Congenital heart disease
Results of Transcatheter Closure of Perimembranous Ventricular Septal Defect

https://doi.org/10.1016/j.amjcard.2010.05.040Get rights and content

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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Methods

Data of patients who underwent transcatheter closure of a perimembranous VSD were collected from May 2002 to December 2008. General characteristics are presented in Table 1. Inclusion criteria of patients were (1) weight ≥8 kg, (2) isolated defects between the 9 and 11 o'clock positions of an analog clock in short-axis view, (3) maximum diameter ≤16 mm by transthoracic echocardiography (TTE), (4) left to right shunt, and (5) pulmonary pressure <70 mm Hg by TTE. Exclusion criteria were (1)

Results

Procedure data and device used are presented in Table 1. In all 301 patients with inclusion criteria, 294 had successful closure (97.6%). VSDs in 7 patients failed to close (Table 2). Reasons for the 7 failures included cAVB in 2 patients (1 during repeated maneuver of catheter, 1 after release of occluder), significant aortic regurgitation in 2 patients (subaortic rim <1 mm by ventriculography, the device impinged on the aortic valve), and instable position of the device in 3 patients (the

Discussion

This series reports a large single-center experience in transcatheter closure of perimembranous VSD. Our study showed encouraging midterm results: the procedure was performed successfully in 294 patients (97.6%), confirming preliminary published studies.2, 3, 4, 5, 6, 7 All patients achieved complete closure 3 months after the procedure. There were no deaths, device embolization, or pericardial tamponade. The most serious complication was occurrence of cAVB. The occurrence rate was 5.8% in our

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Drs. Zuo and Xie contributed equally to this work.

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