open access

Vol 66, No 9 (2008)
Other
Published online: 2008-09-30
Submitted: 2012-12-28
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Original article
Percutaneous closure of perimembranous ventricular septal defects with Amplatzer occluders – a single centre experience

Małgorzata Szkutnik, Jacek Kusa, Jacek Białkowski
Kardiol Pol 2008;66(9):941-947.

open access

Vol 66, No 9 (2008)
Other
Published online: 2008-09-30
Submitted: 2012-12-28

Abstract


Background: Perimembranous ventricular septal defect (VSD) is the most common congenital heart defect. Percutaneous transcatheter closure of VSD is one of the greatest challenges in interventional cardiology. Aim: Presentation of our experience in transcatheter closure of perimembranous VSD.
Methods: Eighteen patients were treated. Nine patients (group I) had VSD closed with implant Amplatzer Perimembranous VSD Occluder (PMVSDO) whereas the other nine had VSD closed with Muscular VSD Occluder (MVSDO). In the second group the presence of at least 4 mm rim from aortic valve was mandatory to undergo the procedure. Average patients age was 17.1 (3.2-40) years, defect diameter – 4.7 (4-8) mm and Qp/Qs ratio – 1.84 (1.5-4.6). Perimembranous interventricular septum aneurysm was noted in 5 cases. Only patients who had hemodynamically important defect (Qp/Qs ratio >1.5) were selected for interventional VSD closure. Patients with subarterial VSDs, pulmonary hypertension or/and aortic regurgitation were excluded. Ventricular septal defect closure was performed with standard techniques.
Results: Procedures were completed successfully in 16 of 18 patients. There was no early or late implant embolisation. After the procedure in every case complete closure or important reduction of the shunt was observed. In the group I there was a trend towards more frequent occurrence of rhythm disturbances (p=0,08), including two cases with severe arrhythmias occurring during VSD closure requiring abandoning of procedure. In other 2 cases (patients age 12 and 14 years) in the second week after PMVSDO placement complete atrio-ventricular block occurred. In one patient sinus rhythm was restored after steroid treatment whereas another patient required pacemaker implantation. In group II mild nonprogressive tricuspid regurgitation was noted in 3 patients.
Conclusions: Percutaneous perimembranous VSD closure is an interesting alternative to surgical treatment. In selected cases closure of the defect with muscular VSD implant is effective and safe.

Abstract


Background: Perimembranous ventricular septal defect (VSD) is the most common congenital heart defect. Percutaneous transcatheter closure of VSD is one of the greatest challenges in interventional cardiology. Aim: Presentation of our experience in transcatheter closure of perimembranous VSD.
Methods: Eighteen patients were treated. Nine patients (group I) had VSD closed with implant Amplatzer Perimembranous VSD Occluder (PMVSDO) whereas the other nine had VSD closed with Muscular VSD Occluder (MVSDO). In the second group the presence of at least 4 mm rim from aortic valve was mandatory to undergo the procedure. Average patients age was 17.1 (3.2-40) years, defect diameter – 4.7 (4-8) mm and Qp/Qs ratio – 1.84 (1.5-4.6). Perimembranous interventricular septum aneurysm was noted in 5 cases. Only patients who had hemodynamically important defect (Qp/Qs ratio >1.5) were selected for interventional VSD closure. Patients with subarterial VSDs, pulmonary hypertension or/and aortic regurgitation were excluded. Ventricular septal defect closure was performed with standard techniques.
Results: Procedures were completed successfully in 16 of 18 patients. There was no early or late implant embolisation. After the procedure in every case complete closure or important reduction of the shunt was observed. In the group I there was a trend towards more frequent occurrence of rhythm disturbances (p=0,08), including two cases with severe arrhythmias occurring during VSD closure requiring abandoning of procedure. In other 2 cases (patients age 12 and 14 years) in the second week after PMVSDO placement complete atrio-ventricular block occurred. In one patient sinus rhythm was restored after steroid treatment whereas another patient required pacemaker implantation. In group II mild nonprogressive tricuspid regurgitation was noted in 3 patients.
Conclusions: Percutaneous perimembranous VSD closure is an interesting alternative to surgical treatment. In selected cases closure of the defect with muscular VSD implant is effective and safe.
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Keywords

perimembranous ventricular septal defects; transcatheter closure; interventional cardiology

About this article
Title

Original article
Percutaneous closure of perimembranous ventricular septal defects with Amplatzer occluders – a single centre experience

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 66, No 9 (2008)

Pages

941-947

Published online

2008-09-30

Bibliographic record

Kardiol Pol 2008;66(9):941-947.

Keywords

perimembranous ventricular septal defects
transcatheter closure
interventional cardiology

Authors

Małgorzata Szkutnik
Jacek Kusa
Jacek Białkowski

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