Ventricular Septal Defect Occluder Research Articles

Reversible atrioventricular block during transcatheter ventricular septal defect closure – a serial case report

Background: The transcatheter ventricular septal defect procedure is a sophisticated intervention that carries potential complications, such as complete heart block. We report two cases of patients who experienced total AV block during transcatheter VSD closure and were successfully treated with steroids and atropine. Case Presentation: Perimembranous VSD was found in a 19-year-old military recruit. A baseline 12-lead EKG showed sinus rhythm and no conduction delays. Echocardiography revealed a 6-9 mm perimembranous VSD. Then the VSD was closed with a VSD Occluder No 10-8. ECG monitor and echocardiography showed a complete atrioventricular block during the procedure. Fortunately, 1mg atropine and 125mg methylprednisolone overcame this. Recurrent atrioventricular block and VSD were not found after the procedure. A 33-year-old male patient was diagnosed with a perimembranous VSD during routine screening. Initial 12-lead electrocardiography was unremarkable, while echocardiographic evaluation revealed a 3-5 mm perimembranous VSD. Transcatheter closure was performed using a VSD Occluder device (No. 10-8). Hemodynamic monitoring and echocardiography demonstrated a complete atrioventricular (AV) block intraoperatively. Pharmacological intervention with 1 mg atropine and 125 mg methylprednisolone resolved the conduction disturbance. Despite this transient complication, the procedure continued with successful device deployment. Post-procedural assessment confirmed complete VSD closure with no residual shunt or persistent AV conduction abnormalities. Conclusions: In the context of transcatheter closure of ventricular septal defects, there exists a risk of atrioventricular block, which can be precipitated by mechanical trauma or compression from the delivery system or device. Ensuring the appropriate sizing of the device is pivotal in minimizing this risk. Continuous heart rhythm monitoring is indispensable during both short-term and long-term follow-up periods. Keywords: Ventricular septal defect, Atrioventricular block, transcatheter device closure, case report

Evaluating the outcomes of ventricular septal defect occlusion intervention at the Cardiovascular Center – E Hospital

Objective: To evaluate the short-term outcomes of percutaneous closure of ventricular septal defects in patients of all age. Summary: Ventricular septal defect (VSD) is the most common congenital heart defect and can be detected during the prenatal and postnatal period. In 1987, Lock et al first applied the technique of interventional occlusion of the VSD using devices through a catheter and this method quickly spread worldwide. Compared with surgery to repair VSD, intervention to occlude the ventricular septum with devices through a catheter helps minimize complications after the procedure, reduces hospital stay time and costs, avoids surgical scars, has less psychological impact. and patient quality of life. Since 2014, the Cardiovascular center – E hospital has also conducted the first VSD occlusion interventions. After 10 years of performing this technique, this is the first study conducted on subjects who underwent intervention using percutaneous devices at the Cardiovascular center – E hospital with a large number of patients including successful, failed, and complicated cases to evaluate the success rate and outcomes after intervention. Subjects and methods: Retrospective, descriptive study. From October 2014 to October 2023, 427 patients diagnosed with ventricular septal defect underwent percutaneous closure of ventricular septal defect. Results: Mean age was 7.37 years old, mean weight was 19.08 kg, In echocardiography, the main ventricular septal defect was membraneous, accounting for 96.3% of all cases. The success rate was 94.6%, with a male/female ratio of 206/221. There were a total of 22 cases of complications, of which 2 cases required surgical intervention to manage the complications. No patient died or developed complete atrioventricular block. Conclusion: Percutaneous ventricular septal defect closure procedure is a high success rate, and should be widely implemented to minimize surgical risks for patients.

Diagnosis and Management of Ventricular Septal Defects.

This review addresses the diagnosis and management of ventricular septal defects (VSDs). The VSDs are classified on the basis of their size, their number, and their location in the ventricular septum. Natural history of VSDs includes spontaneous closure, development of pulmonary hypertension, onset of infundibular obstruction, and progression to aortic insufficiency. While initial diagnostic approaches such as careful history-taking, physical examination, chest X-rays, and electrocardiograms provide basic information, echo-Doppler studies are essential for assessing the defect's clinical significance and determining the need for intervention. Intervention is usually indicated for symptomatic patients with moderate- to large-sized VSDs. Surgical closure is advised for perimembranous, supracristal and inlet VSDs, and for deficits involving prolapsed aortic valve leaflets. While percutaneous methods to occlude perimembranous VSDs with Amplatzer Membranous VSD Occluder are feasible, they are not recommended due to a notable risk of inducing complete heart block in a significant number of patients. Alternatively, percutaneous and hybrid methods employing the Amplatzer Muscular VSD Occluder are effective for treating large muscular VSDs. The majority of treatment options have demonstrated satisfactory outcomes. However, practitioners are urged to exercise caution in managing small defects to avoid unnecessary procedures and to ensure timely intervention for large VSDs to prevent pulmonary vascular obstructive disease.

Interventional Management of a Rare Case of Complex Congenital Heart Disease in an Adult Patient: A Case Report

Congenital heart disease (CHD), which accounts for about one-third of all congenital defects and affects approximately 1% of all live births worldwide, has maintained a stable incidence rate while experiencing a decrease in mortality rates since 1990. Despite advancements in fetal cardiac ultrasound examinations and routine pulse oximetry screening of newborns, a significant proportion of CHD patients may still be undiagnosed until adulthood. This oversight can lead to considerable morbidity and mortality due to physical limitations and reduced quality of life. In this case report, we describe a 29-year-old woman who was initially misdiagnosed as having an inoperable case of CHD and was referred to our center with symptoms of palpitations and exertional dyspnea. During her evaluation, she was diagnosed with severe pulmonary hypertension associated with patent ductus arteriosus (PDA), pre-ductal aortic coarctation, ventricular septal defect (VSD), and bicuspid aortic valve, all of which had been overlooked since infancy. Following initial medical treatment for pulmonary hypertension, a simultaneous transcatheter approach was employed, during which the PDA was closed using an occluder device, and the coarctation was repaired concurrently with a self-expanding stent. Eight months later, her VSD was successfully closed using a muscular VSD occluder device through an interventional technique. This case underscores the importance of adult CHD fellowship training, which enables cardiologists specializing in this field to accurately diagnose and treat complex cases of CHD that may have been missed during infancy and early childhood. This timely intervention ultimately led to the complete relief of her symptoms and prevented progression to Eisenmenger syndrome.

Late complete atrioventricular block after transcatheter perimembranous ventricular septal defect closure with the KONAR-MF™ VSD occluder: a case report and systematic review.

The soft nitinol KONAR-MF™ ventricular septal defect (VSD) Multifunctional Occluder (MFO) device is increasingly used for transcatheter perimembranous ventricular septal defect closure. We report for the first time a case of delayed complete atrioventricular block with pacemaker implantation 20 months post-procedure. Through a systematic review, the overall rate of persistent complete atrioventricular block was 0.6% with this device, but follow-up duration was limited.

Safety and efficacy of perventricular device closure of ventricular septal defects in children

Abstract Objectives To evaluate safety and efficacy of perventricular device closure techniques for the closure of ventricular septal defects (VSD) in children in United Arab Emirates. Methods In the year 2023-24, 13 children underwent per-ventricular device closures of VSD under the guidance of transesophageal echocardiography without cardiopulmonary bypass(CPB). The mean age at operation was 3.76 years (range 3 months-14 years). The ventricular septal defect sizes ranged from 2.7-6 mm. The device sizes ranged from 5-12mm. All patients except two required symmetrical device. Eight defects were peri membranous, 3 were sub-aortic and 2 were muscular. Ventricular septal defect occlusion device (Memoport, Beijing, China) were used through a 3-cm skin incision in the lower third of the sternum. Results All patients underwent VSD device closure successfully. The mean procedural duration was 42 minutes. None of the patients required CPB. The mean ventilation time and ICU stay was 3 hrs. and 24 hrs. respectively. None of the patients required inotropic support or blood transfusions. There were no residual shunt (except small shunt through the device), arrhythmias including heart block post operatively. At follow up, (3 months-7 months) there were no residual shunts, conduction disturbances, device dislodgement or major aortic or tricuspid valve complications. There was no mortality. Conclusions Perventricular device closure of VSD is highly successful, less invasive, safe and effective. It is associated with quick recovery, short length of stay and better cosmetic incision. Moreover, it avoids CPB.

Persistent Fistula Closure After Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography by Postinfarct Ventricular Septal Defect Occluder

Persistent Fistula Closure After Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography by Postinfarct Ventricular Septal Defect Occluder

Feasibility and Success of Muscular Ventricular Septal Defect Occluders and Mushroom-Shaped Occluders in Transcatheter Patent Ductus Arteriosus Closure in Low-Weight Children: A Propensity Score-Matched Retrospective Analysis from a Chinese National Regional Health Center.

Muscular ventricular septal defect occluders (MVSDOs) have been attempted as an option in low-weight patients with patent ductus arteriosus (PDA). However, few studies have assessed the safety of transcatheter patent ductus arteriosus closure (TCPC) using MVSDO. Therefore, we compared the outcomes in low-weight patients who used MVSDO and mushroom-shaped occluder (MSO). Medical records of children under 10 kg (n = 417) who underwent TCPC from 2015 to 2021 at a Chinese health center were reviewed. They were divided into MSO (n = 372) and MVSDO (n = 45) groups. A 1:1 propensity score matching (PSM) was done considering gender, height, weight, body surface area (BSA), PDA diameter, and BSA-corrected PDA diameter. All 45 children in the MVSDO group (mean weight: 5.92 ± 1.32 kg) achieved successful immediate occlusion. One case in the MVSDO group experienced device migration within 24 h requiring unplanned surgery. MVSDO significantly ameliorated pulmonary artery hypertension. After PSM, each group comprised 41 children. The MVSDO group had a smaller effect on platelet counts (MVSDO vs. MSO = 259.85 ± 114.82 vs. 356.12 ± 134.37, p < 0.001), a reduced incidence of thrombocytopenia (MVSDO vs. MSO = 2/41 vs. 7/41, p = 0.001), and a higher rate of residual shunting (MVSDO vs. MSO = 16/41 vs. 5/41, p = 0.005), compared with the MSO group. Thrombocytopenia resolved during hospitalization and micro-shunts disappeared by 6 months. No pulmonary artery or descending aortic secondary stenosis was observed in 1-year follow-up. MVSDO used in low-weight children is feasible, with high success and satisfactory postoperative and short-term follow-up outcomes, including lower thrombocytopenia incidence, compared to MSO. Further long-term studies with larger samples are recommended.

Safety, effectiveness, and complications of the first-in-human minimally invasive transthoracic ventricular septal defect closure using a bioabsorbable occluder: a cohort study with 12-month follow-up.

Ventricular septal defect (VSD) is one of the most common congenital heart diseases. This study aims to evaluate the clinical value and benefit of transesophageal echocardiography (TEE) in transthoracic minimally invasive closure of VSDs using a completely biodegradable occluders, summarize the main points of surgical procedures, and analyze the follow-up results of short-term and medium-term treatment. We conducted a retrospective analysis of 24 pediatric cases of VSD, successfully treated with TEE-guided minimally invasive closure using fully biodegradable occluders between June 2019 and June 2022. The preoperative TEE meticulously examined the defect's location, size, and surrounding anatomical relationships, aiding in the selection of appropriate occluders and guiding the entire closure process. All patients were followed up for 1 year. In our cohort, 13 cases were perimembranous inlet VSDs, and 11 involved VSDs with membranous aneurysm formation. The effective shunt size of VSD measured by TEE preoperatively ranged from 2.8 to 4.9 mm, with the defect located 2-6 mm from the aortic valve. Occluders used were 6-8 mm in diameter. All 24 procedures were successful. TEE confirmed that the occluders were tightly fitted at the edges of the VSDs. Twenty-three cases had no residual shunt post-surgery, while one case exhibited a small left-to-right shunt (<1.5 mm) at the occluder's edge. Follow-up was conducted on postoperative day 3, and in months 1, 3, 6, and 12, showing that the occluder's position remained normal in all patients. Except for one child who had a 1.2 mm left-to-right shunt at the edge of the occluder, no residual shunts were observed in the others. The occluder started to degrade from month 6, and the sizes of the left and right occluder discs were significantly smaller compared to those on postoperative day 3 (P=0.003). TEE-guided minimally invasive VSD occlusion using fully biodegradable occluders has the advantages of minimal trauma, high safety, and few complications, with satisfactory recent efficacy, and good prospects for clinical safety applications.

Transcatheter closure of perimembranous ventricular septal defect using the cocoon membranous VSD occluder

BackgroundTranscatheter device closure is a well-established treatment for suitable ventricular septal defects (VSDs). The Cocoon Membranous VSD Occluder is a relatively new device specifically designed for perimembranous VSDs. Existing research on the Cocoon Membranous VSD Occluder for closing PM VSD is limited. ObjectiveThis study aimed to describe a single-center experience using the Cocoon Membranous VSD Occluder for perimembranous VSD. MethodsWe retrospectively analyzed data from patients who underwent device closure of perimembranous VSD using the Cocoon occluder between May 2023 and April 2024. Procedural success, complications, and short-term outcomes were evaluated. ResultsBetween May 2023 and April 2024, 13 patients with perimembranous VSD and left-to-right shunt underwent device closure with the Cocoon Membranous VSD Occluder. Twelve patients (92.3 %) achieved successful VSD closure. The mean age was 8.06 years with standard deviation (SD) of 7.24 years. The mean weight was 11.98 kg with SD of 18.93 kg. The mean VSD size was 4.96 mm with SD of 0.92 mm. The VSD was crossed from the right ventricle in 5 patients and from the left ventricle in 9 patients. All patients had successful device placement from the right ventricle approach. The Cocoon Membranous VSD device size ranged from 6 to 4 mm to 12–4 mm. In one smaller patient, the device was electively removed due to significant flow through an additional exit, and the patient subsequently underwent surgery. Another patient developed hemoglobinuria on the fourth day, which resolved by the tenth day with hydration therapy. Two patients experienced trivial to mild aortic regurgitation, and one had Wenckebach phenomenon that resolved the next day. In the short-term follow-up (mean duration of 4.33 months), all patients were doing well, had good device performance, and showed no evidence of heart block. ConclusionsDevice closure of perimembranous VSD in infants with the Cocoon Membranous VSD Occluder appears to be safe and effective in carefully selected patients during short-term follow-up. Larger studies with long-term data are necessary for future recommendations.

Perventricular device closure of the ventricular septal defects in children-first experience in the United Arab Emirates

BackgroundVentricular septal defect (VSD) is the most common congenital cardiac malformation, accounting for approximately 30% of congenital heart defects. Conventional surgical repair using cardiopulmonary bypass is invasive and associated with morbidities and prolonged hospital stay. With the advent of interventional approaches and availability of different occluding devices, the technique of perventricular device closure is evolving and being implemented successfully in larger groups of patients. We present herein, our initial experience of perventricular device closure for the ventricular septal defects in children to assess risks and benefits.MethodsFrom March, 2023 to February, 2024, we have performed perventricular closure of ventricular septal defects in 13 children, under guidance of transesophageal echocardiography without cardiopulmonary bypass support. The median age at operation was 2 year (range 1.3–10 years) with the median body weight 11 kg (range 8.7–16.6 kg). Sixty-nine percent were males. The ventricular septal defect sizes ranged from 2.7 to 6 mm (mean 4.7 mm). Seven defects were perimembranous, four sub-aortic and two were muscular. One patient also underwent pulmonary artery de-banding with pulmonary artery balloon angioplasty and other one patent ductus arteriosus ligation, concomitantly. For defect closure, we used ventricular septal defect occlusion device (MemoPart™, Lepu Medical Technology Company, China) through a 3-cm skin incision in the lower- third of the sternum. The device sizes ranged from 5 to 8 mm (mean 6.9+-1.8 mm) and all patients except for two required symmetrical devices.ResultsAll patients underwent device closure successfully. The procedural duration ranged between 32 and 52 min. None of the patients required cardiopulmonary bypass. The mean ventilation time and intensive care unit stay was 3 and 24 h, respectively. None of the patients required inotropic support or blood transfusions. Moreover, no patients developed any arrhythmias including heart block. The average length of hospital stay was 4.4 days. At the latest follow up, there were no residual shunts, conduction disturbances, device dislodgement or major aortic or tricuspid valve complications seen in any patients. There was no mortality.ConclusionsPerventricular device closure of ventricular septal defects is a less invasive, extremely safe and effective method in children. It is associated with very fast recovery, shorter hospitalization time and better cosmetic incision. Moreover, it avoids cardiopulmonary bypass. The modifications and refinements in the design, material and implantation techniques will help in expanding the indications and prevent complications in the long-term.

Percutaneous Retrieval of a Large Muscular VSD Occluder Using a Novel Retrieval Device

Percutaneous Retrieval of a Large Muscular VSD Occluder Using a Novel Retrieval Device

Midterm follow-up results of implantation of a fully biodegradable ventricular septal defect occluder.

Ventricular septal defect (VSD) is a prevalent congenital cardiac anomaly. By enhancing the occluder design and optimizing procedural approaches, the indications for VSD closure can be broadened while minimizing associated complications. The utilization of fully biodegradable occluder holds promising potential in resolving conduction block issues encountered during VSD closure. This study aims to compare the results of the fully biodegradable occluder with the metal occluder in transoesophageal echocardiography-guided VSD closure via lower sternal level minor incision at the interim follow-up, and to find risk factors for the occurrence of electrocardiographic and valvular abnormalities postoperatively. We reviewed the postoperative and 3-year follow-up data of all patients who underwent the randomized controlled study of VSD closure from January 1 to November 7, 2019 in the Second Xiangya Hospital of Central South University. The safety and efficacy of the procedure were assessed and compared between the 2 groups by electrocardiogram and echocardiography results, and the risk factors for the occurrence of postoperative electrocardiogram and valve abnormalities were studied with Logistic regression analysis. Twelve and fifteen patients underwent VSD closure with the metallic occluder and the fully biodegradable occluder, respectively. All patients survived during the follow-up period without major complications such as atrioventricular block, significant residual shunt, too rapid absorption of the occluder, and significant valvular regurgitation. There were no significant differences in the results of electrocardiograph and color Doppler ultrasonography the metal occluder group and the fully biodegradable occluder group 1, 2, and 3 years after operation (all P>0.05). The size of the occluder were risk factors for tricuspid regurgitation at 2 and 3 years postoperatively, and the difference between the occluder size and the VSD defect size were risk factors for tricuspid regurgitation at 2 years postoperatively (P<0.05). This study adequately demonstrates the safety and efficacy of fully biodegradable occluders in small VSD closure and shows the same postoperative effects as conventional nitinol occluders.

An observational study of symmetrical VSD occluder for transcatheter closure of ruptured sinus of Valsalva aneurysm.

This study evaluated the immediate and 1-year postoperative outcomes of 14 patients with ruptured Valsalva aneurysmal sinus (RSVA) using symmetric ventricular septal defect (VSD) occluder for transcatheter closure (TCC). The sites of rupture were from the non-coronary sinus to the right atrium (RA) in 10 cases (71.4%), the right coronary sinus (RCS) to the RA in 3 cases (21.4%) and the RCS to the right ventricle in 1 case (7.2%). The defects (5-11 mm) were closed with a symmetrical VSD device. During the follow-up (12 months), the enlarged heart of the patients had significantly shrunk and the NYHA improved after closure. In 1 case, a moderate residual shunt was present and the patient suffered from hemolysis at 2 h after the operation, and 1 patient was transferred to surgery for aortic regurgitation 1 year after the initial treatment of RSVA. In conclusion, the TCC of RSVA with the China made symmetrical VSD occluder is safe and effective.

Percutaneous Closure of Hemodynamically Significant Postoperative Residual Ventricular Septal Defects.

The experience with percutaneous closure of postoperative residual ventricular septal defects (VSDs) is expanding with improved device technology and techniques. To report our experience with percutaneous closure of residual VSDs after cardiac surgeries. Retrospective clinical data review of patients who had percutaneous closure of postoperative residual VSDs at our institution between 2010 and 2022. Patients' demographics, procedural, and follow-up data were looked at. Twelve patients (50% males) with a median age of 9.2years (range 0.9-22) were identified. Baseline surgeries were 8 tetralogy of Fallot corrections, 2 pulmonary bandings for large muscular VSD (mVSD) including 1 coarctation repair, 1 atrioventricular septal defect repair, 1 sub-aortic membrane resection-induced iatrogenic VSD, 1 isolated VSD closure, and 1 additional mVSD. Median duration between baseline surgery and percutaneous VSD closure was 2.2years (range 0.2-8.3). Residual VSD shunting was secondary to surgical patch leakage in 8/12 patients. The median angiographic defect diameter was 6.8mm (range 4.8-14). The defect was balloon-calibrated in 3/12 patients. Defects were tackled retrogradely in 3/9 patients. Amplatzer Membranous VSD occluder (n = 1), Lifetech Multifunctional (n = 5), Membranous (n = 1) and muscular VSD occluders (n = 2) and Occlutech Membranous (n = 1) and Muscular (n = 2) VSD occluders were used. The procedure was successful in 10/12 patients. Two devices embolized to the pulmonary artery and were snare-retrieved. Both patients were referred for surgery. The median follow-up was 1.3years (range 0.1-12). Six-month ultrasound showed one trivial residual shunt and one mild right ventricular outflow obstruction. One patient is receiving targeted therapy for pulmonary hypertension at 2years of follow-up. Transcatheter closure of postoperative residual VSDs is a feasible yet challenging intervention. Procedural complications can be encountered.

Word of caution: silent late device embolisation after perimembranous ventricular septal defect closure in a 6-Kg infant.

We report on a 6-month-old infant (6 Kg/ 64 cm) with perimembranous ventricular septal defect (absent sub-aortic rim, 10 mm left ventricular entry, and 4 and 6 mm right ventricular exists) and successful retrograde closure using an 8x6 mm KONAR-MF™ VSD occluder (Lifetech, China). Immediate and 48 hours post-procedure ultrasounds showed an accurately positioned device and two jets of mild-to-moderate residual shunts. At the 2-week follow-up, the device did not change position and the shunt was stable and intra-prosthetic. The scheduled 3-month follow-up was skipped for familial reasons. The patient came back without alarming symptoms for the regular 6-month follow-up, and the device was found embolised to the left pulmonary artery. The device was retrieved surgically, and the defect was patch-closed with excellent outcomes. There was a pseudoaneurysm involving the tricuspid valve chordae and the device was endothelialized partially on one edge suggesting that embolization occurred somewhere between 3 months and 6 months post-operative. Defects with compromised anatomies should be closed surgically to avoid suboptimal results, especially in small infants.

Deciphering m6A methylation in monocyte-mediated cardiac fibrosis and monocyte-hitchhiked erythrocyte microvesicle biohybrid therapy.

Rationale: Device implantation frequently triggers cardiac remodeling and fibrosis, with monocyte-driven inflammatory responses precipitating arrhythmias. This study investigates the role of m6A modification enzymes METTL3 and METTL14 in these responses and explores a novel therapeutic strategy targeting these modifications to mitigate cardiac remodeling and fibrosis. Methods: Peripheral blood mononuclear cells (PBMCs) were collected from patients with ventricular septal defects (VSD) who developed conduction blocks post-occluder implantation. The expression of METTL3 and METTL14 in PBMCs was measured. METTL3 and METTL14 deficiencies were induced to evaluate their effect on angiotensin II (Ang II)-induced myocardial inflammation and fibrosis. m6A modifications were analyzed using methylated RNA immunoprecipitation followed by quantitative PCR. NF-κB pathway activity and levels of monocyte migration and fibrogenesis markers (CXCR2 and TGF-β1) were assessed. An erythrocyte microvesicle-based nanomedicine delivery system was developed to target activated monocytes, utilizing the METTL3 inhibitor STM2457. Cardiac function was evaluated via echocardiography. Results: Significant upregulation of METTL3 and METTL14 was observed in PBMCs from patients with VSD occluder implantation-associated persistent conduction block. Deficiencies in METTL3 and METTL14 significantly reduced Ang II-induced myocardial inflammation and fibrosis by decreasing m6A modification on MyD88 and TGF-β1 mRNAs. This disruption reduced NF-κB pathway activation, lowered CXCR2 and TGF-β1 levels, attenuated monocyte migration and fibrogenesis, and alleviated cardiac remodeling. The erythrocyte microvesicle-based nanomedicine delivery system effectively targeted inflamed cardiac tissue, reducing inflammation and fibrosis and improving cardiac function. Conclusion: Inhibiting METTL3 and METTL14 in monocytes disrupts the NF-κB feedback loop, decreases monocyte migration and fibrogenesis, and improves cardiac function. Targeting m6A modifications of monocytes with STM2457, delivered via erythrocyte microvesicles, reduces inflammation and fibrosis, offering a promising therapeutic strategy for cardiac remodeling associated with device implantation.

Safety and efficacy of Amplatzer duct occluder II and konar-MF™ VSD occluder in the closure of perimembranous ventricular septal defects in children weighing less than 10 kg

IntroductionDevice closure of perimembranous ventricular septal defects (pmVSD) is a successful off-label treatment alternative. We aim to report and compare the outcomes of pmVSD closure in children weighing less than 10 kg using Amplatzer Duct Occluder II (ADOII) and Konar-MF VSD Occluder (MFO) devices.MethodsRetrospective clinical data review of 52 children with hemodynamically significant pmVSD, and sent for transcatheter closure using ADOII and MFO, between January 2018 and January 2023. Baseline, procedural, and follow-up data were compared according to the implanted deviceResultsADOII devices were implanted in 22 children with a median age of 11 months (IQR, 4.1–14.7) and weight of 7.4 kg (IQR, 2.7–9.7). MFO devices were implanted in 30 children with a median age of 11 months (IQR, 4.8–16.6) and weight of 8 kg (IQR, 4.1–9.6). ADOII were implanted (retrograde, 68.1%) in defects with a median left ventricular diameter of 4.6 mm (IQR, 3.8–5.7) and right ventricular diameter of 3.5 mm (IQR, 3.1–4.9) while MFO were implanted (antegrade, 63.3%) in defects with a median left ventricular diameter of 7 mm (IQR, 5.2–11.3) (p &amp;gt; 0.05) and right ventricular diameter of 5 mm (IQR, 2.0, 3.5–6.2) (p &amp;lt; 0.05). The procedural and fluoroscopy times were shorter with the MFO device (p &amp;lt; 0.05). On a median follow-up of 41.2 months (IQR, 19.7–49.3), valvular insufficiency was not observed. One 13-month-old child (6.3 kg) with ADOII developed a complete atrioventricular heart block (CAVB) six months postoperative and required pacemaker implantation. One 11-month-old child (5.9 kg) with MFO developed a CAVB 3 days postoperative and the device was removed. At 6 months post-procedure, only one child with MFO still experiences a minor residual shunt. There was one arterio-venous fistula that resolved spontaneously.ConclusionBoth the MFO and ADOII are effective closure devices in appropriately selected pmVSDs. CAVB can occur with both devices. The MFO is inherently advantageous for defects larger than 6 mm and subaortic rims smaller than 3 mm. In the literature, our series represents the first study comparing the mid-term outcomes of MFO and ADOII devices in children weighing less than 10 kg.

An unusual site of ablation for a ventricular tachycardia.

Scar-related ventricular tachycardia (VT) ablation involves localizing the critical isthmuses by overdrive pacing maneuvers and three-dimensional activation mapping. Implantable prosthetic devices have been known to complicate this by covering sites of potential isthmuses. We herein present a sentinel report of scar-VT ablation with a protected isthmus localized over an endothelialized post-myocardial infarction ventricular septal defect occluder device.

A Retrospective Study in Occluding Sub-arterial Ventricular Septal Defect.

To assess the safety and effectiveness of utilizing eccentric occlusion for the treatment of sub-arterial ventricular septal defects, we performed a retrospective study on the classification and analysis of relevant cases. A total of 105 patients with a minimally invasive incision were enrolled in this study, from April 2018 to September 2022. All patients underwent treatment of transthoracic sub-arterial ventricular septal defect occlusion. We analyzed the causes of closure failure, indication, and complication. Briefly, the closure device was successfully implanted in 78 cases (74.2%) with a mean age of 31.4 ± 31.8months, VSD size of 4.3 ± 0.9mm, and device size of 6.0 ± 1.1mm. However, 27 cases (25.8%) required cardiopulmonary bypass due to failure of occlusion. The reasons for failure included 13 cases with worsened aortic regurgitation, two cases with worsened aortic valve prolapse, one case with worsened mitral regurgitation, eight cases with significant residual shunt, and three cases with deviated occlusion morphology. During the 1-36-month follow-up visit, no cases experienced displacement of the eccentric umbrella, shedding, or arrhythmia. All residual shunts resolved during the visit. We concluded that occlusion for sub-arterial VSD has sufficient security and feasibility, under the strict control of surgical indications, appropriate choice of occluder and precise perioperative management.