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

Roberto Mijangos-Vázquez,Safaa Ali,Juan P Sandoval Jones,Rodina Sobhy,Tatiana Molina-Sánchez,Antoine Abdelmassih,Mohammed M Soliman,Carlos Zabal,José A García-Montes,Rogelio Hernández-Reyes,Amal El-Sisi

doi:10.1155/2020/8948249

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. The first and second generation of Amplatzer™ occluders (AVP II, ADO, and ADO II) seem to offer a safe and attractive alternative for this procedure. These 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 The 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.

Highlights

Ventricular septal defects (VSD) are the most common congenital heart malformation accounting for almost onefifth of all defects and can be located in membranous or muscular septum
Percutaneous closure of VSD was first described by Lock et al [4] in 1988, when devices designed for closure of patent ductus arteriosus (PDA) and atrial septal defects (ASD) were implanted in the interventricular septum with variable degrees of success [5, 6]
In all the procedures for transcatheter PmVSD closure, ADO I was attempted in 55 patients; ADO II in 51 patients; and Amplatzer TM Vascular Plug II (AVP II) in 12 patients. e prograde approach was used in 62 patients and the retrograde approach in 58 patients; it was chosen depending on the anatomy of the defect

Summary

Introduction

Ventricular septal defects (VSD) are the most common congenital heart malformation accounting for almost onefifth of all defects and can be located in membranous or muscular septum. Eighty percent of these are perimembranous [1]. Transcatheter closure of congenital VSD for specific and selected patients has been advocated as an alternative to surgical repair as it avoids the risks of cardiopulmonary bypass, postoperative discomfort, and the need for sternotomy and a residual scar [2, 3]. For a successful VSD closure, an anatomic delineation of the defect with its relation to other cardiac structures is needed, so that the development of new aortic/tricuspid regurgitation or conduction defects can be avoided [7]. Percutaneous closure of VSD was first described by Lock et al [4] in 1988, when devices designed for closure of patent ductus arteriosus (PDA) and atrial septal defects (ASD) were implanted in the interventricular septum with variable degrees of success [5, 6].

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