Transcatheter device closure of perimembranous ventricular septal defects: mid-term outcomes

Abstract

AimsThe aim of this study was to evaluate the safety and efficacy of transcatheter closure for perimembranous ventricular septal defect (pmVSD) and its long-term results. The most common congenital heart condition is pmVSD. Transcatheter closure of pmVSD is a recently described technique with limited results for mid- to long-term follow-up.Methods and resultsBetween June 2002 and June 2008, 848 patients with pmVSD were enrolled in our study and treated percutaneously with pmVSD occluders. All patients were followed up until December 2008, an average of 37 months. According to colour Doppler transthoracic echocardiography before the intervention and ventriculography, the average end-diastolic pmVSD size was 5.1 and 5.4 mm, respectively. Placement of the device was successful in 832 patients (98.1%) and the median device size was 8.6 mm. During follow-up, 103 adverse events (12.4%) were reported. Most adverse events were categorized as minor and there were nine major adverse events (8.7%), including two complete atrioventricular block requiring pacemaker implantation. Kaplan–Meier estimates showed >85% freedom from major or minor adverse events during a maximal follow-up of 79 months.ConclusionsIn experienced hands, transcatheter pmVSD closure can be performed safely and successfully with low morbidity and mortality. Long-term prognostic results are favourable, and the transcatheter approach provides a less-invasive alternative that may become the first choice in selected pmVSD patients.This trial is registered with ClinicalTrials.gov, number NCT00890799.

Complete atrioventricular block after percutaneous device closure of perimembranous ventricular septal defect: A single-center experience on 1046 cases

“…[1][2][3] Avoiding sternotomy and cardiopulmonary bypass, the transcatheter approach is assumed to reduce perioperative morbidity and mortality as compared to conventional surgical repair. Nevertheless, the transcatheter technique has subsequent complications, such as embolization of the occluder, valve impairment, and arrhythmia.…”

Transfemoral Device Occlusion and Minimally Invasive Surgical Repair for Doubly Committed Subarterial Ventricular Septal Defects

“…Although surgical repair has been proven safe and effective, it is associated with significant operative trauma, postoperative discomfort, and a large midline scar which has significant adverse psychological consequences and social impact on the growing boys and girls. With the recent development of interventional techniques, device occlusions of VSD gradually become an alternative choice for selected patients, especially those with perimembranous or muscular VSD [4,6,14,20]. Compared with surgical repair through midline sternotomy, transfemoral device closure for perimembranous VSD has the advantage of feeling less discomfort for patients and leaving no incisional scar.…”

“…Since then, many reports have been published regarding the transfemoral device closure of perimembranous VSD and muscular VSD [4,14,20]. Although it is technically difficult, transfemoral device closure for dcVSD has also been tried in a few centers [5,21].…”

The Feasibility and Safety of Interventional Occlusion Treatment of Intracristal Ventricular Septal Defects: Clinical Report of 56 Cases

“…It is better to make an adjustment towards the apex when the occluder is pulled into the delivery sheath so that the occluder can adjust the O in the left ventricle. If the O edge is not under the aorta, the occluder can be completely opened in the left ventricle and adjusted clockwise, and then, the right side disc should be pulled into the delivery sheath again to re-release the occluder; repeated adjustment under the aortic value may damage the aortic valve [8]. …”