scholarly journals Midterm Results of Transaxillary Occluder Device Closure of Perimembranous Ventricular Septal Defect Guided Solely by Transesophageal Echocardiography

2019 ◽  
Vol 22 (2) ◽  
pp. E112-E118
Author(s):  
Weijie Liang ◽  
Sijie Zhou ◽  
Taibin Fan ◽  
Shub Song ◽  
Bin Li ◽  
...  
Keyword(s):  
Adverse Events ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Device Closure ◽  
Bundle Branch Block ◽  
Surgical Closure ◽  
Perimembranous Ventricular Septal Defect ◽  
Occluder Device ◽  
The Mean

Background: Perimembranous ventricular septal defect (pmVSD) is a common congenital heart disease. Transaxillary occluder device closure of the pmVSD has been proved effective and an alternative to surgical closure. The study aimed to evaluate the immediate operation outcomes and the early and midterm follow-up outcomes of transaxillary occluder device closure. Methods: From January 2014 to December 2017, we retrospectively analyzed the patients who underwent transaxillary device closure of the pmVSD. All patients underwent transthoracic echocardiography (TTE), chest x-ray, and electrocardiogram (ECG) before and after the procedure (before discharging). Follow-up evaluation was completed at the time of 3, 6, 12 months and yearly thereafter in outpatient setting with TTE and ECG. Results: A total of 428 patients (216 male, 212 female) underwent transaxillary occluder device closure of the pmVSD under the guidance of transesophageal echocardiography (TEE). The mean age at the operation time was 2.2 ± 1.5 year (range 0.5-16.2 year). The mean weight was 8.5 ± 4.1 kg (range 6-61 kg). The mean size of the occluder implanted in the operation was 5.3 ± 1.4 (range 4-8 mm), matching the mean defect size of 4.2 ± 1.1 (range 3-6 mm). The device closure operation was successfully achieved in 422 pmVSD patients (98.6%), and 6 patients failed in occluding and were converted to open surgery because of a great residual shunt and obvious device-related aortic regurgitation . Immediate complete closure was detected by postoperative TEE in all, but 3 patients had trivial residual shunting. Total early adverse events emerged in 47 patients (11.1%). New mild tricuspid and aortic regurgitation occurred in 17 and 3 patients and disappeared in follow-up. Abnormal atrioventricular conduction events emerged in 23 patients, including left anterior block, complete right bundle branch block (CRBBB), incomplete right bundle branch block (IRBBB), administrated with close follow-up. Pericardial effusion occurred in 2 other patients, managed with puncture drainage. During a median follow-up period of 26.8 months (range 6-48 months), no serious adverse event and later-on complete atrioventricular block were encountered. Conclusion: In our experience, transaxillary device closure was performed via right infra-axillary mini-incision (invisible) guided by TEE, with low incidence of postoperative adverse events, confirming that transaxillary device closure of the pmVSD under the guidance of TEE is an effective alternative to surgical closure in well-selected pmVSD patients.

Complete atrio-ventricular heart block, a not to be forgotten complication in transcatheter closure of perimembranous ventricular septal defect – a case report and review of literature

2021 ◽  
pp. 1-4
Author(s):  
Ming Chern Leong ◽  
Mazeni Alwi
Keyword(s):  
Ventricular Septal Defect ◽  
Heart Block ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Review Of Literature ◽  
Device Closure ◽  
Bundle Branch Block ◽  
Know How ◽  
Perimembranous Ventricular Septal Defect ◽  
New Onset

Abstract Device occlusion of perimembranous ventricular septal defect is gaining popularity with the emergence of newer, softer occluders and improved technical know-how. We report a 26-year-old lady with a moderate size perimembranous ventricular septal defect who had a new onset of bundle branch block shortly after device closure. The patient subsequently developed a complete atrio-ventricular heart block.

scholarly journals The Short and Midterm Follow-Up of Transthoracic Device Closure of Perimembranous Ventricular Septal Defect in Adults

2018 ◽  
Vol 21 (4) ◽  
pp. E242-E246 ◽  
Author(s):  
Ze-wei Lin ◽  
Qiang Chen ◽  
Hua Cao ◽  
Gui-can Zhang ◽  
Liang-wan Chen ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Cardiac Function ◽  
Septal Defect ◽  
Clinical Status ◽  
Perioperative Period ◽  
Device Closure ◽  
Total Occlusion ◽  
Perimembranous Ventricular Septal Defect ◽  
Malignant Arrhythmia

Background: The purpose of this study was to assess the short- and mid-term follow-up results of transthoracic device closure of perimembranous ventricular septal defect (pmVSD) in adults.Methods: Sixty-one adults underwent transthoracic device closure of pmVSD at our institution from Jan. 2012 to Jan. 2016. All relevant clinical data were recorded and analyzed. All patients were invited to undergo contrast transthoracic echocardiography (TTE) for 12 months to 60 months after VSD closure. Phone interviews were conducted to further evaluate the cardiac function status.Results: All patients were successfully occluded using this procedure. The most frequent complication was transient cardiac arrhythmia, which was easily treated during the perioperative period. During the follow-up period, we found no recurrence, malignant arrhythmia, thrombosis, device embolization, valve damage, device failure, or cases of death. The total occlusion rate was 100 percent in the 12 months of follow-up, and most of patients showed significant improvement in their clinical status. From the TTE data, the intracardiac structure and cardiac function were improved in the follow-up.Conclusion: Transthoracic device closure of perimembranous ventricular septal defect in adults is a safe and feasible technique. The short- and mid-term follow-up results were satisfactory, but long-term follow-up is required to better assess the safety and feasibility of this method in adults.

scholarly journals A Novel Approach for Transcatheter Management of Perimembranous Ventricular Septal Defect with a Subaortic Ridge

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Hussein A. Wahab ◽  
Hussein A. Alsalkhi ◽  
Khalid A. Khalid ◽  
Ahmmed F. Abusuda
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Interventricular Septum ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Type I ◽  
Female Ratio ◽  
Surgical Closure ◽  
Perimembranous Ventricular Septal Defect ◽  
The Mean

Introduction. Surgical closure of the perimembranous ventricular septal defect (PM VSD) and resection of the subaortic ridge are the standard methods of management, but there is no definitive agreement regarding the timing of surgery. Objectives. To evaluate the safety and efficacy of the management of patients with PM VSD and subaortic ridge with or without AR via transcatheter closure of the defect and compressing the ridge against the ventricular septum using Amplatzer ductal occluder type I (ADO-I). Patients and Methods. We introduced a new approach for transcatheter management of PM VSD and subaortic ridge by closing the VSD and capturing or compressing the ridge against the interventricular septum (IVS) using the ADO-I device. Thirty-eight (9.5%) of 398 patients with a PM VSD were found to have subaortic ridge and were enrolled in this study from August 1, 2014, to February 1, 2018, at the Ibn Albitar Center for Cardiac Surgery, Baghdad, Iraq. Results. The ages and weights of patients ranged from 1.5 to 25 years and 7 to 73 kg, respectively. The male-to-female ratio was 2.2 : 1. The VSD sizes ranged from 4 to 8 mm, and the median distance of the ridge from the proximal edge of the VSD was 2.5 mm. Prior to closure, 13 patients (34.2%) had mild and mild-to-moderate aortic regurgitation (AR), and nine patients (23.7%) had mild-to-moderate left ventricular outflow tract (LVOT) obstruction. The mean AR pressure half-time increased significantly after intervention (from 385 ± 38 ms to 535 ± 69 ms (significant P value, 0.001)), and the mean of the peak pressure gradient across the LVOT decreased from 33 ± 7 mmHg to 15 ± 2.4 mmHg (significant P value, 0.001). Successful procedures were achieved in 33 patients (86.8%). Conclusion. Transcatheter management of patients with PM VSD and subaortic ridges with or without AR is feasible and effective.

scholarly journals Device closure of ventricular septal defect: Initial experience in Nepal

2019 ◽  
Vol 10 (4) ◽  
pp. 23-27
Author(s):  
Chandra Mani Adhikari ◽  
Manish Shrestha ◽  
Subash Chandra Shah ◽  
Amrit Bogati ◽  
Sachin Dhungel ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Attractive Alternative ◽  
Amplatzer Duct Occluder ◽  
Device Closure ◽  
Bundle Branch Block ◽  
Junctional Rhythm ◽  
Catheterization Laboratory ◽  
The Mean ◽  
Muscular Vsd

Background: Device closure is an attractive alternative in the management of Ventricular Septal defect (VSD). Aims and Objective: The aim of the study was to access the safety and early outcome of VSD device closure at Shahid Gangalal National Heart Centre, Nepal. Materials and Methods: The study was single center, retrospective study. All the VSD cases who were attempted for VSD device closure during December 2016 to February 2019 were included. Catheterization laboratory records for VSD type and size, Device type and size were retrospectively reviewed. Hospital records were reviewed for in-hospital complications.    Results: Sixty-one VSD cases were attempted for device closure. VSD was successfully closed in 55 (90.1%) patients. The mean age of the patient was 11.1 years. Twenty-nine (52.7%) were female and 26 (47.3%) were male. Perimembranous VSD in 49 (89 %) and muscular VSD in 6 (11 %) patients. The size of VSD ranged between 2 and 12mm (Mean 5.4mm). The VSD was closed with Amplatzer duct occluder I, Amplatzer duct occluder II, Amplatzer muscular VSD occluder and Memopart PDA device in 24 (43.7%), 26 (47.3%), 4 (7.2 %) and one patient (1.8%) patients respectively. The postoperative complications were insignicant residual leak across device in 2 (3.6%) patients, mild pericardial effusion in one (1.8%) patient. None of the patient had new onset tricuspid regurgitation, aortic regurgitation and complete heart block. One patient developed Right bundle branch block, one developed Left bundle branch block, one developed Junctional rhythm. There was no mortality. Conclusion: VSD device closure can be safe and effective if patients are selected properly.

scholarly journals Unusual Hybrid Closure of Ventricular Septal Defects

2018 ◽  
Vol 11 (4) ◽  
pp. NP158-NP160
Author(s):  
Thomas Krasemann ◽  
Ingrid van Beynum ◽  
Pieter van de Woestijne
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Open Heart ◽  
Ventricular Septal Defects ◽  
Device Closure ◽  
Surgical Closure ◽  
Septal Defects ◽  
Perimembranous Ventricular Septal Defect ◽  
Patch Closure ◽  
Technical Fault

A planned combined perventricular and “open heart” surgical closure of multiple ventricular septal defects had to be modified intraoperatively due to a technical fault disabling echocardiographic guidance. Through an atriotomy, device closure of a muscular defect and patch closure of a perimembranous ventricular septal defect were performed. In unusual situations, collaboration of the surgical and interventional team is crucial.

scholarly journals Device Closure of Perimembranous Ventricular Septal Defect Under Deep Sedation and Transthoracic Echo Guide: A Case Report

1970 ◽  
Vol 3 (1) ◽  
pp. 89-91
Author(s):  
NN Fatema ◽  
H Rashid ◽  
AK Azad
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Deep Sedation ◽  
Military Hospital ◽  
Device Closure ◽  
Colour Doppler ◽  
Catheterization Laboratory ◽  
Perimembranous Ventricular Septal Defect ◽  
Amplatzer Device

T, an eight years old girl was diagnosed as a case of perimembranous Ventricular Septal Defect (VSD) since 6 months of her age. She had recurrent chest infection since early infancy. Her Echocardiography with colour Doppler showed a 4.5 mm perimembranous VSD which was 5 mm away from the aortic valve. As pulmonary artery pressure was normal, she was kept under follow up and device closure was planned. At last she was taken into the catheterization laboratory of combined military Hospital, Dhaka on 1st July 2008 and VSD was closed with an 8 mm Amplatzer perimembranous VSD device. Whole procedure was done under deep sedation with Ketamine and transthoracic echocardiography (TTE) and fluroscopy guide. It is the first ever case of VSD device closure where procedure was done under sedation and TTE guide which lead to the writing of this report.Keywords: VSD; Transthoracic Echo; Amplatzer Device. DOI: 10.3329/cardio.v3i1.6432Cardiovasc. j. 2010; 3(1): 89-91

Transcatheter device closure of perimembranous ventricular septal defect in children treated with prophylactic oral steroids: acute and mid-term results of a single-centre, prospective, observational study

2015 ◽  
Vol 26 (4) ◽  
pp. 669-676 ◽  
Author(s):  
Bhavesh Thakkar ◽  
Nehal Patel ◽  
Shomu Bohora ◽  
Dharmin Bhalodiya ◽  
Tarandeep Singh ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Heart Block ◽  
Septal Defect ◽  
Device Closure ◽  
Conduction Disturbances ◽  
Perimembranous Ventricular Septal Defect ◽  
Post Procedure ◽  
Oral Steroids ◽  
Transcatheter Device

AbstractBackground and ObjectiveAlthough transcatheter closure of perimembranous ventricular septal defect is emerging as an accepted, viable alternative, conduction disturbances still remain a major concern. Although steroid treatment has shown encouraging results with complete recovery, efficacy of prophylactic use of steroids is still speculative. We aim to study the mid-term outcome of perimembranous ventricular septal defect closure in children who received prophylactic oral steroids.Materials and methodsA prospective study was designed and antegrade device closure was attempted in eligible children who met the following inclusion criteria: age 3–18 years and weight >10 kg, defect diameter ⩽12 mm, and symptomatic, haemodynamic changes or history of infective endocarditis. Prophylactic steroid protocol consisted of 2 weeks oral prednisolone (1 mg/kg/day) initiated immediately after the procedure, and in the event of bradyarrhythmia it was escalated to 2 mg/kg. Patients were regularly followed-up at 1, 6, and 12 months and then annually. Patients with post-procedure heart block underwent Holter monitoring after a minimum of 1 year interval.ResultsBetween May, 2007 and August, 2012, successful device closure was accomplished in 290/297 patients. Mean age and weight were 9±3.12 years and 21±8.27 kg, respectively. The defect measured 5±1.38 mm on echocardiography. Mean fluoroscopy time was 12.98±8.64 minutes. Eight patients with major complications included one each with device embolisation, haemolysis, severe aortic regurgitation, and five with bradyarrhythmias, including complete atrioventricular block in three, Mobitz II in one, and bifascicular block in one. Patients with complete atrioventricular block responded to high-dose steroid and temporary pacemaker. Minor complications included post-procedure heart block (n=22) and blood loss (n=2). At 18.23±13.15 months follow-up, 8/27 (five major, 22 minor) with arrhythmia had persistent post-procedure heart block of no clinical consequences.ConclusionIn our patient population, transcatheter device closure of the perimembranous ventricular septal defect with prophylactic oral steroid resulted in excellent closure rate and acceptably low incidence of conduction disturbances at mid-term follow-up.

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