Transcatheter Closure Of Perimembranous Ventricular Septal Defects Research Articles

Transcatheter closure of perimembranous ventricular septal defects by coils le

Background: Ventricular septal defect (VSD) is the most frequently occurring congenital cardiac disease, accounts nearly 20-30% of all cases.
 Surgery still the corrective therapy with high success and low complication but having some problems: cardiopulmonary bypass, anesthesia, ICU, sternalitis, chest scar...
 Recently many progress in cardiac intervention applied to treat congenital heart disease especially percutaneous VSD closure. currently patients with VSD have other choice to cure safely, effectively and less complication.[1]
 Objectives: To evaluate the long-term (more than 3 years follow-up) results from transcatheter closure of perimembranous VSD by Coil Le.
 Methods: This is the descriptive clinical trial and follow-up.
 Result: 27 patients selected by echocardiography, 25 patients were closed successfully (92.6% success rate) with Coil Le. Complete occlusion (no shunt) is 96.0% and no late AVB at least 3 years follow-up.
 Conclusions: Transcatheter closure of perimembranous VSD by Coil Le is effective with high occlusion rate, no significant complications and is suitable for selected PMVSD.

Heart Function and Ventricular Recovery After Percutaneous Closure of Perimembranous Ventricular Septal Defect in Children: A Cross-sectional Study

Background: Perimembranous ventricular septal defect (VSD) is the most common congenital heart defect. There is a trend for percutaneous VSD closure. However, little evidence is available for the effect of this method on ventricular remodeling. Objectives: This study aimed to investigate the effect of percutaneous closure of perimembranous VSD on cardiac function and ventricular recovery. Methods: A total of 46 pediatric patients (32 males vs. 14 females) who underwent transcatheter closure of perimembranous VSD from 2010 to 2020 were randomly included in the study. Data regarding the demographic profile, angiographic records, and follow-up echocardiography were extracted from their files and recorded in questionnaire templates. The echocardiographic parameters were recorded and compared with published Z-scores for the corresponding age groups. Results: The mean duration of follow-up was 15.76 ± 12.20 months. In M-mode echocardiography, 84.6% had interventricular septum diastolic diameter Z-score ≥ 2; 23.8% had interventricular septum systolic diameter Z-score ≥ 2; 38.5% had left ventricular internal diameter in diastole Z-score ≥ 2; 34.6% had left ventricular internal diameter in systole Z-score ≥ 2; and 65.4% had left ventricular posterior wall in diastole Z-score ≥ 2. In the evaluation of Doppler and tissue Doppler, 36.4% of the patients had a Z-score ≥ 2 for E/Ea of tricuspid. Also, VSD size had a positive correlation with interventricular septal diameter in systole Z-score (P = 0.015, r = 0.537). Conclusions: In the midterm follow-up after percutaneous perimembranous VSD closure, left ventricular dilation and hypertrophy persisted in a significant number of patients. However, early closure of the VSD, especially in patients with lower weight could affect ventricular hemodynamics and remodeling.

Interventional device closure of perimembranous ventricular septal defects: challenges, pitfalls, and advancements in device technology

Percutaneous closure is the standard therapy for muscular Ventricular Septal Defects (VSDs) beyond infancy with a low rate of major complications. The story is somewhat different for Perimembranous Ventricular Septal Defects (PmVSDs) where surgery remains in 2021 the preferable treatment approach in some centers, due to the historical incidence of Complete Atrioventricular Block (CAVB) that has been associated with the asymmetrical Amplatzer Membranous VSD Occluder. It is certain that transcatheter closure of PmVSD is one of the most complex cardiac interventions and have stringent demands on device design due to several challenging considerations. Despite that, experienced interventionists have been continuously reporting successful experiences with PmVSD closure using a variety of off-label device occluders. Recent meta-analyses confirmed the very good outcomes of this approach and the noninferiority compared to surgery. However, these devices represent a compromise, as they are not specifically designed to be placed in the perimembranous position. To date, no device achieved market approval in the United States. The need for a device dedicated to PmVSD transcatheter closure is mandatory to standardize the technique and we are very close to achieving this goal. The most recent KONAR-Multifunctional Occluder (MFO) has been smartly designed, combining technical features of previous devices, to tackle encountered difficulties and the outcomes of emerging clinical reports are consecutively encouraging. The MFO specifications are particular but limitations are present and need to be highlighted. This continuous advancement in device technology through continuous physician input will lead to the birth of the ideal device for this intervention

Changes in electrocardiographic parameters in children with complete left bundle branch block early after transcatheter closure of ventricular septal defect

To observe the changes in electrocardiographic parameters in children with complete left bundle branch block (CLBBB) after the transcatheter closure of simple ventricular septal defect (VSD). A total of 21 children with CLBBB early after transcatheter closure of perimembranous VSD were recruited. Another 21 children without any type of arrhythmia after transcatheter closure of perimembranous VSD were enrolled as the control group. The sex, age, and the size of occluder were matched between the two groups. The changes in the following indices were compared between the two groups: left ventricular voltage, QT interval, corrected QT interval (QTc), QT dispersion (QTd), corrected QT dispersion (QTcd), JT dispersion (JTd), and corrected JT dispersion (JTcd) on the electrocardiogram before transcatheter closure and at 1, 3, 5, 30 days after transcatheter closure. Left ventricular voltage and JTcd changed with operation time in the CLBBB and control groups (P<0.05). There were interaction effects between time and grouping in the changes in left ventricular voltage and QTd (P<0.05). There was a significant difference in JTcd between the CLBBB and control groups (P<0.05). There was also a significant difference in left ventricular voltage between the CLBBB and control groups at 3 and 5 days after the transcatheter closure (P<0.05). There are significant differences in electrocardiographic left ventricular voltage and JTcd between VSD children with and without CLBBB early after transcatheter closure. JTcd might be useful in predicting the development of CLBBB early after transcatheter closure of VSD.

Efficacy and Safety of Using Amplatzer Ductal Occluder for Transcatheter Closure of Perimembranous Ventricular Septal Defect in Pediatrics.

Background:Perimembranous Ventricular Septal Defect (PMVSD) is the most common subtype of ventricular septal defects. Transcatheter closure of PMVSD is a challenging procedure in management of moderate or large defects.Objectives:The purpose of this study was to show that transcatheter closure of perimembranous ventricular septal defect with Amplatzer Ductal Occluder (ADO) is an effective and safe method.Patients and Methods:Between April 2012 and April 2013, 28 patients underwent percutaneous closure of PMVSD using ADO. After obtaining the size of VSD from the ventriculogram a device at least 2 mm larger than the narrowest diameter of VSD at right ventricular side was chosen. The device deployed after confirmation of its good position by echocardiography and left ventriculography. Follow up evaluations were done 1 month, 6 months, 12 months and yearly after discharge with transthoracic echocardiography and 12 lead electrocardiography.Results:The mean age of patients at procedure was 4.7 ± 6.3 (range 2 to 14) years, mean weight 14.7 ± 10.5 (range 10 to 40) kg. The mean defect size of the right ventricular side was 4.5 ± 1.6 mm. The average device size used was 7.3 ± 3.2mm (range 4 to 12 mm). The ADOs were successfully implanted in all patients. The VSD occlusion rate was 65.7% at completion of the procedure, rising up to 79.5% at discharge and 96.4% during follow-up. Small residual shunts were seen at completion of the procedure, but they disappeared during follow-up in all but one patient. The mean follow-up period was 8.3 ± 3.6 months (range 1 to 18 months). Complete atrioventricular block (CAVB), major complication or death was not observed in our study.Conclusions:Transcatheter closure of PMVSD with ADO in children is a safe and effective treatment associated with excellent success and closure rates, but long-term follow-up in a large number of patients would be warranted.

COMPARATIVE STUDY OF TWO OCCLUDER-RELEASE TECHNIQUES IN TRANSCATHETER CLOSURE OF PERIMEMBRANOUS VENTRICULAR SEPTAL DEFECT

ObjectivesReported experience with the retained guidewire technique in transcatheter closure of perimembranous ventricular septal defect (VSD) is limited. To compare two occluder-release techniques in transcatheter closure of perimembranous VSD we...

Transcatheter closure of perimembranous ventricular septal defect in children: Safety and efficiency with symmetric and asymmetric occluders

This study was designed to determine the safety and efficiency of asymmetric and symmetric ventricular septal occluders (AVSDOs and SVSDOs, respectively) for closure perimembranous ventricular septal defect (PMVSD) in children. Between January 2003 and December 2007, 142 children with PMVSD were treated with occluders (64 with AVSDOs and 78 with SVSDOs). The defect diameter was 5.3 ± 1.1 mm in the AVSDO group and 5.4 ± 1.3 mm in the SVSDO group (P > 0.05). The success rates were similar between two groups [93.8% (AVSDO) vs. 94.9% (SVSDO), P > 0.05]. Two patients in the AVSDO group were switched to the SVSDO group due to residual shunts, and one patient in the SVSDO group was switched due to aortic regurgitation after deployment of the occluder. After procedure, 17 patients [seven with AVSDOs and nine with SVSDOs (P > 0.05)] developed various types of heart block (HB). Among them, 13 patients converted to the normal sinus rhythm. The remaining four cases had not recovered at the end of the study. Transcatheter closure of PMVSD using both AVSDO and SVSDO was safe and effective. Development of HB was the main complication for both devices.

Results of Transcatheter Closure of Perimembranous Ventricular Septal Defect

This study reports the midterm results and experience of a single center of transcatheter closure of perimembranous ventricular septal defect (VSD) with Amplatzer membranous VSD occluders. Data of 301 patients who underwent attempted transcatheter closure were collected prospectively from May 2002 to December 2008. Patients' mean age was 9.8 years, and their mean weight was 32 kg. The procedure was successful in 294 patients (97.6%). No death occurred. Complications included aortic regurgitation in 11 patients (3.7%, 2 requiring occluder retrieving), tricuspid regurgitation in 16 patients (5.4%), hemolysis in 2 patients (0.7%), and complete atrioventricular block (cAVB) in 17 patients (15 early cAVBs, 3 late cAVBs, 1 patient had early and late cAVBs). Among the 15 early cAVBs, 12 were transient and 3 were considered prolonged cAVBs (persisted >2 weeks). The 3 patients underwent surgery (1.0%) and obtained stable sinus rhythm. Pacemaker implantation was needed in all 3 patients with late cAVB (1.0%). Univariate analysis showed that risk factors were age (p = 0.01) and weight (p = 0.021). No risk factors were found in multivariate analysis. In conclusion, midterm results of transcatheter closure of perimembranous VSD showed high closure rate and limited complications. The major concern is the occurrence of cAVB. Long-term investigation is needed to assess the efficacy and safety compared to surgery.

Evolution of transcatheter closure of perimembranous ventricular septal defects in a single centre

To describe the evolution of transcatheter closure of perimembranous ventricular septal defects (PMVSD) using either the Amplatzer membranous or muscular occluders in a single centre. Retrospective analysis of all patients referred for transcatheter PMVSD closure from December 2003 to December 2007. All patients met unit criteria for surgical closure. There were 27 procedures on 25 patients (11 male) with a preprocedure diagnosis of a PMVSD. Median age was 9.6 years (1.8-32.8). Median weight was 28 kg (10.2-86). Defect size on TOE ranged from 5 to 12 mm. Median Qp:Qs was 1.6:1. A muscular occluder was used in six patients. Median procedure time was 93.5 min (51-214). Implantation was ultimately successful in 23 patients (92%). Acute aortic incompetence resulting in occluder removal occurred in two cases, one requiring surgical removal. Another patient had an aborted attempt but had subsequent successful closure in another unit. Median follow-up is 19.5 months (1-42). Five patients (22%) have trivial/mild residual leak across the occluder at their latest assessment, the majority of which had an aneurysmal perimembranous septum (n = 4). Two patients (8%) developed new trivial to mild aortic incompetence. To date, none of the patients in our group have developed complete heart block. Transcatheter closure of PMVSD is evolving and should be considered an acceptable alternative to surgery in selected subgroups. Avoidance of oversized occluders and use of muscular occluders in those with aneurysmal defects may help to avoid heart block and aortic regurgitation. Muscular occluders may however interfere with tricuspid valve function.

Atrioventricular Block: A Serious Complication in and After Transcatheter Closure of Perimembranous Ventricular Septal Defects

Transcatheter closure is an effective approach for perimembranous ventricular septal defects (PMVSD). However, atrioventricular blocks (AVB) emerged possibly due to the close proximity of the PMVSD to the conduction system, but concern for the complication was not adequately emphasized. In this study, we report the incidence of AVBs, in and after transcatheter closure of a PMVSD, and the outcome of the complication in our center. One hundred and sixty-eight PMVSD patients were accepted for transcatheter closure with Amplazter PMVSD occluder (AGA Medical, Plymouth, Minn., USA). The procedure was discontinued when a second- or third-degree AVB occurred. A steroid was administered to all patients who developed AVBs. Temporary pacemakers were inserted in patients who developed a complete AVB or Mobitz type II AVB during or after the procedure. During the follow-up period of 6-24 mo (mean 10.6 +/- 3.9), the incidence of AVBs occurring during or after transcatheter closure of PMVSD was 3.5%. The AVB disappeared quickly after discontinuing the procedure in patients who developed AVBs during the procedure, whereas the AVBs disappeared between 2 and 21 d (mean 8.0 +/- 8.8) in the patients who developed AVBs after the procedure. However, complete right bundle branch block (CRBBB) was observed, and a transient complete AVB emerged after 8 mo in 1 case, incomplete right bundle branch block (IRBBB) in 1 case, and CRBBB and left anterior hemiblock (LAH) in 1 case. The AVB is a serious complication during and after transcathter closure of PMVSD. More attention should be paid to the complication, and multicentres are required to monitor the complication.

Angiographic classification of ventricular septal defect with aneurysm and study on its interventional therapeutic methodology

目的 结合介入治疗实践对室间隔缺损(VSD)伴膜部瘤形成进行造影分型,并对不同类型膜部瘤的介入封堵方法进行探讨.方法 2002年11月至2003年11月,采用新型Amplatzer膜部室间隔缺损封堵器对32例合并膜部瘤的膜周部VSD行封堵治疗,平均年龄19岁(3～48岁).封堵术前常规行左室造影,在经胸超声心动图(TTE)及透视监测下通过建立股动静脉轨道、经右心系统释放封堵器,并于术后1、3、6、12个月随访复查胸片、超声心动图、心电图. 结果根据左室造影的不同形态,将VSD膜部瘤分为漏斗型、囊袋型、菜花型、弯管型4种类型.32例VSD合并膜部瘤患者中,30例成功行VSD封堵术,技术成功率94%.其中3例采用封堵瘤体法,9例采用封堵右室面破口法,18例采用封堵左室面破口法.术后即刻发生少量残余分流4例,其中2例3个月随访时消失.1例术后2周出现完全性左束支传导阻滞,但无心肌受损表现,余无其他严重并发症发生.左室舒张末径(LVEDD)由术前的(47.4±7.1)mm缩小为术后的(45.1±7.1)mm,缩小明显(t＝3.83,P＝0.002). 结论应用新型Amplatzer膜部VSD封堵器治疗VSD膜部瘤是安全有效的,VSD膜部瘤的介入治疗需要根据膜部瘤的位置、形态、破口大小、数目等情况采用不同的封堵方法进行封堵,以达到最佳的治疗效果。