open access

Vol 66, No 7 (2008)
Other
Published online: 2008-07-23
Submitted: 2012-12-28
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Oryginal article
Percutaneous closure of post-traumatic and congenital muscular ventricular septal defects with the Amplatzer Muscular VSD Occluder

Małgorzata Szkutnik, Jacek Kusa, Jacek Białkowski
Kardiol Pol 2008;66(7):715-720.

open access

Vol 66, No 7 (2008)
Other
Published online: 2008-07-23
Submitted: 2012-12-28

Abstract

Background: Muscular ventricular septal defects (VSD) are an important and difficult surgical problem. In the last few years a new alternative has emerged – possibility of VSD closure using percutaneous approach. Aim: To present our experience in percutaneous closure of congenital muscular and one posttraumatic VSD. Methods: We treated 10 patients – 7 children (age 0.8-7 years) and 2 adults (43 and 46 years) with congenital VSD, and one 18-year-old patient with posttraumatic VSD (knife stab). All the patients had a large haemodynamic shunt (Qp:Qs 1.9) and in all cases percutaneous closure attempt with an Amplatzer Muscular VSD Occluder (MVSDO) implant was undertaken. Five of 6 children with multiple muscular VSDs had in infancy previous pulmonary artery banding and one patient had complex heart disease: transposition of great arteries (dTGA), pulmonary stenosis (PS) and perimembranous VSD. All procedures were performed using the standard technique. Results: Eleven procedures were performed in 10 patients (one child had 2 attempts). Seven procedures were successful. In all cases a considerable reduction in flow or complete closure was achived. In one case, despite multiple attempts, VSD caniulation was ineffective and the procedure was abandoned. The patient had oblique VSD – morphology confirmed was later by the operating surgeon. The reason for the other 3 failures was early embolisation to the left ventricle and aorta. This complication was noted in 2 adult patients – one with congenital and one with post-traumatic VSD. In both cases the interventricular septum was thick (10 and 11 mm) and implants were removed with a bioptome or vascular lasso. Another embolisation occurred in a child with TGA – in this case the cardiac surgeon removed the implant from the aortic arch during Rastelli operation. Conclusion: Our experience acquired during muscular VSD closure with MVSDO indicates that the method is useful in children with isolated defects. Adult patients and children with a complex form of congenital defects should have morphology of MVSDO carefully evaluated and width of the interventricular septum measured to avoid potential implant embolisation.

Abstract

Background: Muscular ventricular septal defects (VSD) are an important and difficult surgical problem. In the last few years a new alternative has emerged – possibility of VSD closure using percutaneous approach. Aim: To present our experience in percutaneous closure of congenital muscular and one posttraumatic VSD. Methods: We treated 10 patients – 7 children (age 0.8-7 years) and 2 adults (43 and 46 years) with congenital VSD, and one 18-year-old patient with posttraumatic VSD (knife stab). All the patients had a large haemodynamic shunt (Qp:Qs 1.9) and in all cases percutaneous closure attempt with an Amplatzer Muscular VSD Occluder (MVSDO) implant was undertaken. Five of 6 children with multiple muscular VSDs had in infancy previous pulmonary artery banding and one patient had complex heart disease: transposition of great arteries (dTGA), pulmonary stenosis (PS) and perimembranous VSD. All procedures were performed using the standard technique. Results: Eleven procedures were performed in 10 patients (one child had 2 attempts). Seven procedures were successful. In all cases a considerable reduction in flow or complete closure was achived. In one case, despite multiple attempts, VSD caniulation was ineffective and the procedure was abandoned. The patient had oblique VSD – morphology confirmed was later by the operating surgeon. The reason for the other 3 failures was early embolisation to the left ventricle and aorta. This complication was noted in 2 adult patients – one with congenital and one with post-traumatic VSD. In both cases the interventricular septum was thick (10 and 11 mm) and implants were removed with a bioptome or vascular lasso. Another embolisation occurred in a child with TGA – in this case the cardiac surgeon removed the implant from the aortic arch during Rastelli operation. Conclusion: Our experience acquired during muscular VSD closure with MVSDO indicates that the method is useful in children with isolated defects. Adult patients and children with a complex form of congenital defects should have morphology of MVSDO carefully evaluated and width of the interventricular septum measured to avoid potential implant embolisation.
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Keywords

muscular septal defects; interventional cardiology

About this article
Title

Oryginal article
Percutaneous closure of post-traumatic and congenital muscular ventricular septal defects with the Amplatzer Muscular VSD Occluder

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 66, No 7 (2008)

Pages

715-720

Published online

2008-07-23

Bibliographic record

Kardiol Pol 2008;66(7):715-720.

Keywords

muscular septal defects
interventional cardiology

Authors

Małgorzata Szkutnik
Jacek Kusa
Jacek Białkowski

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