Amplatzer Muscular Ventricular Septal Defect Research Articles

Transcatheter Closure of a Paravalvular Leak Guided by Transesophageal Echocardiography and Three-Dimensional Printing

BackgroundClosure of a percutaneous paravalvular leak (PVL) is a technically challenging procedure because of the specific anatomy postoperatively and the complex catheter techniques required. Transesophageal echocardiography (TEE) and three-dimensional (3D) printing might be helpful in identifying complex anatomical structures and the procedural design.ObjectivesThe purpose of this study was to review our experiences with transcatheter closure of PVL guided by TEE and 3D (TEE&3D) printing.MethodsA total of 166 patients with PVL after surgical valve replacement underwent transcatheter closure, from January 2015 through December 2020. Among these patients, 68 had preoperative guidance from TEE&3D printing. We reviewed the catheter techniques, perioperative characteristics, and prognosis. The median follow-up period was 36 (3–70) months.ResultsAcute procedural success was achieved in 154/166 (92.8%) patients; of these, 64/68 (94.1%) had TEE&3D guidance and 90/98 (91.8%) had transthoracic echocardiography (TTE) guidance. No hospital deaths occurred. All patients having percutaneous procedures were given local anesthesia, while 13 patients having transapical procedures were given general anesthesia. Multiple approaches were used, including transfemoral, transapical, and transseptal via the arteriovenous loop. We also deployed multiple devices, including the Amplatzer Vascular Plug II (AVP II), the Amplatzer duct occluder II, the patent ductus arteriosus (PDA) occluder, and the Amplatzer muscular ventricular septal defect occluder. Those cases guided by TEE&3D printing had shorter procedural times compared with those guided by TTE [(61.2 ± 23.4) vs. (105.7 ± 53.9) min, p < 0.05]. The fluoroscopic time was also shorter for operations guided by TEE&3D printing compared with those guided by TTE alone [(18.5 ± 11.4) vs. (27.3 ± 5.6) min, p < 0.05]. The complications included recurrent hemolysis, residual regurgitation, acute renal insufficiency, and anemia. There was no significant difference in the incidence of complications between the 2 groups.ConclusionTransesophageal echocardiography and 3D printing show advantages compared with standalone TTE in guiding the transcatheter closure of PVL with shorter procedural and fluoroscopic times. This minimally invasive treatment could provide reliable outcomes in selected patients.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NCT02917980].

Transcatheter closure of ventricular septal defects: preliminary results in children weighing 10 kg or less.

Ventricular septal defect is one of the commonest heart defect in children and closure of this defect with devices has seen a rapid progression over a period of time. The availability of new and safer devices has made the transcatheter closure of ventricular septal defect a suitable option even in young children. The study was done to evaluate the feasibility and complications of device closure of ventricular septal defect in children weighing 10 kg or less with different types of devices. The present study was undertaken in a newly established dedicated Paediatric Cardiac Unit at a Tertiary Care Hospital. Relevant data were obtained retrospectively from the case files and the catheterisation records and data were analysed for first 50 patients with ventricular septal defect weighing 10 kg or less between March 2018 and March 2021. Among these 50 patients selected, device closure was successfully done in 45 (90%) cases while 5 (10%) attempts were unsuccessful for various reasons. The mean weight in this study was 7.46 ± 1.89 kg (2.3-10 kg), 21 (42%) cases were females while 29 (58%) were males; mean age was 19.4 ± 11.88 months (4-48 months). Right heart catheterisation study showed 21 (42%) patients with normal pulmonary artery pressures (no pulmonary artery hypertension). Among 29 patients with pulmonary arterial hypertension, 13 patients (22%) were having mild pulmonary arterial hypertension, 4 (8%) were with moderate pulmonary arterial hypertension, and 12 (24%) were with severe pulmonary arterial hypertension. Mean Qp/Qs was 2.73 ± 0.72 (2.5-4.5) and mean pulmonary vascular resistance was 1.5 ± 1.04 (0.6-4.6 WU). Amplatzer Duct Occluder (ADOI) was used in 15 (30%) cases, 27 (52%) cases were closed with Amplatzer Duct Occluder (ADOII), and the 3 (6%) cases closure was done with Amplatzer muscular ventricular septal defect occluder. Transcatheter closure of ventricular septal defect in children 10 kg or less is feasible and safe alternative to surgical ventricular septal defect closure. The immediate and short-term outcomes have proven this method to be safe and valid.

Combination of a vascular plug and coiling to treat an ascending aortic pseudoaneurysm following aortic surgery

Combination of a vascular plug and coiling to treat an ascending aortic pseudoaneurysm following aortic surgery

Long-term results of transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension in pediatric patients

Aims:Patent ductus arteriosus (PDA) is one of the most commonly seen congenital heart diseases prevalent today. The aim of this study is to evaluate the safety and efficacy of transcatheter closure of hypertensive ductus at long-term follow-up.Materials and Methods:Transcatheter closure was attempted in 52 patients with hypertensive ductus arteriosus. A lateral or right anterior oblique view aortogram was done to locate and delineate PDA. All the patients underwent clinical examination, electrocardiography, chest X-rays, and echocardiography before discharge and at 1, 6, and 12 months after the procedure and yearly thereafter.Results:The mean age of patients at procedure was 7.98 ± 4.79 (11 months–17 years), and the mean weight was 17.72 ± 10.81 (4–47) kg. Transcatheter closure of hypertensive ductus was successful in 50 (96.15%) patients. The mean preprocedural pulmonary artery pressure was 81.38 ± 17.31 (range: 55–113) mmHg which decreased to 29.65±8.63 (19-38) mmHg at follow up. The most commonly used device was Amplatzer duct occluder in 63% of the patients followed by Amplatzer muscular ventricular septal defect occluder in 37% of the patients. There were two procedural failures, namely aortic obstruction and left pulmonary artery stenosis, which were managed uneventfully. There were no procedural deaths or device embolization. At median follow-up of 86 months, all the patients are well with no complications.Conclusion:The long-term results suggested that transcatheter closure of PDA with severe pulmonary hypertension in pediatric patients is safe and effective with minimal complications.

Characteristics and transcatheter closure of patent ductus arteriosus in patients living at moderate-to-high altitude in Eastern Anatolia

The incidence of patent ductus arteriosus (PDA) is greater among patients living at high altitude. In this po-pulation, the ductal diameter is often larger and pulmonary hypertension is more frequent. The aim of this study was to evaluate the hemodynamic and morphological features of PDA and transcatheter closure procedures performed with various devices in a group of patients living at high altitude in Turkey. The data of 327 patients who lived at an altitude of at least 1600 m above sea level and who had undergone cardiac catheterization for isolated PDA between May 2010 and July 2018 were retrospectively analyzed. The mean age was 7.33±7.67 years, and 62.4% of the patients were female. The mean ductal diameter was 3.74±2.14 mm. Pulmonary hypertension was present in 57.8%. Transcatheter closure was performed in 322 patients, with a 97.3% success rate. The Amplatzer duct occluder I (ADO I) was used most often, as well as off-label use of the Amplatzer vascular plug II (AVP) and the Amplatzer muscular ventricular septal defect occluder (AMVSDO). Pulmonary artery pressure decreased immediately in the vast majority after percutaneous closure. Transient left ventricular systolic dysfunction after ductal closure was seen only rarely. Follow-up was uneventful. Transcatheter PDA closure can be performed with high success rate in highlanders. Off-label devices may be required for these procedures. Pulmonary hypertension is frequent but regresses after ductal closure. Transient left ventricular dysfunction after transcatheter closure is rarely seen in these patients and resolves without any medication.

Transcatheter device closure of postmyocardial infarction ventricular septal defect

BackgroundTranscatheter device closure of postmyocardial infarction ventricular septal defect (PMIVSD) is less invasive than surgical repair. However, its feasibility, timing, outcome, and prognostic factors remain unclear. MethodsThis was a multicenter, retrospective cohort study. Between February 2012 and July 2015, a total of 10 (8 male and 2 female) patients with PMIVSD undergoing attempted device closure were enrolled retrospectively. The procedures were performed under general anesthesia with fluoroscopic and transesophageal echocardiographic guidance. ResultsThe patients enrolled in the study were in the age range 50–85 years (median age of 76.5 years). The interval from infarction to device closure ranged from 6–147 days, with the median of 12 days. A total of 13 devices were implanted in 10 patients. There were five Amplatzer muscular ventricular septal defect occluders, four Amplatzer septal occluders, three Amplatzer PMIVSD occluders and one Amplatzer vascular plug II. Complications included transient ventricular tachycardia in three patients, device embolization in one patient, and tracheal bleeding in one patient. No procedure-related death, stroke, or cardiac tamponade was noted. During follow-up, two patients died of heart failure and two patients died of sepsis. Overall, subjects with age ≥ 80 years, systolic blood pressure ≤ 90 mmHg, and procedure time ≥180 minutes were significant predictor factors for mortality. All patients with the interval of infarction to device closure >12 days survived. ConclusionOur findings indicate that transcatheter device closure of PMIVSD is technically feasible, safe, and effective to reduce the shunt. The crucial prognostic factors were ascertained to be age ≥ 80 years, systolic blood pressure ≤ 90 mmHg, and procedure time ≥180 minutes.

TRANSCATHETER CLOSURE OF VENTRICULAR SEPTAL DEFECTS IN INFANTS AND CHILDREN

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

Percutaneous closure of perimembranous ventricular septal defects associated with septal aneurysm in adults.

Percutaneous closure of perimembranous ventricular septal defects (pmVSD) has become an accepted alternative to surgical closure in selected cases. However, closure of pmVSDs associated with septal aneurysm is more challenging. We report our experience of device closure of pmVSDs associated with septal aneurysm. Between 2008 and 2012, percutaneous closure of pmVSD associated with septal aneurysm was attempted in 11 adult patients in our institution. The patients were followed up at 1, 3, 6, and 12 months after the procedure. Mean age of the patients (64% male, 36% female) was 36.2±1.3 years. Diameter of the left and right ventricular openings of the aneurysm measured by ventriculography was 13.5±5.6 mm and 5.9±2.2 mm, respectively. The defect was occluded with Amplatzer pmVSD Occluder in 4 patients, Amplatzer Muscular Ventricular Septal Defect Occluder in 4 patients, Amplatzer Duct Occluder I in 1 patient, and Amplatzer Duct Occluder II in 2 patients (AGA Medical Corp., Plymouth, MN, USA). The procedure was succesfull in all patients. Mean follow-up time was 22±1.9 months. There was no device- or procedure-related complications at the acute setting or mid-term follow-up. Percutaneous closure of pmVSDs associated with aneurysm is more challenging than that of simple defects. The selection of the device type and size should be made according to the configuration and size of the aneurysm and defect.

Closure of large patent ductus arteriosus using the Amplatzer Septal Occluder

Percutaneous closure of patent ductus arteriosus has become the treatment of choice in many centres. In patients with large ducts and pulmonary hypertension, transcatheter closure has been achieved with success using the Amplatzer Duct Occluder or even the Amplatzer Muscular Ventricular Septal Defect Occluder. We present a series of 17 patients with large and hypertensive ductus arteriosus who were treated with an Amplatzer Septal Occluder. The group had 11 female patients (64.7%) and a mean age of 18.6±12.1 years. The haemodynamic and anatomical data are as follows: pulmonary artery systolic pressure 71.3±31.8 mmHg, pulmonary to systemic flow ratio 3.14±1.36, ductal diameter at the pulmonary end 12.5±3.8 mm, and at the aortic end 20.2±7.7 mm; 14 cases (82.3%) had type A ducts. In 11 patients, we began the procedure using a different device - six with duct occluder and five with ventricular septal occluder - and it was changed because of device embolisation in six (35.3%). All septal occluders were delivered successfully. Residual shunt was moderate in six patients (35.3%), mild in eight (47%), trivial in two (11.8%), and no shunt in one (5.9%). Pulmonary systolic pressure decreased to 48.9±10.8 mmHg after occlusion (p=0.0015). Follow-up in 15 patients (88.2%) for 28.4±14.4 months showed complete closure in all cases but one, and continuous decrease of the pulmonary systolic pressure to 31.4±10.5 mmHg. No complications at follow-up have been reported. The Amplatzer Septal Occluder is a good alternative to percutaneously treat large and hypertensive ductus arteriosus.

Post Melody valve implant in a conduit with regurgitant native outflow tract successful closure by Amplatzer muscular device

We describe the technique of closure of native right ventricular outflow tract by Amplatzer muscular ventricular septal defect device because of severe regurgitation in a patient who had tetralogy of Fallot repair with conduit at 3 years of age followed by percutaneous Melody valve implant 6 years later.

Transcathether closure of a right pulmonary artery-to-left atrial fistula using Amplatzer muscular ventricular septal defect occluder

A right pulmonary artery-to-left atrial fistula is a very rare cyanotic congenital heart defect and is characterized by cyanosis and normal auscultation of the heart. Interventional closure of the fistula using occluder devices and coils has been rarely reported. We report the successful closure of a RPA-to-left atrial fistula using an Amplatzer muscular ventricular septal defect occluder in a child with cyanosis. The two-dimensional echocardiogram with bubble contrast study demonstrated the communication between right pulmonary artery and left atrium. Computerized tomography confirmed the diagnosis and delineated the anatomy.

Transapical closure of mitral paravalvular leak over a surgically constructed mitral annulus

Paravalvular leakage (PVL) after mitral valve replacement surgery is a rare but serious complication occurring in approximately 5% of cases. Although many patients remain asymptomatic, those that develop heart failure, arrhythmias, endocarditis or severe hemolysis conventionally undergo surgical repair or replacement despite the higher morbidity and mortality with reoperation. Transcatheter techniques introduced in 1992 have proven to be a safe alternative to surgery, especially in high-risk patients with only a 1–2% risk of emergent surgery or death, with technical success rates ranging from 63 to 100% and clinical success rates ranging from 54 to 100% [1,2]. We report the first transapical PVL closure of a surgically constructed mitral annulus in a high-risk patient with an Amplatzer muscular ventricular septal defect (mVSD) closure device (AGA Medical Corporation; Plymouth, MN). A 56-year-oldmanhad an elective aorto-coronary bypass (LIMA-LAD, SVG-PDA, sequential SVG-OM1 and OM2) and mitral annuloplasty ring for severe mitral regurgitation in September 2006. In October 2006, he developed severe mitral PVL due to dehiscence of the annuloplasty ring with resultant hemolytic anemia. During surgery, the dehiscence of the annuloplasty ring was deemed to be unrepairable and a CarboMedics 33 mm mechanical valve with pledgetted sutures was placed in the mitral annulus. In November 2006, the patientwas readmitted for severe mitral PVL. During surgery, the valve was excised and due to insufficient tissue to hold the valve in the mitral annulus, a new annulus was surgically constructed and a CarboMedics 31 mm mechanical valve was implanted. In May 2007, he presented again with mitral PVL and hemolysis for which the patient underwent right thoracotomy, fibrillatory arrest and suture repair of two areas of mitral PVLs with pledgetted sutures. InNovember 2012, the patientwas admitted forheart failure and a three-dimensional TEE showed a severe mitral PVL due to large dehiscence from 9 to 12 o'clock in the left atrial view and no other leaks (Fig. 1). Since the mitral prosthesis was functioning well and the patient refused redo-surgery (logistic EuroSCORE—18.27%), we opted for the percutaneous PVL closure. The trans-septal approach was deemed to be

Perforated Sinus of Valsalva (PSOV) aneurysm closure with a muscular VSD occluder

We report a case of a Perforated Sinus of Valsalva Aneurysm (PSOV) closure using an Amplatzer muscular ventricular septal defect occluder (mVSD) device and describe a novel and potentially safer way for defect sizing. A literature review of the endovascular treatment of this disease is presented.

The off-label use of the Amplatzer muscular VSD occluder for large patent ductus arteriosus: a case report and review

A percutaneous approach to the closure of patent ductus arteriosus (PDA) is the preferred procedure in the majority of cases. However, there is little experience with percutaneous closure of unusually large PDA. We report the case of a 28-year-old female with moderate left ventricular dilation and pulmonary hypertension resulting from a large 16mm PDA. Percutaneous closure was successfully performed using an off-label Amplatzer muscular ventricular septal defect occluder after intravascular ultrasound assessment. Technical challenges, including accurate assessment of defect size and device selection are exemplified along with a comprehensive overview of the available literature.

Ruptured Sinus of Valsalva Found Incidentally in a Patient with Tetralogy of Fallot

Ruptured sinus Valsalva aneurysm (SVA) in a patient with tetralogy of Fallot is a very rare cardiac complication. This report describes the case of a 10-year-old Hispanic girl who presented to her cardiologist for a routine transthoracic echocardiography (TTE), which showed a ruptured sinus of Valsalva, with left-to-right shunting noted from the right cusp to the right ventricular outflow tract and pulmonic insufficiency. The patient underwent right and left heart catheterization with transesophageal echocardiography guidance and closure of the ruptured sinus of Valsalva with an Amplatzer muscular ventricular septal defect (VSD) device. Later that day, after the procedure, it was noted that the patient had a recurrence of continuous murmur. The TTE did not visualize the Amplatzer VSD device, and chest X-ray showed that the device had embolized to the right pulmonary artery. The device was successfully retrieved percutaneously. The patient returned 2 weeks later for surgical repair of a ruptured SVA and pulmonary valve replacement, which went well. This case report is the first to describe congenital rupture of a Valsalva aneurysm in a patient with tetralogy of Fallot. The conventional treatment for a ruptured sinus of Valsalva is surgical, although transcatheter approaches have been used increasingly in recent years.

Early migration of an Amplatzer muscular ventricular septal defect occluder device causing severe tricuspid valve obstruction

Percutaneous closure of perimembranous and muscular ventricular septal defects is becoming well established worldwide. We present the case of a 15-year-old girl with postoperative tetrology of Fallot and a residual ventricular septal defect that was closed with Amplatzer device complicated by early device migration and severe tricuspid valve obstruction.

Closure of Apical Access Site After Transapical, Transcatheter Paravalvular Leak Closure

The safety of percutaneous transapical mitral paravalvular leak (PVL) closure could potentially be enhanced by device closure of the ventricular access site. Percutaneous transapical PVL closure was performed. The 9F delivery sheath was pulled back, and a 6-mm Amplatzer muscular ventricular septal defect occluder was deployed at the apical puncture site. Immediate hemostasis was achieved. Total hospitalization was 9 days. New York Heart Association functional class was improved, hemoglobin and haptoglobin rose, while lactate dehydrogenase fell. Follow-up fluoroscopy and transthoracic echocardiography revealed a good functional result. Closure of the apical access site by means of an Amplatzer muscular ventricular septal defect occluder is feasible.

Transcatheter Closure of a Large Left Atrial Aneurysm With a Right Pulmonary Artery-to-Left Atrium Connection Using the Amplatzer Ventricular Septal Occluder

A right pulmonary artery-to-left atrium connection is a very rare cyanotic congenital heart defect. Although it is generally treated with surgery, we describe the case of a 5-year-old girl whose connection was successfully closed the Amplatzer muscular ventricular septal defect occluder. The patient was asymptomatic at last follow-up.

Defect closure in the lipomatous hypertrophied atrial septum with the amplatzer muscular ventricular septal defect closure device: A case series

Variations in the anatomy of the atrial septum can confound the transcatheter closure of atrial septal defects and patent foramen ovale. While lipomatous hypertrophy of the atrial septum is not frequently encountered, attempts to use standard atrial septal occlusion devices in such patient can lead to malapposition and continued shunt. Some operators have suggested that atrial septal hypertrophy is a relative contraindication to transcatheter-based closure techniques. We present a novel technique exploiting the features of the Amplatzer muscular ventricular septal defect occluder to treat atrial septal defects in the setting of lipomatous hypertrophy of the atrial septum in two patients.

Ventricular septal defect closure in a small children with the Amplatzer Duct Occluder II

Transcatheter technique for muscular ventricular septal defect closure remains challenging, particularly in small patients. We report the successful use of the low profile Amplatzer Duct Occluder II for multiple ventricular septal defect closure in an infant with D-transposition of the great arteries, status postpulmonary artery banding. The multiple apical ventricular septal defects were successfully closed with two Amplatzer Duct Occluder II and one Amplatzer Muscular Ventricular Septal Defect Occluder during two interventional catheterizations. The patient subsequently underwent successful surgical repair.