Ventricular Septal Defect Occluder Device Research Articles

Recurrent Stroke after Percutaneous Placement of Post-Infarct Septal Occluder Device

Surgical intervention for post-infarct ventricular septal defect (VSD) is a challenging procedure due to patients’ complex preoperative conditions. While percutaneous VSD closure can be considered as an alternative to surgical repair, complete closure of the defect remains difficult and is associated with various procedural complications. We report a rare case of a patient with postoperative residual shunts who experienced recurrent stroke episodes, requiring surgical intervention for repair. The patient, a 71-year-old female, developed acute anterior myocardial infarction and post-infarct VSD. Percutaneous closure with a 14-mm Amplatzer VSD occluder device was performed, yet the closure was incomplete. Following discharge, she developed multiple embolic stroke episodes, likely stemming from the residual VSD, which led to the surgical extraction of the device and VSD repair. Fibrous tissue was found to be solely attached to the core and right ventricle side of the device, whilst no fibrous tissue was observed on the side of the left ventricle. The patient has not experienced new neurological symptoms at an 18-month follow-up. Thus, it is paramount to keep in mind that an embolic stroke may occur in the setting of percutaneous post-infarct VSD closure. Surgical repair of VSD with device removal should be considered as a treatment option to such a complex case.

B-PO04-208 A TELEMETRY ALARM: WHEN THE PACEMAKER IS SILENCED BY THE NOISE

Accurate ventricular sensing is necessary for appropriate delivery of pacing and shocks. Ventricular oversensing can cause failure to pace in a pacer dependent patient. We describe a case of lead-device interaction causing oversensing and failure to pace after ventricular septal defect (VSD) occluder device placement. To our knowledge, this is the first report of lead-device interference with a VSD occluder device. N/A A 60 year old man with chronic stage D systolic heart failure, LVAD, and VSD underwent percutaneous VSD repair with an Amplatzer VSD occluder. In the immediate post-procedure period, he became bradycardic despite having an ICD with programmed brady-therapy. Device interrogation demonstrated normal impedance, sensing, and pacing parameters, but also revealed intermittent noise on both channels the near-field and the shock channel causing oversensing. Presence of noise on both channels was more consistent with device-device interaction than lead fracture. Fluoroscopic images revealed intermittent contact between the RV lead and VSD occluder. Adjustment of sensitivity, refractory, and blanking periods was not effective. As a temporizing solution, the ICD was placed in asynchronous mode, acutely improving the heart rate. The RV lead was revised, resolving the clinical problem. Device-device interactions are rare but can be a result of lead-lead chatter or mechanical interference with other intracardiac devices such as retained fragments, or in this case, a VSD occluder device. As structural interventions become more prevalent, electrophysiologists need to be aware of lead-device interactions.

Trans-catheter closure of large PDA in adult patients with Amplatzer device: case series.

Ductus arteriosus is a physiological structure if not closed after birth, may lead to many complications. Today, trans-catheter closure of patent ductus arteriosus with Occluder devices is the preferred method. Surgical ligation is used only in certain cases such as large symptomatic patent ductus arteriosus in very small infants and premature babies; unfavourable structure of the duct or economic considerations. In this article, we described haemodynamic and morphological characteristics of five patients with large patent ductus arteriosus which were occluded with Amplatzer device.From 23 January, 2010 to 31 July, 2018, five patients referred to our clinic with large patent ductus arteriosus and pulmonary arterial hypertension for further evaluation. After assessing them with various diagnostic methods, we decided to close defect with ventricular septal defect Occluder device. Patients aged 21-44 years and one of them was male. Ductus closure was successfully done with ventricular septal defect Occluder device. Closure was successful for all of them but in one case, whose device was embolized to pulmonary artery after 24 hr and he underwent surgery.Trans-catheter closure of large patent ductus arteriosus in adult patients with pulmonary hypertension is feasible. Despite the fact that complications may occur even with the most experienced hands, the 'double disk' Amplatzer ventricular septal defect muscular Occluder could be advantageous in this setting.

Device closure of ventricular septal defect: Initial experience in Nepal

Background: Device closure is an attractive alternative in the management of Ventricular Septal defect (VSD).
 Aims and Objective: The aim of the study was to access the safety and early outcome of VSD device closure at Shahid Gangalal National Heart Centre, Nepal.
 Materials and Methods: The study was single center, retrospective study. All the VSD cases who were attempted for VSD device closure during December 2016 to February 2019 were included. Catheterization laboratory records for VSD type and size, Device type and size were retrospectively reviewed. Hospital records were reviewed for in-hospital complications. 
 Results: Sixty-one VSD cases were attempted for device closure. VSD was successfully closed in 55 (90.1%) patients. The mean age of the patient was 11.1 years. Twenty-nine (52.7%) were female and 26 (47.3%) were male. Perimembranous VSD in 49 (89 %) and muscular VSD in 6 (11 %) patients. The size of VSD ranged between 2 and 12mm (Mean 5.4mm). The VSD was closed with Amplatzer duct occluder I, Amplatzer duct occluder II, Amplatzer muscular VSD occluder and Memopart PDA device in 24 (43.7%), 26 (47.3%), 4 (7.2 %) and one patient (1.8%) patients respectively. The postoperative complications were insignicant residual leak across device in 2 (3.6%) patients, mild pericardial effusion in one (1.8%) patient. None of the patient had new onset tricuspid regurgitation, aortic regurgitation and complete heart block. One patient developed Right bundle branch block, one developed Left bundle branch block, one developed Junctional rhythm. There was no mortality.
 Conclusion: VSD device closure can be safe and effective if patients are selected properly.

No escape from a VSD device? Complete heart block and cardiac arrest associated with a ventricular septal defect occluder device

A 15 month old boy with a ventricular septal defect (VSD) underwent percutaneous device closure of the VSD. Five days later he collapsed; on arrival to hospital he was asystolic and received prolonged cardio-pulmonary resuscitation (CPR) with intermittent return of spontaneous circulation (ROSC). He had recurrent episodic complete heart block with no ventricular escape rhythm, associated with loss of cardiac output, unresponsive to transcutaneous pacing. He was transferred to theatre, while receiving CPR, for urgent removal of the VSD device. Estimated total 'down time' was 70 min. The device was removed and patch closure of the VSD was performed. He made a full neurological recovery. Device closure of septal defects has become widespread. We discuss the incidence and type of arrythmias associated with their use. This case highlights an uncommon but life threatening complication of a VSD device. It also highlights that good quality CPR may lead to positive outcomes following pediatric cardiac arrest.

Failed Closure of Paravalvular Leak with an Amplatzer® Occluder Device After Mitral Valve Replacement

Failed Closure of Paravalvular Leak with an Amplatzer® Occluder Device After Mitral Valve Replacement

Transcatheter Closure of a Postinfarction Ventricular Septal Rupture

An 84-year-old woman with cardiomyopathy secondary to severe atherosclerotic coronary artery disease presented with biventricular heart failure. She was admitted to the hospital after a non-S-T elevation myocardial infarction 5 days earlier that led to progressive congestive heart failure. A transthoracic echocardiogram revealed an apical ventricular septal defect with bidirectional shunting and pulmonary hypertension. Cardiovascular operation was declined; therefore, a post-infarction ventricular septal defect occluder device was placed across the ventricular septal defect leaving only a tiny residual shunt. The patient had symptomatic improvement after the procedure and had no complications related to the procedure.

Combined catheter ventricular septal defect closure and multivessel coronary stenting to treat postmyocardial infarction ventricular septal defect and triple‐vessel coronary artery disease: A case report

Ventricular septal defect following acute myocardial infarction is a rare but life-threatening complication. Early surgical closure improves survival but carries a considerable risk. Percutaneous transcatheter closure is an alternative but experience to date is limited. We report a case of successful transcatheter closure of postmyocardial infarction ventricular septal defect (VSD) in a 55-year-old male with the Amplatzer muscular VSD occluder device and complete percutaneous revascularization with successful multivessel coronary stenting for three-vessel disease as a staged procedure. The technique and its potential use as an alternative to surgical approach for treatment of acute myocardial infarction and its complication (VSD) are discussed.