Left ventricular segmental dysfunction following percutaneous transcatheter closure of a membranous ventricular septal defect

Longer-term outcome of perventricular device closure of muscular ventricular septal defects in children

OBJECTIVE

To describe the longer-term clinical experience and follow-up with perventricular device closure of ventricular septal defects (VSD) in children.

METHODS

Between January 2005 and December 2013, muscular ventricular septal defect closure with the Amplatzer Muscular VSD Occluder was undertaken using a hybrid perventricular approach. Data including demographic, echocardiographic parameter, and clinical outcome were reviewed retrospectively.

RESULTS

Median age at the time of procedure was 8.9 months (range 1.9-31.0 months) and median weight was 6.6 kg (range 4.5-12.9 kg). All had a moderate to large muscular VSD, three had more than one VSD, four had previous coarctation repair, and five had previous pulmonary artery (PA) banding. A single Amplatzer muscular occluder (range 8-18 mm) was deployed in each patient without cardiopulmonary bypass under echocardiographic guidance. Two of ten patients subsequently required a short period of cardiopulmonary bypass for reconstruction of PA after de-banding and closure of atrial septal defect in one. Occluder removal was necessary in one patient due to entrapment of the tricuspid valve and progressive tricuspid regurgitation. This patient underwent surgical repair with a good result and no device-related valve damage. In the remaining nine patients, no severe complications such as device embolization, arrhythmia, or significant valve regurgitation were noted in the post-operative period or follow-up. At a median time of 6.5 years (range 0.9-8.4 years) post device implantation, complete closure was achieved in five patients and four had small residual leaks, which were not hemodynamically significant.

CONCLUSION

Perventricular muscular VSD closure is effective in small children with suitable muscular defects and may avoid the morbidity associated with cardiopulmonary bypass and conventional surgical repair. There have been no late complications with this approach.

Late high degree atrioventricular block after percutaneous closure of a perimembranous ventricular septal defect

Atrioventricular block is an important complication after percutaneous closure of perimembranous ventricular septal defects. In the majority of cases, it appears in early or in the midterm of closure. We present a patient who developed symptomatic Mobitz 2 second-degree atrioventricular block 3 years following percutaneous closure of such a defect.

How to choose an occluder for two nearby muscular ventricular septal defects?

Multiple muscular ventricular septal defects treated with a single device have been reported before, but the way of choosing a suitable occluder is not well described. Implantation of an oversized device might lead to potential side effects. We described our experience with a single device to close two nearby muscular ventricular septal defects perventricularly, and specifically the decision-making process used to choose the suitable occluder.