Muscular Ventricular Septal Defect Device Research Articles

Off-label use of muscular VSD device for closure of a rare congenital portosystemic shunt

BackgroundCongenital portosystemic shunt (CPSS) is a vascular malformation in which portal blood drains toward the systemic circulation, leading to pulmonary hypertension.Case presentationA 10-year-old patient was brought for evaluation because of dyspnea on exertion. Echocardiography revealed a pulmonary hypertension of 75 mmHg, and multi-slice CT angiography revealed the presence of a CPSS. Closure was finally implemented using a muscular ventricular septal defect device. Follow-up of the patient revealed a gradual decline in pulmonary hypertension.ConclusionsCPSS is an overlooked cause of reversible pulmonary hypertension (PH). Closure of such lesions and reversal pulmonary hypertension are possible via catheterization. The preferred device type depends largely on the intervening team. Plugs are the first choice for interventional radiologists, while ventricular and atrial septal occluder devices and duct occluders are preferred by pediatric cardiologists.

Transcatheter closure of tubular patent ductus arteriosus using muscular ventricular septal defect devices in infants and small children with congestive heart failure

Transcatheter closure of a patent ductus arteriosus in children is widely performed to reduce symptoms and decrease the risk of endocarditis. Most arterial ducts are closed successfully with dedicated devices. However, in a tubular or "type C" patent ductus arteriosus with congestive heart failure, the occlusion is more challenging with these devices, with a higher risk of complications, such as aortic or left pulmonary stenosis and device embolization. To report our experience with muscular ventricular septal defect devices for patent ductus arteriosus occlusion in small children. Retrospective observational series of patients weighing<10kg, with a tubular patent ductus arteriosus (typeC) and congestive heart failure, who underwent transcatheter closure with a muscular ventricular septal defect device between 2017 and 2019. Eight patients were included. The mean age and weight at closure were 6.3 months (range 1-18 months) and 5.3kg (range 2.4-8.2kg), respectively. All patent ductus arteriosus were occluded successfully using Occlutech® (N=3) or Amplatzer® (N=5) muscular ventricular septal defect devices. In four cases, the muscular ventricular septal defect device was used after failure to close the patent ductus arteriosus with a dedicated patent ductus arteriosus device. Two patients had mild left pulmonary artery stenosis, with a maximum velocity on continuous Doppler of 3m/s and 2.7m/s, respectively. After a mean follow-up of 28 months (range 14-41 months), all patients were asymptomatic with excellent results. The mild pulmonary stenosis improved, with a maximum velocity of 2.3m/s in both patients. Closure of tubular patent ductus arteriosus in small children with congestive heart failure using a muscular ventricular septal defect device is safe in this preliminary experience. Further studies with more patients are warranted.

A case series of ventricular cystic masses.

BackgroundVentricular cystic masses are uncommon. Elucidating the cause is essential for early directed therapy and prevention of complications. We present two cases of ventricular cystic masses, one in each ventricle, after myocardial infarction (MI) and ventricular septal rupture (VSR), respectively.Case summaryPatient 1 is a 58-year-old male with left brachio-facial stroke and evolved anterior MI. A left ventricular (LV) cystic thrombus was seen on transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) imaging. He was started on anticoagulation with reduction in thrombus size 11 days later. Patient 2 is a 67-year-old male with evolved anterior MI, severe LV systolic dysfunction, and normal right ventricular (RV) function. He was readmitted two weeks later with fever, heart failure, Streptococcus agalactiae bacteraemia, and septic pulmonary emboli. Transthoracic echocardiogram showed biventricular systolic dysfunction and a RV cystic mass associated with a partial VSR. He was treated with anticoagulation and antibiotics. Repeat TTE 5 weeks later revealed near resolution of the cystic mass and complete VSR. Cardiac magnetic resonance confirmed these findings and also showed a localized mid-septal transmural infarction at the VSR site. He underwent percutaneous coronary intervention to the left anterior descending and circumflex arteries, and percutaneous VSR closure with a muscular ventricular septal defect device later.DiscussionOur two cases demonstrate that ventricular thrombi can present as cystic masses after MI and VSRs. Infectious, vascular, or oncogenic causes should be considered in the appropriate clinical context. Early diagnosis and treatment is essential to prevent embolic complications, and secondary infection.

APerventricular device closure of post-myocardial infarction ventricular septal defect: Can it combine best of both worlds!

Introduction: Post-myocardial infarction ventricular septal defect (VsD) is a rare but dreadful complication of acute myocardial infarction. current management of this complication has high morbidity and mortality rates. A hybrid approach (perventricular device closure) to high risk congenital muscular VsD has shown promising results. We report first case of a perventricular device closure of post infarct VsD by Amplatzer post-infarct muscular VsD device. case report: A 52-year-old male was referred to us for rapidly progressive dyspnea. He had anterior wall myocardial infarction, complicated by post-infarct VsD. His coronary angiography revealed 90% lesion in left anterior descending (LAD) artery. Perventricular device closure of VsD (Amplatzer post-infarct muscular VsD device) and graft to the LAD were performed using a beating heart technique. His postoperative stay was complicated by an enlarged secondary

Retrograde closure of perimembranous ventricular septal defect using muscular ventricular septal occluder: a single-center experience of a novel technique.

We herein report the advantages of retrograde ventricular septal defect (VSD) closure using a muscular VSD device for perimembranous VSDs. Perimembranous VSDs are conventionally closed by an antegrade technique (arteriovenous looping technique) using a patent ductus arteriosus or asymmetric perimembranous VSD device. However, we used a symmetrical muscular VSD device in all cases described in this report. Use of the antegrade technique for the first few patients with VSD resulted in prolonged procedural and fluoroscopic times and frequent slippage of the device into the right ventricle. Subsequent use of the retrograde technique shortened the procedural time and allowed for easier closure of the perimembranous VSD. We performed retrograde closure of perimembranous VSDs using a symmetrical muscular VSD device in 130 patients. We obtained a high rate of successful deployment (88.5%) and a low rate of complications (6.0%). We also achieved shorter procedural and fluoroscopic times than those associated with the antegrade technique.

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.

Percutaneous Closure of Postinfarction Ventricular Septal Defect: Cardiac Magnetic Resonance-Guided Case Selection and Postprocedure Evaluation

Despite modern surgical techniques, complications and early mortality remain high following postinfarction ventricular septal defect (VSD) repair. It is now possible to close these acquired defects percutaneously using, for example, the Amplatzer postinfarct muscular VSD device. Cardiovascular magnetic resonance is an important tool in determining appropriate case selection and device sizing as it can provide a multicomponent assessment of the VSD anatomy, ventricular volumes and function, infarct extent, and left-to-right shunt calculations.

The results of transcatheter closure of VSD using amplatzer® device and nit occlud® Lê coil

We retrospectively reviewed the result of patients who underwent transcatheter closure of ventricular septal defect (VSD) using Amplatzer® Perimembranous or Amplatzer® muscular VSD device (the Amplatzer® group) and Nit Occlud® Lê VSD Coil (the Pfm group). Perimembranous type (PmVSD) and doubly committed subarterial (DCSA) VSD were the major isolated congenital heart defects in Thai children. Transcatheter device closure technique for both types of VSD has emerged as an alternative treatment to surgery. Retrospectively, data was reviewed between 2003 and 2009. 116 patients were enrolled. Device or coil was successfully implanted in 94%. Complete closure at 24 hr is slightly higher in the Amplatzer® group. The average size of VSD in the Amplatzer® group was larger than the Pfm group (P = 0.001). The Pfm coil was primarily deployed in DCSA VSD when compared with the Amplatzer® group (P < 0.01). At 6 months follow-up the residual shunt was comparable (P = 0.054). There was only one transient AV block (AVB) in the Pfm group and 5 AVB in the Amplatzer® group. Four pacemakers were placed in the Amplatzer® group. Transcatheter closure of VSD in both Pm VSD and DCSA can be achieved by using either of the device. The Amplatzer® VSD device had the advantage of closure of larger defects with immediate less residual shunt but appeared to have a significant number of 3° AVB, which required pacemaker implantation. The Nit Occlud® Lê VSD Coil had the advantage of closure of both types of defects, in particular DCSA VSD with only small residual shunt.

Percutaneous closure of postoperative ventricular septal defects with the amplatzer device

The objective of this study was to look at the procedure, the results, and the follow-up of patients who underwent percutaneous closure of a residual ventricular septal defect (VSD) following a surgical closure using the Amplatzer VSD device. Four patients had an original diagnosis of tetralogy of Fallot, two patients had a patch leak following a surgical repair of a VSD, and three patients had a VSD not repaired at the time of surgery. All patients fulfilled the currently accepted surgical criterion for reoperation (Qp/Qs>1.5). The mean Qp/Qs was 1.8+/-0.3 (1.5-2.3). Four patients underwent VSD closure using an Amplatzer perimembranous VSD device and in five patients an Amplatzer muscular VSD device was implanted. We performed percutaneous closure in nine patients. The size of the residual shunt ranged from 6 to 14 mm and the size of device used ranged from 8 to 16 mm. The arteriovenous loop needed to be recreated in two patients because of failure to advance the delivery sheath. There was complete closure of the defect in six cases, and a small residual shunt remained in three cases. Percutaneous closure of postoperative VSDs appears to be an effective way to resolve a hemodynamically significant residual shunt. There were no difficulties encountered with implantation of the devices. These promising short-term results need reinforcement with additional long-term data.

Percutaneous Closure of Ventricular Septal Defect With an Amplatzer Device

We present a series of 4 patients in whom a ventricular septal defect (VSD) was closed with an Amplatzer muscular VSD device during cardiac catheterization. In one patient with type I truncus arteriosus and subarterial VSD, closure of a wide apical defect was done to allow further surgical correction while avoiding left ventricular ventriculotomy. The second patient had congenitally corrected transposition of the great arteries with complete A-V block and a pacemaker implanted from birth. Our intention was unload the systemic anatomical right ventricle. The third patient had had 3 heart surgeries to correct a double outlet right ventricle. She had a residual ventricular septal defect which was large enough to cause heart failure. The last patient had an isolated muscular ventricular septal defect. Percutaneous closure was successful in all patients, and there were no complications. Percutaneous closure of the defect may be used as a primary procedure, before surgery, or as a complementary procedure after surgery.

Cierre percutáneo de la comunicación interventricular con dispositivo Amplatzer

We present a series of 4 patients in whom a ventricular septal defect (VSD) was closed with an Amplatzer muscular VSD device during cardiac catheterization. In one patient with type I truncus arteriosus and subarterial VSD, closure of a wide apical defect was done to allow further surgical correction while avoiding left ventricular ventriculotomy. The second patient had congenitally corrected transposition of the great arteries with complete A-V block and a pacemaker implanted from birth. Our intention was unload the systemic anatomical right ventricle. The third patient had had 3 heart surgeries to correct a double outlet right ventricle. She had a residual ventricular septal defect which was large enough to cause heart failure. The last patient had an isolated muscular ventricular septal defect. Percutaneous closure was successful in all patients, and there were no complications. Percutaneous closure of the defect may be used as a primary procedure, before surgery, or as a complementary procedure after surgery.