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Kozlik-Feldmann R, Lorber A, Sievert H, Ewert P, Jux C, Müller GC, Dalla Pozza R, Yigitbasi M, Schranz D, Lindinger A, Galal O, Meinertz T. Long-term outcome of perimembranous VSD closure using the Nit-Occlud® Lê VSD coil system. Clin Res Cardiol 2020; 110:382-390. [PMID: 33128576 PMCID: PMC7906931 DOI: 10.1007/s00392-020-01750-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/30/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study presents data from the admission trial to show the feasibility, safety and effectiveness of the Nit-Occlud® Lê VSD in the treatment of perimembranous ventricular septal defects with an aneurysmal configuration and a diameter up to 8 mm. BACKGROUND The majority of ventricular septal defects (VSD) are still closed surgically, while a less invasive transcatheter treatment by closure devices is available. Device-based closure is reported to be associated with the risk of complete atrio-ventricular block, especially with double-disc devices in perimembranous defects. METHODS In six tertiary centers in Germany and Israel, an interventional closure of a periembranous VSD was attempted in 88 patients using the Nit-Occlud® Lê VSD. RESULTS The interventional VSD closure was performed in 85 patients. Patients had a median age of 8.0 (2-65) years and a median body weight of 26.7 (10-109) kg. A complete closure of the defects was achieved in 85.4% 2 weeks after device implantation, in 88.9% after three months and in 98.6% at the 5-year follow-up. There was no incidence of death during the study nor did any patient suffer of permanent atrio-ventricular block of higher degree. Serious adverse events, by definition, are potentially life-threatening or require surgery to correct, while major serious events require medical or transcatheter intervention to correct. The study results exhibit a serious adverse event rate of 3.5% (3/85 patients) and a major adverse event rate of 5.9% (5/85 patients). CONCLUSION The Nit-Occlud® Lê VSD coil offers the possibility of an effective and safe approach in patients with aneurysmal perimembranous ventricular septal defects.
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Affiliation(s)
- Rainer Kozlik-Feldmann
- Department of Pediatric Cardiology, University Heart and Vascular Center, Hamburg, Germany.
| | - Avraham Lorber
- Department of Pediatric Cardiology and Adults With Congenital Heart Disease, Faculty of Medicine, Technion, Meyer Children's Hospital of Haifa, Rambam Medical Center, Haifa, Israel
| | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany.,Anglia Ruskin University, Chelmsford, UK
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center Munich, Munich, Germany
| | - Christian Jux
- Department of Pediatric Cardiology and Congenital Heart Defects, University Hospital Giessen and Marburg, Giessen, Germany
| | - Götz C Müller
- Department of Pediatric Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Robert Dalla Pozza
- Department of Pediatric Cardiology and Pediatric Intensive Care, Grosshadern Medical Center, University of Munich, Munich, Germany
| | - Mustafa Yigitbasi
- Department of Congenital Heart Defects-Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Dietmar Schranz
- Department of Pediatric Cardiology and Congenital Heart Defects, University Hospital Giessen and Marburg, Giessen, Germany
| | - Angelika Lindinger
- Member of the Data Safety and Monitoring Board, Westpfalz-Klinikum, Pediatric Cardiology, Kaiserslautern, Germany
| | - Omar Galal
- Member of the Data Safety and Monitoring Board, King Faisal Specialist Hospital and RC, Pediatric Cardiology, Jeddah, Saudi Arabia
| | - Thomas Meinertz
- Head of Clinical Trial and Member of the Data Safety and Monitoring Board, Cardiological-Internal Practice, Hamburg, Germany
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2
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Haas NA, Kock L, Bertram H, Boekenkamp R, De Wolf D, Ditkivskyy I, Freund MW, Gewillig M, Happel CM, Herberg U, Karthasyan E, Kozlik-Feldmann R, Kretschmar O, Kuzmenko Y, Milanesi O, Mueller G, Pongiglione G, Schubert S, Tarusinov G, Kampmann C. Interventional VSD-Closure with the Nit-Occlud ® Lê VSD-Coil in 110 Patients: Early and Midterm Results of the EUREVECO-Registry. Pediatr Cardiol 2017; 38:215-227. [PMID: 27847970 DOI: 10.1007/s00246-016-1502-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/26/2016] [Indexed: 11/25/2022]
Abstract
In August 2010, the Nit-Occlud® Lê (EUREVECO) became available for transcatheter coil occlusion of ventricular septal defects (VSDs). Retrospective European Registry for VSD Closure using the Nit-Occlud® Lê-VSD-Coil; analysis of the feasibility, results, safety and follow-up of VSD-closure over a 3-year period in 18 European centers. In 102 of 111 patients (female 66), successful VSD closure was performed (mean age 8.2 years, mean weight 28.82 kg), 81 perimembranous VSDs (48 with aneurysm), 30 muscular VSDs, mean procedure time was 121.1 min, and mean fluoroscopy time was 26.3 min. Short- and midterm term follow-up was possible in 100/102 patients, there was 1 embolization and 1 explantation after 24 months. Immediate complete closure occurred in 49 of 101 patients (48.5%), trivial residual shunt was present in 51 (50.0%), closure rate was 95% after 6 months and 97% after 1 year. Out of the 102 patients, there were 2 severe complications (1.8%) (1 severe hemolysis, 1 embolization) and 8 moderate/transient (=7.2%) including 1 transient AV block. During a mean follow-up period of 31.3 months (range 24-48) and a total follow-up time of 224.75 patient years, no further problems occurred. VSD closure with the Nit-Occlud® Lê VSD coil is feasible and safe with a minimal risk of severe side effects. The long-term effects and safety require further clinical follow-up studies.
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Affiliation(s)
- Nikolaus A Haas
- Department for Congenital Heart Defects, Heart and Diabetes Center North Rhine Westphalia, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
- Department of Pediatric Cardiology and Pediatric Intensive Care, Klinikum der Ludwigs Maximilian Universität München, Munich, Germany.
| | - Laura Kock
- Department for Congenital Heart Defects, Heart and Diabetes Center North Rhine Westphalia, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Harald Bertram
- Department of Pediatric Cardiology and Pediatric Intensive Care, Children's Hospital Hannover Medical School, Hannover, Germany
| | - Regina Boekenkamp
- Department for Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Daniel De Wolf
- Department for Pediatric Cardiology, Ghent University Hospital, UZ Ghent, Ghent, Belgium
| | - Igor Ditkivskyy
- Department of Interventional Cardiology, National Amosov Institute of Cardio-Vascular Surgery, Kiev, Ukraine
| | - Matthias W Freund
- Department for Pediatric Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marc Gewillig
- Department for Pediatric Cardiology, University Hospital Leuven, Louvain, Belgium
| | - Christoph M Happel
- Department for Congenital Heart Defects, Heart and Diabetes Center North Rhine Westphalia, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Ulrike Herberg
- Department for Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Edvard Karthasyan
- Center for Congenital Heart Defects and Pediatric Cardiology, Research Institution for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Rainer Kozlik-Feldmann
- Department of Pediatric Cardiology and Pediatric Intensive Care, Klinikum der Ludwigs Maximilian Universität München, Munich, Germany
| | - Oliver Kretschmar
- Department for Pediatric Cardiology/Congenital Heart Defects, University Children's Hospital Zurich, Zurich, Switzerland
| | - Yulia Kuzmenko
- Department of Pediatric Cardiology, The Scientific Practical Children's Cardiac Center, Kiev, Ukraine
| | - Ornella Milanesi
- Department of Women and Children's Health Pediatric Cardiac Unit, University Hospital of Padova, Padua, Italy
| | - Goetz Mueller
- Department for Pediatric Cardiology, University Heart Centre Hamburg, Hamburg, Germany
| | - Giacomo Pongiglione
- Department for Pediatric Cardiology and Pediatric Cardiac Surgery, Bambino Gesú Children's Hospital, Rome, Vatican, Italy
| | - Stephan Schubert
- Department for Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Gleb Tarusinov
- Center for Congenital Heart Defects, Pediatric Cardiology, Heart Centre Duisburg, Evangelic Hospital Niederrhein, Duisburg, Germany
| | - Christoph Kampmann
- Department for Pediatric Cardiology, University Children's Hospital, Mainz, Germany
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3
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First in man closure of a fenestrated ventricular septal defect (VSD) with a new paravalvular leak device (Occlutech PLD). Int J Cardiol 2015; 201:137-8. [PMID: 26298355 DOI: 10.1016/j.ijcard.2015.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/01/2015] [Indexed: 11/20/2022]
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4
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Interventionelle Kinderkardiologie. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-014-3263-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Scott JP, Hoffman GM. Near-infrared spectroscopy: exposing the dark (venous) side of the circulation. Paediatr Anaesth 2014; 24:74-88. [PMID: 24267637 DOI: 10.1111/pan.12301] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 11/28/2022]
Abstract
The safety of anesthesia has improved greatly in the past three decades. Standard perioperative monitoring, including pulse oximetry, has practically eliminated unrecognized arterial hypoxia as a cause for perioperative injury. However, most anesthesia-related cardiac arrests in children are now cardiovascular in origin, and standard monitoring is unable to detect many circulatory abnormalities. Near-infrared spectroscopy provides noninvasive continuous access to the venous side of regional circulations that can approximate organ-specific and global measures to facilitate the detection of circulatory abnormalities and drive goal-directed interventions to reduce end-organ ischemic injury.
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Affiliation(s)
- John P Scott
- Departments of Anesthesiology and Pediatrics, Medical College of Wisconsin, Pediatric Anesthesiology and Critical Care Medicine, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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6
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Zeinaloo A, Macuil B, Zanjani KS, Sideris E. Transcatheter patch occlusion of ventricular septal defect in Down syndrome. Am J Cardiol 2011; 107:1838-40. [PMID: 21481831 DOI: 10.1016/j.amjcard.2011.02.316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 02/12/2011] [Accepted: 02/12/2011] [Indexed: 11/15/2022]
Abstract
Closure of perimembranous ventricular septal defects in patients with Down syndrome, either surgically or by Amplatzer occluders, carries a high risk of complete heart block. We report 5 closures using the transcatheter patch, a wireless bioabsorbable device without any reported heart block to date. The median defect size was 11 mm. Small devices were used in 4 patients and a medium size in 1. The patch was released after 48 hours in 3 patients and immediately in the other 2. Of the 5 patients, 3 were followed up for >5 years and 2 for 1 year. None of these patients had atrioventricular block during their follow-up. In conclusion, the transcatheter patch might be superior in terms of cardiac conduction system protection in patients with Down syndrome after ventricular septal defect closure.
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Affiliation(s)
- Aliakbar Zeinaloo
- Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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7
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Herzkatheterinterventionen bei angeborenen Herzfehlern. Monatsschr Kinderheilkd 2010. [DOI: 10.1007/s00112-010-2178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Transcatheter closure of perimembranous ventricular septal defect using a modified double-disk occluder. Am J Cardiol 2008; 101:1781-6. [PMID: 18549859 DOI: 10.1016/j.amjcard.2008.02.069] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Revised: 02/10/2008] [Accepted: 02/10/2008] [Indexed: 11/23/2022]
Abstract
This multicenter study assessed the efficacy and safety of transcatheter closure of perimembranous ventricular septal defect (VSD) using a modified double-disk occluder. In 5 different centers in China, 412 patients with VSD, including 202 men and 210 women, underwent attempted transcatheter closure. The age range was 3 to 65 years (mean 16.4+/-9.1). The diameter of defect was 3 to 15 mm by transthoracic echocardiography and 3 to 18 mm by left ventriculography. The ratio of pulmonary to systemic flow varied from 1.6 to 2.3 (1.9+/-0.4). The device diameter was 4 to 20 mm (7.09+/-3.60). The ventricular septal rim below the aortic valve was 0 to 5 mm. The immediate success rate was 96.6%; 6 cases had third degree atrioventricular block and recovered within 3 weeks. None needed a permanent pacemaker. Dislodgement of the device occurred in 3 patients but the device was recaptured and redeployed in 2 cases. During the follow-up period of 2 years, there was no evidence of residual shunt and device-related complications. In conclusion, transcatheter closure of VSD is safe and effective in most selected patients; the mid-term prognosis of patients with transcatheter closure is good.
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Esmaeili A, Höhn R, Koch A, Vogl TJ, Hofstetter R, Abolmaali N. Assessment of shunt volumes in children with ventricular septal defects:. Clin Res Cardiol 2006; 95:523-30. [PMID: 16830267 DOI: 10.1007/s00392-006-0415-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 05/23/2006] [Indexed: 10/24/2022]
Abstract
The aim of this study was to compare the results of magnetic resonance based shunt volume measurements with the results of the invasive method by the principle of Fick. In 14 children (median age: 16.5 months) with ventricular septal defects the shunt volume was quantified by magnetic resonance flow measurements under spontaneous breathing conditions as well as with invasive angiography during one sedation. A good correlation between both methods was observed (r(2) = 0.8, p <0.0001, CI(95%) = 0.62-1.22). A tendency towards higher values in the noninvasive technique was found in the Bland-Altman plot (bias = 3.79). Magnetic resonance based shunt measurements are a reliable alternative to the invasive shunt measurement by cardiac catheterization.
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Affiliation(s)
- Anoosh Esmaeili
- Department of Pediatric Cardiology, Johann Wolfgang Goethe University, Hospital, Frankfurt/M, Germany
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10
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Emmel M, Sreeram N, Pillekamp F, Boehm W, Brockmeier K. Transhepatic approach for catheter interventions in infants and children with congenital heart disease. Clin Res Cardiol 2006; 95:329-33. [PMID: 16598389 DOI: 10.1007/s00392-006-0382-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Accepted: 02/21/2006] [Indexed: 11/27/2022]
Abstract
UNLABELLED We report on our experience with transhepatic access for catheter interventions in six children (age range 2.5 months-9 years). Three had systemic venous anomalies, and one infant a femoral venous occlusion. In two further patients with bradyarrhythmia after a Fontan operation with an intraatrial Gore-Tex tunnel, transhepatic access was chosen to achieve a perpendicular orientation of the transseptal needle to the atrial baffle, allowing puncture of the Gore-Tex membrane. Two of the patients underwent ablation of an accessory pathway; in one an atrial septal defect was closed. A 2.5 month old baby after Norwood I operation, underwent balloon dilation of the pulmonary arteries. Two patients after prior Fontan surgery underwent DDDR pacemaker implantation. The size of the introducer sheath ranged from 4 F up to two 9 F introducers in the same vein for pacemaker insertion. At the end of the procedure, hemostasis was achieved by external compression. RESULTS Transhepatic access could be established in all six patients (using a mirror image approach in children with left atrial isomerism) and the interventional procedures could be performed as planned. In one patient with implantation of a permanent pacemaker, a subcutaneous hematoma occurred, requiring blood transfusion. CONCLUSION In selected pediatric patients, transhepatic access for catheter intervention can easily be achieved.
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Affiliation(s)
- M Emmel
- Klinik und Poliklinik für Kinderkardiologie, Kerpener Str. 62, 50937, Köln, Germany
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11
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Handke R, Jux C, Schranz D, Schneider M. Transcatheter closure of perimembranous ventricular septal defects using umbrella devices. Catheter Cardiovasc Interv 2006; 68:936-41. [PMID: 17086519 DOI: 10.1002/ccd.20766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
UNLABELLED There is only limited experience of interventional closure of perimembranous ventricular septal defects (pmVSDs), particularly on the long-term follow-up. This is a report on our long-term results after transcatheter closure of pmVSDs using the Cardioseal, Starflex, or Rashkind devices. PATIENTS Between 1993 and 2005, we performed interventional occlusions of pmVSDs in 18 patients. The size of the defect ranged between 4 and 8.5 mm, Q(p)/Q(s) was calculated between 1.3 and 2.2. Except for two, the patients had no other structural heart defect. In the early days, we used the Rashkind PDA occluder (17 mm) in seven, followed by the Cardioseal device (17 mm) in nine, and the 23 mm Starflex device in two patients. RESULTS Interventional closure of the defects was performed successfully in all patients without any complication during the procedure. Fluoroscopy times were 11.8-53.7 min (median 28.65 min). We achieved a complete closure in 13 patients, three patients with recently implanted devices still show minimal shunting. In two patients the occluder had to be removed surgically because of embolization into the pulmonary artery and significant residual shunting resulting in severe hemolysis in the second patient. In long- (mean 10.7 years) and short-term (mean 0.85 years) follow-up we have not observed any hemolysis, arrhythmias, device dislocations, or device-related aortic or tricuspid regurgitation. CONCLUSION Transcatheter closure of small pmVSDs using non-selfcentering devices can be performed successfully. Long-term follow-up investigations show encouraging results. Complications like device-embolization and significant residual shunting occur in the presence of large defects and/or concomitant malformations.
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Affiliation(s)
- Ronald Handke
- Department of Paediatric Cardiology, The Children's Heart Center St Augustin, St Augustin, Germany.
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Hein R, Büscheck F, Fischer E, Leetz M, Bayard MTY, Ostermayer S, Reschke M, Lang K, Römer A, Wilson N, Sievert H. Atrial and Ventricular Septal Defects Can Safely Be Closed by Percutaneous Intervention. J Interv Cardiol 2005; 18:515-22. [PMID: 16336434 DOI: 10.1111/j.1540-8183.2005.00094.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Various transcatheter devices and methods to close congenital heart defects are currently available. Devices have been designed specifically for atrial septal defect (ASD), patent foramen ovale (PFO), and ventricular septal defect (VSD) closure. The trend in interventional treatment of intracardiac shunts shows toward defect-specific systems. The PFO is a tunnel defect requiring occluders that adapt to its length while common ASD strongly vary in their diameter, making a large scale of device sizes indispensable. VSDs are predominantly sealed by coils or tissue-adapted devices like muscular or perimembranous occluders. Since VSDs may occur with an aneurysm (VSA), a multi-perforated septum, an instable myocardial situation (postinfarction) or a high interventricular pressure gradient, closure of these defects is regarded sometimes as complicated. But during the last 30 years (since King and Mills implanted the first double-umbrella occluding system) several studies have proven procedure efficacy and safety of both ASD and VSD closure. This article reviews a large scale of studies and includes our single center data on 1,609 PFO, ASD, and VSD patients.
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Affiliation(s)
- Ralph Hein
- The CardioVascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany
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13
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Michel-Behnke I, Le TP, Waldecker B, Akintuerk H, Valeske K, Schranz D. Percutaneous closure of congenital and acquired ventricular septal defects--considerations on selection of the occlusion device. J Interv Cardiol 2005; 18:89-99. [PMID: 15882154 DOI: 10.1111/j.1540-8183.2005.04051.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Nonsurgical closure of congenital and acquired ventricular septal defects (VSD) has become increasingly acceptable with the availability of various occlusion systems that allow percutaneous treatment of muscular and membranous defects. This study describes a series of 12 patients (0.2-74-years-old) who underwent defect closure with six different occlusion systems. Device selection according to anatomy and outcome is highlighted. Seven VSDs were located in the membranous part of the septum, five in the mid-muscular septum. Complex heart lesions were present in five postmyocardial infarction VSD in one and residual postsurgical defects in three patients. The size of the VSD ranged from 2.6 to 10 mm. The applied devices were: Amplatzer muscular VSD occluder (n=4), Amplatzer septal occluder (n=2), Amplatzer duct occluder (n=1), Amplatzer membranous VSD occluder (n=2), Nit-Occlud coil (n=2), and Cook PDA coil (n=1). The devices were implanted successfully in nine patients. There was complete VSD closure in eight patients within the first 24 hours. In one patient, a trivial residual shunt disappeared at 6 months follow-up. Because of device instability, two occluders were removed during catheterization. In two other cases, tricuspid valve tissue was entrapped in the occluder and had to be removed surgically, one of them during the consecutive Rastelli operation. Neither significant arrhythmia, nor thromboembolism or hemolysis occurred in out patients during follow-up. Transcatheter closure of VSD is an attractive alternative to surgery. In complex congenital heart disease, surgical-interventional hybrid therapy may improve morbidity and total outcome. The recently developed Amplatzer VSD devices allow closure of muscular and membranous VSDs. Implantation and short-term follow-up are superior to the formerly used devices. Long-term effects have to be evaluated in further studies.
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Girisch M, Sieverding L, Rauch R, Kaulitz R, Gass M, Ziemer G, Hofbeck M. Recanalisation of bilateral superior vena cava after total cavopulmonary connection. Interventional occlusion with the Amplatzer VSD Occluder. ZEITSCHRIFT FUR KARDIOLOGIE 2005; 94:469-73. [PMID: 15997349 DOI: 10.1007/s00392-005-0250-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Accepted: 02/10/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED Formation of systemic to pulmonary venous or systemic venous left atrial collaterals frequently occurs in patients after Glenn or Fontan-type operations. Embolization with detachable metal coils is the therapy of choice for the closure of small vessels. These devices however are not appropriate for the occlusion of large collaterals, e. g. recanalized bilateral caval veins. We report two patients who presented late after Fontan-type operations with a gradual decrease in oxygen saturation due to recanalisation of bilateral caval veins. Interventional closure of these large veins was carried out successfully with the use of 8 mm Amplatzer muscular VSD Occluders, resulting in an increase of arterial oxygen saturations. CONCLUSION The closure of recanalized bilateral superior caval veins after Fontan procedures is possible without technical problems by means of the Amplatzer muscular VSD Occluder. In order to avoid future formation of venous collaterals via the azygos or hemiazgos system, the occluder should be placed in the vena cava below the orifice of the azygos/ hemiazygos vein.
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Affiliation(s)
- M Girisch
- University Hospital for Children and Adolescents, Department of Pediatric Cardiology, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
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15
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Kotthoff S, Lê TP, Debus V. Late coil displacement after interventional closure of a perimembranous ventricular septal defect: A case report. Catheter Cardiovasc Interv 2005; 66:273-6. [PMID: 16086430 DOI: 10.1002/ccd.20452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Muscular and perimembranous ventricular septal defects can be closed with nitinol plugs or spiral coils. Displacement and embolization of the device are well known complications that usually occur during or early after the procedure. We present the case of a 12-year-old boy with asymptomatic coil displacement detected at a routine examination 5 months after closure of a perimembranous ventricular septal defect.
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Affiliation(s)
- Stefan Kotthoff
- Department of Pediatric Cardiology, University Children's Hospital Muenster, Muenster, Germany.
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