder II (ADO II) device in children.Material and methodsBetween May 2013 and June 2015, 26 patients between 13 days and 16 years of age underwent percutaneous closure of a VSD with an ADO II device at our institute. The decision to use the ADO II device was based primarily on lower risk of total atrioventricular block (TAVB) after VSD closure reported in the literature, reduction of the cost of the procedure and the need to close symptomatic VSDs in young patients.ResultsThe location of the VSD was perimembranous in 21 patients, postsurgical residual in 2, midmuscular in 2 and apical muscular in 1. Complex procedures including newborn, combined procedures and postsurgical residual VSD were performed in 5 (19%) patients. The median duration of follow-up was 12 months. The complete VSD closure rate was 81% immediately after the procedure, 85% at 24 h, and 93% at the last follow-up. There was no device embolization. During the entire follow-up period, TAVB did not develop.ConclusionsThe ADO II constitutes a safe and effective therapeutic alternative for morphologically varied VSDs in all pediatric age groups. A larger range of sizes and configurations of this occluder may be required to successfully occlude a wider range of VSDs.

Transcatheter closure of congenital perimembranous ventricular septal defect using the Amplatzer duct occluder 2

“…Recently, several studies on the transcatheter device of ventricular septal defect using Amplatzer duct occluder 2 have been reported. [6][7][8][9] However, most of the reports were based on small samples without a long-term follow-up. The appropriate time of usage and ventricular septal defect size capable of closure, the accurate indications, and long-term results of Amplatzer duct occluder 2 were not yet clarified.…”

Transcatheter closure of ventricular septal defect from retrograde transarterial approach: immediate and long-term outcome

“…16 Off label use of this device reduces the risk of feared complication of atrioventricular block which occur in 3% to 20% of the cases closed with membranous occluder. [17][18][19] So, ADO II was used in this series to close perimembraneous VSD to eliminate the risk of complete atrioventricular block. With this device, up to 6.5 mm size defects can be closed with a minimum distance of 3 mm from its upper margin to aortic valve.…”

Percutaneous closure of perimembranous ventricular septal defects utilizing almost ideal Amplatzer Duct Occluder II: Why limitation in sizes?

“…12,13 Due to the more flexible and finer meshwork of the ADO II device, the devices can advance through small 4F of 5F catheter systems, which from the technical point of view allow theoretically VSD closure even in young infants or newborns. 12,13 Due to the more flexible and finer meshwork of the ADO II device, the devices can advance through small 4F of 5F catheter systems, which from the technical point of view allow theoretically VSD closure even in young infants or newborns.…”

“…An "off-label" use of ADO II for the closure of VSDs is already described in some small case numbers. 12,13 Due to the more flexible and finer meshwork of the ADO II device, the devices can advance through small 4F of 5F catheter systems, which from the technical point of view allow theoretically VSD closure even in young infants or newborns. Additionally, lower risk for the occurrence of cAVB is expected by the soft ADO II design.…”

“…Additionally, lower risk for the occurrence of cAVB is expected by the soft ADO II design. 12 Until today only one single case with a late onset of cAVB is described. 14 We report our follow-up results of percutaneous closure of perimembranous VSDs in different ages and locations with ADO II supporting the requirement of larger sizes of ADO II devices.…”