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Michel-Behnke I, Kumar RK, Justo R, Zabal C, Marshall AC, Jacobs JP. Closing the gap between acceptable and ideal in catheterisation for paediatric and congenital heart disease-A global view. Cardiol Young 2024:1-8. [PMID: 38699826 DOI: 10.1017/s1047951124000027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
In recent issues of the Journal of the Society for Cardiovascular Angiography and Interventions and the Journal of the American College of Cardiology: Cardiovascular Interventions, Holzer and colleagues presented an Expert Consensus Document titled: "PICS / AEPC / APPCS / CSANZ / SCAI / SOLACI: Expert consensus statement on cardiac catheterization for pediatric patients and adults with congenital heart disease." This Expert Consensus Document is a massively important contribution to the community of paediatric and congenital cardiac care. This document was developed as an Expert Consensus Document by the Pediatric and Congenital Interventional Cardiovascular Society, the Association for European Paediatric and Congenital Cardiology, the Asia-Pacific Pediatric Cardiac Society, the Cardiac Society of Australia and New Zealand, the Society for Cardiovascular Angiography and Interventions, and the Latin American Society of Interventional Cardiology, as well as the Congenital Cardiac Anesthesia Society and the American Association of Physicists in Medicine.As perfectly stated in the Preamble of this Expert Consensus Document, "This expert consensus document is intended to inform practitioners, payors, hospital administrators and other parties as to the opinion of the aforementioned societies about best practices for cardiac catheterisation and transcatheter management of paediatric and adult patients with congenital heart disease, with added accommodations for resource-limited environments." And, the fact that the authorship of this Expert Consensus Document includes global representation is notable, commendable, and important.This Expert Consensus Document has the potential to fill an important gap for this patient population. National guideline documents for specific aspects of interventions in patients with paediatric heart disease, including training guidelines, do exist. However, this current Expert Consensus Document authored by Holzer and colleagues provides truly globally applicable standards on cardiac catheterisation for both paediatric patients and adults with congenital heart disease (CHD).Our current Editorial provides different regional perspectives from senior physicians dedicated to paediatric and congenital cardiac care who are practicing in Europe, the Asia-Pacific region, Latin America, Australia/New Zealand, and North America. Establishing worldwide standards for cardiac catheterisation laboratories for children and adults with CHD is a significant stride towards improving the quality and consistency of care. These standards should not only reflect the current state of medical knowledge but should also be adaptable to future advancements, ultimately fostering better outcomes and enhancing the lives of individuals affected by CHD worldwide.Ensuring that these standards are accessible and adaptable across different healthcare settings globally is a critical step. Given the variability in resources and infrastructure globally, the need exists for flexibility and tailoring to implement recommendations.The potential impact of the Expert Consensus Document and its recommendations is likely significant, but heterogeneity of healthcare systems will pose continuing challenges on healthcare professionals. Indeed, this heterogeneity of healthcare systems will challenge healthcare professionals to finally close the gap between acceptable and ideal in the catheterisation of patients with paediatric and/or congenital heart disease.
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Affiliation(s)
- Ina Michel-Behnke
- Pediatric Heart Center Vienna, Division of Pediatric Cardiology, University Hospital for Children and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | | | - Robert Justo
- Queensland Children's Hospital, University of Queensland, South Brisbane, Australia
| | - Carlos Zabal
- CMO Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | - Audrey C Marshall
- Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Phillip Jacobs
- Congenital Heart Center, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida, United States of America
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Chin CY, Chen CA, Fu CM, Hsu JY, Lin HC, Chiu SN, Chang YM, Lu CW, Chou HW, Huang SC, Chen YS, Wu MH, Wang JK, Lin MT. Risk Factors of Long-Term Sequelae After Transcatheter Closure of Perimembranous Ventricular Septal Defect in Young Children. Circ J 2024; 88:663-671. [PMID: 38325819 DOI: 10.1253/circj.cj-23-0891] [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] [Indexed: 02/09/2024]
Abstract
BACKGROUND Complications arising from transcatheter closure of perimembranous ventricular septal defects (pmVSD) in children, such as residual shunts and aortic regurgitation (AR), have been observed. However, the associated risk factors remain unclear. This study identified risk factors linked with residual shunts and AR following transcatheter closure of pmVSD in children aged 2-12 years. METHODS AND RESULTS The medical records of 63 children with pmVSD and a pulmonary-to-systemic blood flow ratio <2.0 who underwent transcatheter closure between 2011 and 2018 were analyzed with a minimum 3-year follow-up. The success rate of transcatheter closure was 98.4%, with no emergency surgery, permanent high-degree atrioventricular block, or mortality. Defects ≥4.5 mm had significantly higher odds of persistent residual shunt (odds ratio [OR] 6.85; P=0.03). The use of an oversize device (≥1.5 mm) showed a trend towards reducing residual shunts (OR 0.23; P=0.06). Age <4 years (OR 27.38; 95% confidence interval [CI] 2.33-321.68) and perimembranous outlet-type VSD (OR 11.94, 95% CI 1.10-129.81) were independent risk factors for AR progression after closure. CONCLUSIONS Careful attention is crucial for pmVSDs ≥4.5 mm to prevent persistent residual shunts in transcatheter closure. Assessing AR risk, particularly in children aged <4 years, is essential while considering the benefits of pmVSD closure.
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Affiliation(s)
- Chia-Yi Chin
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine
- Department of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Chun-Min Fu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Jui-Yu Hsu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Hsin-Chia Lin
- Department of Pediatrics, National Taiwan University Hospital Yunlin Branch
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Ya-Mei Chang
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Heng-Wen Chou
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Shu-Chien Huang
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Yih-Sharng Chen
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
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Lozier JS, Sati M, Cheifetz IM, Bocks ML. Update on percutaneous and perventricular device closure of congenital ventricular septal defect. Expert Rev Cardiovasc Ther 2023; 21:337-345. [PMID: 37096558 DOI: 10.1080/14779072.2023.2206566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Ventricular septal defect is the most common congenital heart defect. Surgical repair has been standard therapy for symptomatic ventricular septal defects since the 1950's. Catheter-based device closure of ventricular septal defects emerged in the 1980's and has become a safe and effective alternative in select patients. AREAS COVERED This review focuses on patient selection and procedural techniques for device closure of ventricular septal defects, including percutaneous and hybrid perventricular approaches. The available devices used for these procedures, and outcomes of their use, are reviewed. EXPERT OPINION Percutaneous and perventricular device closure of ventricular septal defects is safe and effective in select patients. However, the majority of ventricular septal defects requiring closure continue to be managed with conventional surgery. Further development and investigation of transcatheter and hybrid surgical approaches for closing ventricular septal defects is required.
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Affiliation(s)
- John S Lozier
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Maram Sati
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ira M Cheifetz
- Divisions of Pediatric Cardiac Critical Care and Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Martin L Bocks
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
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Buntharikpornpun R, Roymanee S, Promphan W. Challenging transcatheter closure of a perimembranous ventricular septal defect using the Amplatzer Trevisio delivery cable. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2021.101483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Ramakrishnan S. Pediatric cardiology: Is India self-reliant? Ann Pediatr Cardiol 2021; 14:253-259. [PMID: 34667394 PMCID: PMC8457276 DOI: 10.4103/apc.apc_153_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 11/07/2022] Open
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Jiang D, Han B, Zhao L, Yi Y, Zhang J, Fan Y, Lv J, Wang J, Wang Y. Transcatheter Device Closure of Perimembranous and Intracristal Ventricular Septal Defects in Children: Medium- and Long-Term Results. J Am Heart Assoc 2021; 10:e020417. [PMID: 33998288 PMCID: PMC8483536 DOI: 10.1161/jaha.120.020417] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background In children, the practice of transcatheter closure of intracristal ventricular septal defect (icVSD) has been limited. Currently, there is a lack of comparison between device closure of perimembranous ventricular septal defect (pmVSD) and icVSD, and long‐term clinical outcomes are rare. Methods and Results This study included a total of 633 children (39 with icVSD and 594 with pmVSD), aged 18 months to 16 years, who underwent transcatheter closure of ventricular septal defect between January 2014 and December 2018. All patients were followed up until September 2020, with a median follow‐up of 46 months in the pmVSD group and 52 months in the icVSD group. The procedural success rate was 96.3% and 84.6% in pmVSD and icVSD groups, respectively (P=0.002). The median of age, weight, procedure time, fluoroscopic time, and radiation dose were greater in the icVSD group compared with the pmVSD group. More eccentric ventricular septal defect occluders were used in the icVSD group. Most adverse events were minor without any intervention, with cardiac rhythm/conduction abnormalities being the most common. In the pmVSD group, 2 patients experienced complete atrioventricular block, with one implanting a permanent pacemaker and the other dying of cardiac arrest secondary to reversible complete atrioventricular block 40 days postprocedure. Complete left bundle‐branch block occurred in 14 patients, and 12 cases were transient. In the icVSD group, no complete atrioventricular block or death occurred, and one patient developed transient complete left bundle‐branch block. Conclusions In selected patients, transcatheter device closure of pmVSD and icVSD can be performed safely and successfully, with excellent medium‐ and long‐term results in children.
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Affiliation(s)
- Diandong Jiang
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Bo Han
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Lijian Zhao
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Yingchun Yi
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Jianjun Zhang
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Youfei Fan
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Jianli Lv
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Jing Wang
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Yan Wang
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
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Safety and Efficacy of Transcatheter Occlusion of Perimembranous Ventricular Septal Defect with Aortic Valve Prolapse: A Six-Year Follow-Up Study. J Interv Cardiol 2021; 2021:6634667. [PMID: 33824626 PMCID: PMC7997740 DOI: 10.1155/2021/6634667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/24/2021] [Accepted: 03/06/2021] [Indexed: 12/14/2022] Open
Abstract
Background With the rapid development of transcatheter techniques and instruments, transcatheter occlusion for patients with perimembranous ventricular septal defect (pVSD) and aortic valve prolapse (AVP) was constantly being tried, while the efficacy and safety of pVSD with AVP remain controversial. Objective The aim of this study was to evaluate long-term efficacy and safety of transcatheter occlusion of pVSD with AVP. Methods We retrospectively analyzed 164 children with pVSD and AVP who underwent transcatheter occlusion between January 2013 and November 2014. AVP was divided into 3 degrees according to right coronary leaflet morphology at end-diastole during aortic root angiography. Patient demographic and clinical data were collected. Results There were 97 males and 67 females (median age, 40.0 (30.0–62.7) months; average weight, 16.94 ± 9.02 kg). Mild (n = 63), moderate (n = 89), and severe (n = 12) AVP success rates were 93.7%, 89.9%, and 58.3%, respectively. Immediately after procedure, there was no new-onset aortic regurgitation (AR) above trivial degree, residual shunt above mild degree, or complications requiring medication or operation, except for 1 patient who developed transient complete atrioventricular block. During follow-up, 1 mild AVP patient aggravated from mild to moderate AR and 1 moderate AVP patient aggravated from trivial to moderate AR. The new-onset AR in mild, moderate, and severe AVP was 2%, 1.8%, and 20%, respectively. AR disappeared in 17 patients. Residual shunt occurred in 9 patients after procedure, 4 of which disappeared during the follow-up period. No serious complications occurred in any patient during follow-up. Five-year cardiovascular event-free survival rates for mild, moderate, and severe AVP were 89.6%, 94.5%, and 80.0%, respectively. Conclusion Transcatheter occlusion of pVSD with mild and moderate AVP has a high success rate and few complications, which is safe and effective in long-term follow-up. Transcatheter occlusion of pVSD with severe AVP has low success rates and high AR incidence. Therefore, transcatheter occlusion of pVSD with AVP is recommended for mild to moderate, but not severe, AVP.
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Jiang D, Zhang J, Fan Y, Han B, Zhao L, Yi Y, Lv J, Wang J. The Efficacy and Medium to Long-Term Follow-Up of Transcatheter Retrograde Closure of Perimembranous Ventricular Septal Defects via the Femoral Artery With Amplatzer Duct Occluder II in Children. Front Pediatr 2021; 9:571407. [PMID: 34113582 PMCID: PMC8185017 DOI: 10.3389/fped.2021.571407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study was to assess the efficacy and safety of transcatheter retrograde closure of perimembranous ventricular septal defect (pmVSD) via the femoral artery with an Amplatzer Duct Occluder II (ADO II) in children. Methods: The clinical and follow-up data of 102 children who had successfully undergone transcatheter retrograde closure of pmVSD via the femoral artery with Amplatzer Duct Occluder II (ADO II) from February 2012 to June 2019 in our center were retrospectively reviewed. Results: In 102 of 103 patients, the defects were successfully closed (99.0%). The average age was 4.03 ± 1.84 years and the mean weight was 17.50 ± 5.58 kg. The mean diameter of the defects was 2.58 ± 0.63 mm. Hundred of the occluders had a waist length of 4 mm. The complete closure rate was 89.2% 24 h after the procedure and 98% at the last follow-up. The follow-up period ranged from 6 to 92 months, with a median of 36 months. One child developed new mild aortic regurgitation (AR), and 9 patients developed new mild tricuspid regurgitation (TR). During follow-up, TR disappeared in 5 patients and decreased in 4 patients, and AR relieved in one patient. One patient developed intermittent complete left bundle branch block 4 days after the procedure and recovered sinus rhythm 2 days later. No serious complications occurred. Conclusion: Transcatheter retrograde closure of pmVSD via the femoral artery with ADO II in children is safe, feasible, and effective in selected patients.
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Affiliation(s)
- Diandong Jiang
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jianjun Zhang
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Youfei Fan
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Bo Han
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Lijian Zhao
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yingchun Yi
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jianli Lv
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jing Wang
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Transesophageal echocardiography in the pediatric interventional cardiac catheterization laboratory. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tanidir IC, Baspinar O, Saygi M, Kervancioglu M, Guzeltas A, Odemis E. Use of Lifetech™ Konar-MF, a device for both perimembranous and muscular ventricular septal defects: A multicentre study. Int J Cardiol 2020; 310:43-50. [DOI: 10.1016/j.ijcard.2020.02.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/06/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
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Castro Rodriguez J, Berdaoui B, Morissens M. Percutaneous Closure of an Iatrogenic Inlet Ventricular Septal Defect in an Atrioventricular Canal. JACC Case Rep 2020; 2:911-914. [PMID: 34317380 PMCID: PMC8302112 DOI: 10.1016/j.jaccas.2020.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/26/2020] [Accepted: 05/06/2020] [Indexed: 11/29/2022]
Abstract
A 45-year-old woman with a partial atrioventricular canal presented with an iatrogenic interventricular shunt after implantation of a mechanical mitral prosthesis. The shunt was occluded percutaneously with an Amplatzer Duct Occluder II. This is the first reported percutaneous closure of a ventricular septal defect in an atrioventricular canal defect. (Level of Difficulty: Intermediate.)
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Beyond atrial septal defect closure, it is time to start seriously considering closing ventricular septal defects with devices. Curr Opin Cardiol 2019; 35:58-62. [PMID: 31652133 DOI: 10.1097/hco.0000000000000695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the history and current state of transcutaneous device closure of ventricular septal defects. RECENT FINDINGS Newer devices and techniques have expanded the role of transcutaneous device closure of ventricular septal defects. Device closure of ventricular septal defects is a mainstay of therapy in many parts of the world. Device closure in smaller infants has relatively higher risks than larger infants and older children. The potential for the development of complete heart block remains a concern with this procedure. SUMMARY Transcutaneous device closure of ventricular septal defects is a safe alternative to surgical repair in many patients.
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Esmaeili A, Behnke-Hall K, Schrewe R, Schranz D. Percutaneous closure of perimembranous ventricular septal defects utilizing almost ideal Amplatzer Duct Occluder II: Why limitation in sizes? CONGENIT HEART DIS 2018; 14:389-395. [PMID: 30561883 DOI: 10.1111/chd.12731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/27/2018] [Accepted: 11/26/2018] [Indexed: 11/28/2022]
Abstract
AIM The purpose of this study is to describe the special aspects of perimembranous ventricular septal defects (pmVSD) closure by utilizing Amplatzer Duct Occluder II (ADO II) devices with a rational request for bigger ADO-II sizes, based on our experience in transcatheter device closure of pmVSD. METHODS AND RESULTS At our institution, placement of an ADO II device was used in 15 patients with pmVSD; the patients' age ranged between 6 months and 20 years. The indications for closure were CHF (n = 4), hemodynamically significant shunt (n = 7), tricuspid regurgitation (n = 3), and high risk for infective endocarditis (n = 2), respectively. The location of the VSD was infracristal in 13 patients, supracristal in 1, and a postsurgical Gerbode VSD in another one. Implantation of the device was successfully performed without embolization, any evidence of an AV block, or other conductance abnormalities during implantation and follow-up in the mean of 2.5 years (range 2 months-6.5 years). CONCLUSIONS Transcatheter closure of a pmVSD with ADO II is feasible in all pediatric and young adult age groups, by considering the device diameter limitations. The off-label use of ADO II implantation seems to be safe for VSDs closure up to 6 mm of size and feasible for various locations including unusual morphology such as postsurgical Gerbode defect.
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Affiliation(s)
- Anoosh Esmaeili
- Pediatric Heart Center of Hessen, Goethe University, Frankfurt am Main, Germany
| | - Kachina Behnke-Hall
- Pediatric Heart Center of Hessen, Goethe University, Frankfurt am Main, Germany
| | - Roland Schrewe
- Pediatric Heart Center of Hessen, Goethe University, Frankfurt am Main, Germany
| | - Dietmar Schranz
- Pediatric Heart Center of Hessen, Goethe University, Frankfurt am Main, Germany
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