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Baspinar O, Kosger P, Aydin Sahin D. Percutaneous Closure of Hemodynamically Significant Postoperative Residual Ventricular Septal Defects. Pediatr Cardiol 2024; 45:272-281. [PMID: 38194099 DOI: 10.1007/s00246-023-03366-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 11/27/2023] [Indexed: 01/10/2024]
Abstract
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 9.2 years (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 2.2 years (range 0.2-8.3). Residual VSD shunting was secondary to surgical patch leakage in 8/12 patients. The median angiographic defect diameter was 6.8 mm (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 1.3 years (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 2 years of follow-up. Transcatheter closure of postoperative residual VSDs is a feasible yet challenging intervention. Procedural complications can be encountered.
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Affiliation(s)
- Osman Baspinar
- Department of Pediatric Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Pelin Kosger
- Department of Pediatric Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Derya Aydin Sahin
- Department of Pediatric Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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Song J. Percutaneous Transcatheter Closure of Congenital Ventricular Septal Defects. Korean Circ J 2023; 53:134-150. [PMID: 36914603 PMCID: PMC10011220 DOI: 10.4070/kcj.2022.0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/27/2022] [Indexed: 02/17/2023] Open
Abstract
Ventricular septal defects (VSDs) are the most common kind of congenital heart disease and, if indicated, surgical closure has been accepted as a gold-standard treatment. However, as less-invasive methods are preferred, percutaneous device closure has been developed. After the first VSD closure was performed percutaneously by Lock in 1988, both techniques and devices have developed consistently. A perventricular approach for closure of muscular VSD in small patients and the closure of perimembranous VSD using off-label devices are key remarkable developments. Even though the Amplatzer membranous VSD occluder (Abbott) could not be approved for use due to the high complete atrioventricular conduction block rate, other new devices have shown good results for closure of perimembranous VSDs. However, the transcatheter technique is slightly complicated to perform, and concerns about conduction problems after VSD closure with devices remain. There have been a few reports demonstrating successful closure of subarterial-type VSDs with Amplatzer devices, but long-term issues involving aortic valve damage have not been explored yet. In conclusion, transcatheter VSD closure should be accepted as being as effective and safe as surgery but should only be performed by experienced persons and in specialized institutes because the procedure is complex and requires different techniques. To avoid serious complications, identifying appropriate patient candidates for device closure before the procedure is very important.
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Affiliation(s)
- Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Taha FA, Alnozha F, Amoudi O, Almutairi M, Abuelatta R. Transcatheter Closure of Residual and Iatrogenic Ventricular Septal Defects: Tertiary Center Experience and Outcome. Pediatr Cardiol 2022; 43:308-323. [PMID: 34495353 DOI: 10.1007/s00246-021-02722-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022]
Abstract
Residual or iatrogenic ventricular septal defects (VSDs) may result in significant hemodynamic effect. This study aimed to review our center experience in transcatheter closure of post-surgical and post-intervention residual and iatrogenic VSDs and to report on their 12-month long-term outcome. All patients who underwent transcatheter closure of residual/iatrogenic VSDs after surgical or transcatheter CHD interventions between January-2015 and January-2020 were included. Patients' medical records were reviewed and analyzed. Twenty-three patients with a mean age of 14.3 ± 8.8 years were included. The VSD was residual in 18 (78.3%) patients and iatrogenic in 5 (21.7%) patients, post-operative in 19 (82.6%) patients and post-transcatheter in 4 (17.4%) patients. The VSD site was peri-membranous in 9 (39.1%) patients, high-muscular in 6 (26.1%) patients, mid-muscular in 4 (17.4%) patients, and Gerbode shunt in 4 (17.4%) patients. The QP/QS ratio was 2.5 ± 0.7, and the VSD diameter was 6.1 ± 2.1 mm. Most, 16 (71.43%) patients underwent antegrade device deployment, and 7 (28.57%) patients underwent retrograde transaortic device deployment with 3 (13.0%) patients required two devices. Amplatzer™ Muscular VSD devices were used in 16 (69.6%) patients, Amplatzer™ Duct occlude-I devices were used in 4 (17.4%) patients, and Amplatzer™ Duct Occluder-II devices were used in 3 (13.0%) patients with a mean device size of 8.8 ± 2.8 mm. Procedural and fluoroscopy times were 55.1 ± 16.2 and 16.3 ± 4.0 min respectively. During follow-up (23.3 ± 15.9 months), no patient required re-intervention or exhibited mortality. Transcatheter closure of post-operative and post-intervention residual/iatrogenic VSDs represents a safe, feasible, and effective therapeutic approach.
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Affiliation(s)
- Fatma A Taha
- Adult Cardiology Department, Madinah Cardiac Center, Khaled Bin Waleed Road, Madinah, 6167, Saudi Arabia. .,Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Fareed Alnozha
- Adult Cardiology Department, Madinah Cardiac Center, Khaled Bin Waleed Road, Madinah, 6167, Saudi Arabia
| | - Osama Amoudi
- Adult Cardiology Department, Madinah Cardiac Center, Khaled Bin Waleed Road, Madinah, 6167, Saudi Arabia
| | - Mansour Almutairi
- Adult Cardiology Department, Madinah Cardiac Center, Khaled Bin Waleed Road, Madinah, 6167, Saudi Arabia
| | - Reda Abuelatta
- Adult Cardiology Department, Madinah Cardiac Center, Khaled Bin Waleed Road, Madinah, 6167, Saudi Arabia
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Bricker RS, Quaife RA, Chen SYJ, Messenger JC, Hammers J, Carroll JD. Transcatheter Closure of Left Ventricle to Coronary Sinus Fistula Post-MVR and Septal Myectomy. JACC Case Rep 2021; 3:1258-1263. [PMID: 34471874 PMCID: PMC8387808 DOI: 10.1016/j.jaccas.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Abstract
This paper describes the case of a patient who developed refractory heart failure due to a fistula from the left ventricle to the coronary sinus that was unintentionally created after a surgical myectomy and mitral valve replacement. Advanced image guidance with a pre-procedure 3-dimensional physical model and intraprocedure echocardiography fusion facilitated transcatheter plugging of the shunt with symptom resolution. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Rory S Bricker
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robert A Quaife
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shiuh-Yung J Chen
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John C Messenger
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - John D Carroll
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Kouakou NYN, Song J, Huh J, Kang IS. The experience of transcatheter closure of postoperative ventricular septal defect after total correction. J Cardiothorac Surg 2019; 14:104. [PMID: 31186037 PMCID: PMC6558918 DOI: 10.1186/s13019-019-0933-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to describe our experience with patients who underwent transcatheter closure of a post-operative ventricular septal defect (VSD). METHODS All patients who underwent transcatheter closure of a VSD after total correction of congenital heart disease since 2012 were enrolled. Medical records were retrospectively reviewed to determine the patients' initial diagnosis, closure device used, and final outcome after device closure. RESULTS Six patients with a median age of 17.7 years (range: 7 months-48 years) underwent transcatheter closure of an unresolved VSD. The median time interval from the initial corrective surgery to the percutaneous closure procedure was 10.4 years (range: 0.3-33.0 years). The initial diagnoses included tetralogy of Fallot (one patient), VSD (two patients), double outlet of the right ventricle (two patients), and aortic valve stenosis (one patient). The reasons for unresolved VSD (other than leakage) after corrective surgery included previous fenestration (in two patients), and iatrogenic Gerbode shunt (in one patient). Various devices were used, including the Amplatzer duct occluder I, Amplatzer duct occluder II, Amplatzer vascular plug II, and Cocoon membranous VSD occluder. Only one device was used in each patient. There were no major complications associated with the closure procedures. The immediate results were satisfactory. The median follow-up duration was 2.75 years. All cases were successful, with the exception of minimal leak in one patient. CONCLUSIONS Transcatheter device closure of post-operative VSD can be performed using various device types of devices and is safe and effective. But more experiences are mandatory.
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Affiliation(s)
| | - Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - I-Seok Kang
- Department of Pediatrics, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
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Gu X, Zhang Q, Sun H, Fei J, Zhang X, Kutryk MJ. Transcatheter Closure Versus Repeat Surgery for the Treatment of Postoperative Left-to-Right Shunts: A Single Center 15-Year Experience. Cardiol Res 2018; 8:286-292. [PMID: 29317971 PMCID: PMC5755660 DOI: 10.14740/cr629e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/05/2017] [Indexed: 11/28/2022] Open
Abstract
Background Repeat surgery and the percutaneous approach (transcatheter closure (TCC)) have been used for the management of postoperative left-to-right shunts. In this study, we described our 15 years of experience in treating postoperative left-to-right shunts with these two approaches. Methods From February 2002 to February 2017, 50 patients with residual left-to-right shunts, following cardiac surgery, were treated using TCC or repeat surgery. Clinical examination, standard 12-lead electrocardiography, chest X-ray, and a transthoracic echocardiogram were performed before hospital discharge and at all follow-ups. Results The closure rate was 100% in both groups and there was no procedure-related mortality. Patients with TCC had few complications. The procedure time and duration of hospital stay for TCC patients were 58.9 ± 27.7 min and 6.1 ± 0.8 days, respectively. Eleven out of 19 patients receiving reoperation suffered serious complications after surgery, e.g., bleeding and nosocomial infections. The operation time and duration of hospital stay for reoperation patients were 256.7 ± 60.5 min and 17.0 ± 4.0 days, respectively. No other serious complications were seen at all follow-up visits for both groups. Conclusions In conclusions, TCC is safe and effective for the management of postoperative left-to-right shunts, and is associated with few complications, which can be the favored closure strategy over repeat surgery for the management of postoperative left-to-right shunts.
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Affiliation(s)
- Xinghua Gu
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan 250012, China
| | - Qiuwang Zhang
- Division of Cardiology, Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Hourong Sun
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan 250012, China
| | - Jianchun Fei
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan 250012, China
| | - Xiquan Zhang
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan 250012, China
| | - Michael J Kutryk
- Division of Cardiology, Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Zhou W, Li F, Fu L, Gao W, Guo Y, Liu T, Huang M, Zhang Y. Clinical Experience of Transcatheter Closure for Residual Ventricular Septal Defect in Pediatric Patients. CONGENIT HEART DIS 2016; 11:323-31. [PMID: 27029420 DOI: 10.1111/chd.12357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Open cardiac surgery has traditionally been the gold standard for repair of ventricular septal defect (VSD). The inherent risks and complications associated with open surgery and the incidence of postoperative residual VSD are significant disadvantages of the open surgical approach. OBJECTIVE To evaluate the methodology and efficacy of transcatheter closure of postoperative residual VSD in children. METHODS Patients with postoperative VSD who underwent percutaneous device closure in the period from August 2010 and February 2014 in our center were analyzed retrospectively. Twelve children, including 8 males and 4 females, with mean age of 8.13 ± 5.39 years (range 0.67-17 years) and mean weight of 29.63 ± 20.86 kg (range 5.5-66 kg) were included in the study. RESULTS Ten cases had residual shunts situated at the margin of the patches while the other two had residual shunts because of multiple muscular VSD. The mean VSD diameter was 3.84 ± 1.86 mm (range 2.3-8.7 mm). On cardiac catheterization, the reported mean pulmonary circulatory blood volume/systemic circulation volume (Qp/Qs) ratio was 1.86 ± 0.91 (range 1.1-4.25) and the mean pulmonary artery pressure was 25.92 ± 12.42 mm Hg (range 7-52 mm Hg). Successful transcatheter closure was obtained in all twelve patients with postsurgery residual VSD. Two cases with residual muscular VSD underwent retrograde catheterization via the femoral artery while one case with residual VSD located at the lower margin of the patch was accessed via the internal jugular vein. The mean procedure time was 81.25 ± 25.86 minutes (range 40-120 minutes). There was no evidence of residual VSD, and no instances of new-onset valvular regurgitation were reported, with the only two exceptions being patients who had multiple muscular VSDs where clinically insignificant residual shunts were detected. CONCLUSION Our retrospective study highlights the potential safety and therapeutic efficacy of transcatheter approach for closing postoperative residual VSD in children. RECOMMENDATIONS More robust studies with longer-term follow-up of outcomes are required to firmly establish the safety profile and respective indications for use of various occluder devices for treating different categories of residual VSD.
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Affiliation(s)
- Wanping Zhou
- Cardiology Department, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Pudong New Area, Shanghai, China.,Cardiology Department, Children's Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Fen Li
- Cardiology Department, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Pudong New Area, Shanghai, China
| | - Lijun Fu
- Cardiology Department, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Pudong New Area, Shanghai, China
| | - Wei Gao
- Cardiology Department, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Pudong New Area, Shanghai, China
| | - Ying Guo
- Cardiology Department, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Pudong New Area, Shanghai, China
| | - Tingliang Liu
- Cardiology Department, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Pudong New Area, Shanghai, China
| | - Meirong Huang
- Cardiology Department, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Pudong New Area, Shanghai, China
| | - Yuqi Zhang
- Cardiology Department, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Pudong New Area, Shanghai, China
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Ebeid MR, Batlivala SP, Salazar JD, Eddine AC, Aggarwal A, Dodge-Khatami A, Maposa D, Taylor MB. Percutaneous Closure of Perimembranous Ventricular Septal Defects Using the Second-Generation Amplatzer Vascular Occluders. Am J Cardiol 2016; 117:127-30. [PMID: 26589818 DOI: 10.1016/j.amjcard.2015.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/09/2015] [Accepted: 10/09/2015] [Indexed: 11/19/2022]
Abstract
Earlier attempts at percutaneous closure of perimembranous ventricular septal defects (Pm VSDs) were abandoned because of incidence of heart block likely as a result of device rigidity and/or oversizing. This is retrospective review and data reporting of patients who underwent percutaneous closure using the softer second-generation Amplatzer vascular occluders; namely the Amplatzer vascular plug, second generation, (AVP II) and the Amplatzer duct occluder, second generation (ADO II) in our institution. A total of 20 patients were identified; AVP II was used in 9 patients and ADO II in 11 patients. Median weight was 13.45 kg (range 6.5 to 76); age 28.5 months (range 11 to 352). After procedure, 4 were noted to have aortic insufficiency; trivial in 3 and mild in 1 (unrelated to the device). Mild tricuspid regurgitation possibly device or procedure related was seen in 4. Residual flow through the device was common after procedure and disappeared in all but 3, graded as trivial in 1, small in 2. Average follow-up period was 7.54 months ± 7.5 (1 day to 25 months). There was no incidence of heart block, bacterial endocarditis, hemolysis, device embolization, or fracture. The aortic insufficiency resolved in 1 patient and was estimated to be trivial in the remaining 3 patients. In conclusion, percutaneous closure of Pm VSDs using the softer new generation devices as the AVP II and the ADO II is feasible and safe. Longer follow-up and larger series are needed.
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Affiliation(s)
- Makram R Ebeid
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi.
| | - Sarosh P Batlivala
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jorge D Salazar
- Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - Ahmad Charaf Eddine
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Avichal Aggarwal
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Ali Dodge-Khatami
- Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - Douglas Maposa
- Department of Anesthesia, University of Mississippi Medical Center, Jackson, Mississippi
| | - Mary B Taylor
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
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Transcatheter closure of ventricular septal defects with nitinol wire occluders of type patent ductus arteriosus. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 10:21-5. [PMID: 24799923 PMCID: PMC4007293 DOI: 10.5114/pwki.2014.41462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 01/17/2014] [Accepted: 01/17/2014] [Indexed: 11/17/2022] Open
Abstract
Ventricular septal defects closure (VSD) depending on the anatomy and clinical setting can be performed surgically or by a hybrid and transcatheter approach. Two cases of children with VSD will be presented. Patients’ defects were closed with various types of occluders made of nitinol wire mesh occluder, patent ductus arteriosus (PDA) type. The first case was a 2.5-year-old boy after cardiosurgical correction of tetralogy of Fallot (TOF). After the procedure, a significant haemodynamic residual VSD was observed, which was not successfully closed during the subsequent reoperation. Despite pharmacological treatment, symptoms of heart failure were observed in this patient. In echocardiographic images the residual VSD was presented as a tunnel-like dissection of the ventricular septum (length 6 mm and diameter 3.4 mm). The defect was closed via arterial access with an Amplatzer Duct Occluder II (ADO II). The procedure was successfully performed without any medical complications. In this child, a significant shunt reduction and a noticeable improvement in the patient's clinical status and diminished symptoms of heart failure were noticed. The second patient was a 4-year-old girl suffering from a multi-perforated perimembranous VSD accompanied by a ventricular septal defect with aneurysm. The defect was closed by a venous approach with a PDA Cardio-O-Fix occluder (very similar to ADO I). No short-term or long-term complications were visible during or after the procedure. Only a mild residual shunt through the VSD was observed 6 months afterwards. Transcatheter VSD closure with a proper morphology, with occluders of type Amplatzer Duct Occluder ADO I or ADO II, constitutes a safe and effective therapeutic alternative.
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10
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Dua JS, Carminati M, Lucente M, Piazza L, Chessa M, Negura D, Bussadori C, Saliba Z, Butera G. Transcatheter closure of postsurgical residual ventricular septal defects: Early and mid-term results. Catheter Cardiovasc Interv 2010; 75:246-55. [DOI: 10.1002/ccd.22262] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Gu MB, Bai Y, Zhao XX, Zheng X, Li WP, Qin YW. Transcatheter closure of postoperative residual perimembranous ventricular septal defects. Ann Thorac Surg 2009; 88:1551-5. [PMID: 19853111 DOI: 10.1016/j.athoracsur.2009.07.071] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 07/28/2009] [Accepted: 07/29/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND The presence of postoperative residual perimembranous ventricular septal defect (PmVSD) is relatively uncommon. However, reoperation might be associated with an increased surgical risk. Transcatheter device closure is an alternative strategy for management of postoperative residual defects. METHODS Between July 2002 and November 2008, transcatheter closure of postoperative residual PmVSDs was attempted in 26 patients (11 male, 15 female). Symmetric and asymmetric PmVSD occluders were used. RESULTS The diameter of residual defects was from 3 mm to 10 mm (mean 6.3 +/- 2.3 mm) on transthoracic echocardiography. In 24 of 26 patients, the residual defects were successfully closed. No direct residual defect was found on left ventriculography after the procedure. Total occlusion rate was 62% (15 of 24) at completion of the procedure, rising to 71% (19 of 24) at one week and 96% (23 of 24) during the follow-up. Twenty patients had only one device implanted, whereas 4 patients had two devices implanted. The waist size of occluders used ranged from 5 mm to 12 mm (mean 8.6 +/- 2.5 mm). One patient presented with complete atrioventricular block 3 days after the procedure and recovered 2 weeks later. Hemolysis occurred in 3 patients after the procedure within 12 hours. These patients recovered 4 weeks, 4 days, and 8 days later, respectively. During follow-up, the devices were in a stable position with optimal shapes. No late complications were observed. CONCLUSIONS Transcatheter closure of postoperative residual PmVSDs is possible without the need for reoperation. The early and midterm prognosis of patients with transcatheter closure is good.
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Affiliation(s)
- Ming-Biao Gu
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
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12
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Spies C, Ujivari F, Schraeder R. Transcatheter Closure of a Ventricular Septal Defect following Myectomy for Hypertrophic Obstructive Cardiomyopathy. Cardiology 2009; 112:31-4. [DOI: 10.1159/000137695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Accepted: 01/17/2008] [Indexed: 11/19/2022]
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13
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Klein AJ, Garcia JA, Carroll JD. Percutaneous closure of an iatrogenic ventricular septal defect following mechanical aortic valve replacement using the transseptal technique. Catheter Cardiovasc Interv 2007; 70:1018-24. [PMID: 17621666 DOI: 10.1002/ccd.21268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Iatrogenic ventricular septal defects (VSDs) following aortic valve replacement are relatively uncommon and are challenging to close percutaneously given their typical proximity to the prosthetic valve. We describe the successful percutaneous closure of an iatrogenic VSD in a patient with a recent mechanical AVR using the transseptal approach.
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Affiliation(s)
- Andrew J Klein
- University of Colorado Health Sciences at Denver, Department of Medicine, Division of Cardiology, Denver, Colorado 80262, USA
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