TRANSCATHETER CLOSURE OF VENTRICULAR SEPTAL DEFECTS IN INFANTS AND CHILDREN

Abstract

Objectives: The objective of this study was to evaluate the safety and efficacy of the transcatheter approach to correct congenital ventricular septal defects (VSDs) in a prospective clinical trial. Background: VSD is a common congenital heart disease in children. Surgical closure of VSD is a well-established therapy but requires open-heart surgery with cardiopulmonary bypass. Although the transcatheter approach is associated with significant incidence of complete artioventricular block, it may provide a less invasive alternative. Methods and results: Implantation of transcatheter devices was attempted in 30 patients (pts.) with congenital VSDs aged 1 to 14years from November 2013 to November 2014 and follow up for one year. The following anatomic types were present: 11 muscular, 19 perimembranous, single in 26, two in one and multiple in three, Mean VSD size was 6.6 mm (range 3–14), fluoroscopy time 51 min (range 13-107). Devices implanted were Amplatzer duct OcculderI (ADOI) in12, Amplatzer duct Occulder II (ADOII) in8, Amplatzer muscular VSD in 5, PFM in 3 and Cribriform septal occluder in 1 case. Procedure was successful in 25 cases (83.3%). Complications: device embolization in one case (surgical retrieval), unstable device in two pts., minor rhythm disturbances in 2 pts., complete heart block (cAVB) in one pt. NO deaths. All patients were Symptoms free and gaining weight one year after closure. Conclusion Transcatheter closure of congenital VSDs offers encouraging results. Recommendation: More experience and long-term follow-up are mandatory to assess safety and effectiveness of this procedure as an alternative to conventional surgery