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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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2
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Tessitore A, Caiffa T, D'Agata Mottolese B, Chicco D, Barbi E, Bobbo M. Infant with poor growth after cardiac surgery: Do not miss the rhythm! J Paediatr Child Health 2022; 58:707-709. [PMID: 34159665 DOI: 10.1111/jpc.15621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 11/27/2022]
Affiliation(s)
| | - Thomas Caiffa
- Department of Pediatrics, Institute for Maternal and Child Health, Trieste, Italy
| | | | - Daniela Chicco
- Department of Pediatrics, Institute for Maternal and Child Health, Trieste, Italy
| | - Egidio Barbi
- Department of Pediatrics, University of Trieste, Trieste, Italy.,Department of Pediatrics, Institute for Maternal and Child Health, Trieste, Italy
| | - Marco Bobbo
- Department of Pediatrics, Institute for Maternal and Child Health, Trieste, Italy
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Lin L, Liu J, Guo X, Chen H, Huang Y, Zheng H, Chen W, Chen L, Chen L, Chen Z. Risk factors for atrioventricular block after occlusion for perimembranous ventricular septal defect. Heart Rhythm 2021; 19:389-396. [PMID: 34843969 DOI: 10.1016/j.hrthm.2021.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The risk factors for complete atrioventricular block (CAVB) after device closure of perimembranous ventricular septal defect (pmVSD) remain unclear. OBJECTIVE The purpose of this study was to analyze the incidence and risk factors for CAVB after device closure for pmVSD. METHODS We reviewed 1884 patients with pmVSD who had undergone successful device occlusion between June 2005 and January 2020. Permanent CAVB was defined as CAVB requiring implantation of a permanent pacemaker (PPM) or extraction of the occluder. RESULTS In total, 14 patients (0.7%) developed permanent CAVB. Of these patients, 10 (0.5%) required PPM implantation. Four permanent CAVB occurred within 7 days after the procedure (acute), 2 between 7 and 30 days (subacute), 3 between 30 days and 1 year (late), and 5 more than 1 year (very late). None of the subacute, late, and very late CAVB recovered normal conduction with medication and eventually required device removal or PPM implantation. Four patients with acute CAVB and 1 with subacute CAVB underwent device removal, and 4 (80%) recovered normal conduction. Multivariate regression revealed that the ratio of device to defect size was the only independent risk factor for permanent CAVB (odds ratio 3.027; 95% confidence interval 1.476-6.209; P = .003). CONCLUSION The incidences of permanent CAVB after occlusion for pmVSD and PPM implantation were 0.7% and 0.5%, respectively. The ratio of device to defect size was the only independent risk factor for permanent CAVB. Device removal is an effective therapeutic modality for recovering normal conduction in acute and subacute CAVB patients.
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Affiliation(s)
- Li Lin
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Jianwen Liu
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Xiufen Guo
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Hang Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Yu Huang
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Huiying Zheng
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Wanhua Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Lianglong Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Liangwan Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Zhaoyang Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China.
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Ghaderian M, Salemi N. Comparison of Long-Term Complications of Using Amplatzer Ductal Occluder and Ventricular Septal Defect Occluder for Transcatheter Ventricular Septal Defect Closure. Heart Views 2021; 22:102-107. [PMID: 34584620 PMCID: PMC8445135 DOI: 10.4103/heartviews.heartviews_166_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/31/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Ventricular Septal Defect (VSD) is the most common type of congenital heart disease and perimembranous type is the commonest form of these defects. Trans-catheter management of these defects is a challenging procedure. Objectives: The purpose of this study was to compare of Trans-catheter closure of perimembranous ventricular septal defect (PMVSD) using Amplatzer Ductal Occluder (ADO) and VSD occluder and their complications and follow-up. Patients and Methods: Between 2013 and April 2019, 69 patients underwent percutaneous closure of PMVSD using ADO (29 patients) and VSD occluder (40 patients). After obtaining the size of VSD from the ventriculogram at least 2 mm larger than the orifice diameter of VSD at the right ventricular side was chosen. The devices were positioned after verification of the proper device position by echocardiography, aortogram and left ventriculography. Results: The mean age of patients were 9.07 ± 7.73 years, mean weight 26.12 ±16.25 kg. The mean defect size of the right ventricular orifice and device sizes were 5.54 ± 1.83 mm 7.72 ± 1.94 mm respectively. Small residual shunts were seen at the completion of the procedure, but they disappeared during follow-up in all but one patient. Two patients had mild AI before the procedure in ADO group that disappeared during the follow-up. The mean follow-up period was 3.3 ± 1.7 years (range 1 to 6 years). Complete atrioventricular block (CAVB) was seen in one patient (VSD occluder) during the procedure that disappeared after the retrieval of the device. Major complication or death was not observed in our study. Conclusions: Trans-catheter closures of PMVSD with ADO or VSD occluder had similar effects in these patients and are safe and effective treatment associated with excellent success and closure rates. Long-term follow-up in a large number of patients is warranted.
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Affiliation(s)
- Mehdi Ghaderian
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Negin Salemi
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Ghosh S, Mukherji A, Pathak NL, Mazumdar J, Chattopadhyay A. Delayed onset atrioventricular block following transcatheter closure of peri-membranous VSD using Amplatzer duct occluder-II device: Discussion with review of literature. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101371] [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: 11/26/2022]
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Zheng H, Lin A, Wang L, Xu Y, Zhang Z. The Long-Term Change of Arrhythmias after Transcatheter Closure of Perimembranous Ventricular Septal Defects. Cardiol Res Pract 2021; 2021:1625915. [PMID: 34239725 PMCID: PMC8241517 DOI: 10.1155/2021/1625915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/09/2021] [Accepted: 06/12/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To observe and analyze the long-term change of different types of arrhythmias after transcatheter closure of perimembranous ventricular septal defect (pmVSD). METHODS We retrospectively collected the data of patients who underwent pmVSD closure in our institution from March 2002 to December 2010. RESULTS One hundred thirty-nine patients met the inclusion criteria, of which 265 (25.5%) had early arrhythmia. They were classified into two categories: conduction abnormality (191/1039; 18.4%) and origin abnormality (94/1039; 9.0%), including 20 patients with both types of arrhythmias. The median follow-up time was 84.5 months, and 103 patients (103/191; 53.9%) with early conduction block got permanent arrhythmias, while only three patients (3/94; 3.2%) with early anomalous origin arrhythmias still had an abnormal electrocardiogram. Serious arrhythmias (28/1039; 2.7%), including II° atrioventricular block (AVB), III° AVB, and complete left bundle branch block (CLBBB), can appear immediately in the early postoperative period (21 patients) or in the late outset (seven patients) after several months or even years (6 months to 8.3 years). Twenty patients (20/21; 95.2%) with serious arrhythmia in the early postoperative period improved after early treatment, but six patients relapsed or worsened during follow-up. At the endpoint, severe arrhythmia persisted in 13 patients, of which four patients got permanent pacemaker implanted, and one patient with recurrent CLBBB died from heart failure. CONCLUSIONS The probability of delayed CAVB or bundle branch block after VSD closure is low but often occurs several years after surgery. Therefore, long-term ECG follow-up should last for several years or even decades. Serious arrhythmias that appear early after transcatheter pmVSD closure may impose a risk of recurrence although they have been cured already. Close attention should be paid to the changes of cardiac function in patients with CLBBB after VSD closure, and the severity of such arrhythmia should be taken seriously and reexamined.
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Affiliation(s)
- Hongyan Zheng
- Department of Cardiology, Cardiovascular Institute of Panyu District, Panyu Central Hospital, No. 8 Fuyudong Rd, Guangzhou City, Guangdong Province 511400, China
| | - Aiwen Lin
- Department of Cardiology, Cardiovascular Institute of Panyu District, Panyu Central Hospital, No. 8 Fuyudong Rd, Guangzhou City, Guangdong Province 511400, China
| | - Li Wang
- Department of Obstetrics and Gynecology, Panyu Central Hospital, No. 8 Fuyudong Rd, Guangzhou City, Guangdong Province 511400, China
| | - Yukai Xu
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, No. 96 Dongchuan Rd, Guangzhou City, Guangdong Province 510100, China
| | - Zhiwei Zhang
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, No. 96 Dongchuan Rd, Guangzhou City, Guangdong Province 510100, China
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Oestreich B, Gurevich S, Adabag S, Kelly R, Helmer G, Raveendran G, Yannopoulos D, Biring T, Garcia S. Exposure to glucocorticoids prior to transcatheter aortic valve replacement is associated with reduced incidence of high-degree AV block and pacemaker. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:328-331. [DOI: 10.1016/j.carrev.2018.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 12/20/2022]
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Garcia RU, Safa R, Karpawich PP. Postoperative complete heart block among congenital heart disease patients: Contributing risk factors, therapies and long-term sequelae in the current era. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.04.003] [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: 10/17/2022]
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Mandal KD, Su D, Pang Y. Long-Term Outcome of Transcatheter Device Closure of Perimembranous Ventricular Septal Defects. Front Pediatr 2018; 6:128. [PMID: 29774208 PMCID: PMC5943568 DOI: 10.3389/fped.2018.00128] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 04/16/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Ventricular septal defect is a common congenital heart defect. Transcatheter closure of perimembranous ventricular septal defect (pmVSD) is an effective method alternative to surgical closure. The aim of the study is to evaluate the procedural result, early and long-term follow-up outcome of transcatheter closure of pmVSD. Methods: From January 2005 to December 2016, we retrospectively identified the patients who underwent transcatheter device closure of pmVSD. All patients underwent transthoracic echocardiography (TTE) and electrocardiogram (ECG) before and after the procedure. Follow-up evaluation was done at 1, 3, 6, 12 months and yearly thereafter with TTE and ECG. Results: Total 186 patients (95 male, 91 female) had catheter-based intervention of pmVSD. The mean age at the time of procedure was 5.4 ± 2.8 years (range 2~14 years) and the mean weight was 18.1 ± 6.7 kg (range 10.5~43 kg). The mean size of the implanted device was 8.4 ± 2.1 mm (range 5~16 mm). The device was successfully implanted in 180 patients (96.8%). Immediate post-procedural echocardiography showed complete occlusion in all but one patient had trivial residual shunt. Total early adverse events occurred in 16 patients (8.9%). Only in two patients it was significant, complete AVB occurred in a 9 years old boy, managed with temporary pacemaker and one patient had complete left bundle branch block, recovered fully after steroid therapy. During a median follow-up period of 18.4 months (range 6~120 months), no serious adverse events and complete AVB were encountered. Conclusion: In our experience, The incidence of serious adverse event is low and no late onset of complete AVB with excellent success rate and follow-up results, confirming the transcatheter closure of pmVSD is a valuable alternative to surgical closure in selected patients.
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Affiliation(s)
- Krishna D Mandal
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Danyan Su
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yusheng Pang
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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10
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Zhao LJ, Han B, Zhang JJ, Yi YC, Jiang DD, Lyu JL. Postprocedural Outcomes and Risk Factors for Arrhythmias Following Transcatheter Closure of Congenital Perimembranous Ventricular Septal Defect: A Single-center Retrospective Study. Chin Med J (Engl) 2017; 130:516-521. [PMID: 28229981 PMCID: PMC5339923 DOI: 10.4103/0366-6999.200551] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Currently, transcatheter closure of perimembranous ventricular septal defect (pmVSD) is a widely accepted therapeutic modality. However, arrhythmias, especially postprocedural heart blocks, are a concern and outcomes are not very clear. This study explored the outcomes and risk factors of arrhythmias associated with transcatheter device closure of pmVSD. METHODS A total of 395 patients diagnosed with pmVSD who successfully underwent transcatheter intervention between January 2010 and December 2015 in our center were retrospectively reviewed. Electrocardiographic data before and after the procedure were collected and analyzed. We first evaluated the potential risk factors including gender, age, weight, inlet and outlet diameters of defect, subaortic rim length, occluder size, corrected occluder size into body surface area, fluoroscopy time, presence of aneurysm, and deployment position. We compared the potential risk factors between arrhythmia and nonarrhythmia groups using univariate analysis, followed by logistic analysis for independent risk factors. RESULTS Various arrhythmias were detected in 95 cases (24.1%) following transcatheter closure procedure. Logistic regression analysis revealed that eccentric (odds ratio [OR] 2.9, 95% confidence interval [CI]: 1.2-7.2) and large occluders (OR 2.0, 95% CI: 1.6-2.5), as well as long fluoroscopy time (OR 1.1, 95% CI: 1.1-1.2), were correlated with postprocedural arrhythmia. During 35.5 months (range: 9-80 months) of follow-up, most of the patients (74 out of 95) reverted to normal heart rhythm. CONCLUSIONS The mid-term outcome of patients with arrhythmias after transcatheter closure of pmVSD was satisfactory as most of the patients recovered normal rhythm. Eccentric, large device and long fluoroscopy time increase the risk of arrhythmias after transcatheter closure of pmVSD.
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Affiliation(s)
- Li-Jian Zhao
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Bo Han
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Jian-Jun Zhang
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Ying-Chun Yi
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Dian-Dong Jiang
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Jian-Li Lyu
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
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Havakuk O, Konigstein M, Ben Assa E, Arbel Y, Abramowitz Y, Halkin A, Bazan S, Shmilovich H, Keren G, Finkelstein A, Banai S. Steroid therapy and conduction disturbances after transcatheter aortic valve implantation. Cardiovasc Ther 2016; 34:325-9. [DOI: 10.1111/1755-5922.12202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Ofer Havakuk
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Maayan Konigstein
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Eyal Ben Assa
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Yaron Arbel
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Yigal Abramowitz
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Amir Halkin
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Samuel Bazan
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Haim Shmilovich
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Gad Keren
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Ariel Finkelstein
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Shmuel Banai
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
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Marshall AM. A Review of Surgical Atrioventricular Block with Emphasis in Patients with Single Ventricle Physiology. CONGENIT HEART DIS 2016; 11:462-467. [PMID: 27139742 DOI: 10.1111/chd.12372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2016] [Indexed: 11/30/2022]
Abstract
We perceived an increased incidence of surgical atrioventricular (AV) block in patients with single ventricle physiology undergoing two ventricle rehabilitation for hypoplastic left heart syndrome compared to the overall incidence of surgical AV block for our institution. Retrospective investigation of our center's data revealed a statistically significant increase in the incidence of surgical AV block in the single ventricle population and two ventricle rehabilitation population compared to the two ventricle population. Here we review the literature with respect to historic definitions, incidence, risk factors, pre- and post-op management, current indications for pacemaker placement and added cost and comorbidity associated with surgical AV block. We then offer possible strategies for decreasing the incidence of surgical AV block within both the single and two ventricle populations.
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Affiliation(s)
- Amanda M Marshall
- Pediatric Cardiology, Children's Hospital & Medical Center, University of Nebraska Medical Center/Children's Hospital & Medical Center, Omaha, Neb, USA.
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13
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Ghaderian M, Merajie M, Mortezaeian H, Aarabi M, Mohammad Y, Shah Mohammadi A. Efficacy and Safety of Using Amplatzer Ductal Occluder for Transcatheter Closure of Perimembranous Ventricular Septal Defect in Pediatrics. IRANIAN JOURNAL OF PEDIATRICS 2015. [PMID: 26196005 PMCID: PMC4506009 DOI: 10.5812/ijp.386] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Perimembranous Ventricular Septal Defect (PMVSD) is the most common subtype of ventricular septal defects. Transcatheter closure of PMVSD is a challenging procedure in management of moderate or large defects. Objectives: The purpose of this study was to show that transcatheter closure of perimembranous ventricular septal defect with Amplatzer Ductal Occluder (ADO) is an effective and safe method. Patients and Methods: Between April 2012 and April 2013, 28 patients underwent percutaneous closure of PMVSD using ADO. After obtaining the size of VSD from the ventriculogram a device at least 2 mm larger than the narrowest diameter of VSD at right ventricular side was chosen. The device deployed after confirmation of its good position by echocardiography and left ventriculography. Follow up evaluations were done 1 month, 6 months, 12 months and yearly after discharge with transthoracic echocardiography and 12 lead electrocardiography. Results: The mean age of patients at procedure was 4.7 ± 6.3 (range 2 to 14) years, mean weight 14.7 ± 10.5 (range 10 to 40) kg. The mean defect size of the right ventricular side was 4.5 ± 1.6 mm. The average device size used was 7.3 ± 3.2mm (range 4 to 12 mm). The ADOs were successfully implanted in all patients. The VSD occlusion rate was 65.7% at completion of the procedure, rising up to 79.5% at discharge and 96.4% during follow-up. Small residual shunts were seen at completion of the procedure, but they disappeared during follow-up in all but one patient. The mean follow-up period was 8.3 ± 3.6 months (range 1 to 18 months). Complete atrioventricular block (CAVB), major complication or death was not observed in our study. Conclusions: Transcatheter closure of PMVSD with ADO in children is a safe and effective treatment associated with excellent success and closure rates, but long-term follow-up in a large number of patients would be warranted.
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Affiliation(s)
- Mehdi Ghaderian
- Department of Pediatric Cardiology, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
- Corresponding author: Mehdi Ghaderian, Department of Pediatric Cardiology, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran. E-mail:
| | - Mahmood Merajie
- Pediatric Cardiology Department, Shaheed Rajaiee Cardiovascular Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hodjjat Mortezaeian
- Pediatric Cardiology Department, Shaheed Rajaiee Cardiovascular Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Moghadam Aarabi
- Pediatric Cardiology Department, Shaheed Rajaiee Cardiovascular Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Yoosef Mohammad
- Pediatric Cardiology Department, Shaheed Rajaiee Cardiovascular Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Akbar Shah Mohammadi
- Pediatric Cardiology Department, Shaheed Rajaiee Cardiovascular Research Center, Iran University of Medical Sciences, Tehran, IR Iran
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14
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Surgical treatment for patients with complete atrioventricular block after device closure of perimembranous ventricular septal defects. J Thorac Cardiovasc Surg 2015; 149:530-1. [DOI: 10.1016/j.jtcvs.2014.09.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/15/2014] [Accepted: 09/21/2014] [Indexed: 11/19/2022]
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15
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Mah DY, Porras D, Bergersen L, Marshall AC, Walsh EP, Triedman JK. Incidence of and risk factors for catheterization-induced complete heart block in the pediatric cardiac catheterization laboratory. Circ Arrhythm Electrophysiol 2014; 7:127-33. [PMID: 24382412 DOI: 10.1161/circep.113.000731] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The majority of the literature on catheterization-induced heart block (CIHB) was published >30 years ago. The field of cardiac catheterization has evolved, performing more interventional compared with diagnostic cases. We sought to determine the incidence and risk factors of CIHB. METHODS AND RESULTS A catheterization database that records the occurrence of adverse events on all cases was queried for heart block. Additional retrospective data on event outcome were collected on patients who developed CIHB. Multivariable logistic regression modeling was used to identify risk factors of CIHB (odds ratio, 95% confidence interval). In a 6-year period, 6183 cases were performed. The median weight was 15.0 (7.0-47.0) kg, with 29% consisting of infants <1 year. A total of 72% involved complex congenital heart disease. One hundred thirty-five cases were complicated by CIHB (2.2%; 95% confidence interval, 1.9-2.6). Age <1 year (3.0; 2.2-4.3) and case duration ≥2 hours (3.4; 2.0-6.0) were risk factors of CIHB; cardiac anatomy and intervention performed were not. A total of 96% of CIHB recovered within 1 week but 6 patients underwent pacemaker placement (3 L-loop ventricles, 2 intracardiac devices, 1 double inlet-double outlet RV). Of these, 50% recovered atrioventricular nodal conduction within 1 month; 2 patients with L-loop ventricles and 1 patient with a left ventricular-to-right atrial device did not recover. CONCLUSIONS The incidence of CIHB in the pediatric cardiac catheterization laboratory is low at 2.2%. Risk factors include young age and long case duration. The recovery of atrioventricular nodal function after CIHB is high and follows a similar time course to that of postsurgical heart block.
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Affiliation(s)
- Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, MA; and Department of Pediatrics, Harvard Medical School, Boston, MA
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Lee SM, Song JY, Choi JY, Lee SY, Paik JS, Chang SI, Shim WS, Kim SH. Transcatheter closure of perimembranous ventricular septal defect using Amplatzer ductal occluder. Catheter Cardiovasc Interv 2013; 82:1141-6. [PMID: 23554093 DOI: 10.1002/ccd.24810] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 01/02/2013] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To show that transcatheter closure of perimembranous ventricular septal defect (PMVSD) with the Amplatzer ductal occluder (ADO, AGA Medical Corp, Plymouth, Minnesota) is a safe and effective treatment option. BACKGROUND Transcatheter closure of PMVSD is a challenging procedure. Recently, the Amplatzer PMVSD occluder (APMVSDO, AGA Medical Corp, Plymouth, Minnesota) has been shown to be effective in closing hemodynamically significant PMVSDs. However, the high incidence of complete atrioventricular block (CAVB) after device occlusion of a PMVSD has been a hot issue as well. METHODS Among several devices used in closing PMVSD percutaneously, we prefer the ADO because of the anatomic resemblance between PMVSD with aneurysm and patent ductus arteriosus, and it has no right ventricular disc which may contribute to the occurrence of CAVB. RESULTS Between August 2009 and May 2012, 21 patients (5 males and 16 females) underwent percutaneous PMVSD closure using ADO. The patients' ages ranged from 3 to 42 years (median: 7 years), and their weights ranged from 18 kg to 60 kg (median: 27 kg). All patients showed echocardiographic signs of left ventricular volume overload and trivial to small mitral regurgitation (Qp/Qs = 1.7 ± 0.4). The mean defect size of the right ventricular side was 4.3 ± 1.0 mm. Devices 2 mm larger than the measured narrowest VSD diameter were selected in most patients. The ADOs were successfully implanted in all patients without any significant complications except one transient CAVB, one case of delivery wire fracture, and one case of surgery due to significant residual leak. Small residual shunts were observed immediately after the device implantation, but they disappeared during follow-up for 18 of 20 patients. The mean follow-up period was 20 ± 9 months, and CAVB or aortic regurgitation was not observed in all patients. CONCLUSION Transcatheter closure of PMVSD with the ADO is a safe and promising treatment option, but long-term follow-up in a large number of patients would be warranted.
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Affiliation(s)
- Sang Mi Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Butera G, Piazza L, Saracino A, Chessa M, Carminati M. Transcatheter Closure of Membranous Ventricular Septal Defects-Old Problems and New Solutions. Interv Cardiol Clin 2013; 2:85-91. [PMID: 28581989 DOI: 10.1016/j.iccl.2012.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Isolated perimembranous ventricular septal defect (VSD) is the most common congenital heart defect (after bicuspid aortic valve). Surgery is considered the gold standard for the treatment of these VSDs. However, it is associated with morbidity and mortality. Less invasive techniques have been developed, and percutaneous closure of perimembranous VSDs is now considered a possible alternative to the standard surgical approach. The main problem associated with transcatheter closure of VSD is the occurrence of complete atrioventricular block and need for pacemaker implantation. Improvements in technology and design will help to reduce the occurrence of this problem in the near future.
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Affiliation(s)
- Gianfranco Butera
- Pediatric Cardiology and GUCH Unit, Policlinico San Donato IRCCS, Via Morandi 30, San Donato Milanese 20097, Italy.
| | - Luciane Piazza
- Pediatric Cardiology and GUCH Unit, Policlinico San Donato IRCCS, Via Morandi 30, San Donato Milanese 20097, Italy
| | - Antonio Saracino
- Pediatric Cardiology and GUCH Unit, Policlinico San Donato IRCCS, Via Morandi 30, San Donato Milanese 20097, Italy
| | - Massimo Chessa
- Pediatric Cardiology and GUCH Unit, Policlinico San Donato IRCCS, Via Morandi 30, San Donato Milanese 20097, Italy
| | - Mario Carminati
- Pediatric Cardiology and GUCH Unit, Policlinico San Donato IRCCS, Via Morandi 30, San Donato Milanese 20097, Italy
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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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Results of transcatheter closure of perimembranous ventricular septal defect. Am J Cardiol 2010; 106:1034-7. [PMID: 20854970 DOI: 10.1016/j.amjcard.2010.05.040] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Revised: 05/14/2010] [Accepted: 05/14/2010] [Indexed: 11/22/2022]
Abstract
This study reports the midterm results and experience of a single center of transcatheter closure of perimembranous ventricular septal defect (VSD) with Amplatzer membranous VSD occluders. Data of 301 patients who underwent attempted transcatheter closure were collected prospectively from May 2002 to December 2008. Patients' mean age was 9.8 years, and their mean weight was 32 kg. The procedure was successful in 294 patients (97.6%). No death occurred. Complications included aortic regurgitation in 11 patients (3.7%, 2 requiring occluder retrieving), tricuspid regurgitation in 16 patients (5.4%), hemolysis in 2 patients (0.7%), and complete atrioventricular block (cAVB) in 17 patients (15 early cAVBs, 3 late cAVBs, 1 patient had early and late cAVBs). Among the 15 early cAVBs, 12 were transient and 3 were considered prolonged cAVBs (persisted >2 weeks). The 3 patients underwent surgery (1.0%) and obtained stable sinus rhythm. Pacemaker implantation was needed in all 3 patients with late cAVB (1.0%). Univariate analysis showed that risk factors were age (p = 0.01) and weight (p = 0.021). No risk factors were found in multivariate analysis. In conclusion, midterm results of transcatheter closure of perimembranous VSD showed high closure rate and limited complications. The major concern is the occurrence of cAVB. Long-term investigation is needed to assess the efficacy and safety compared to surgery.
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