scholarly journals Transcatheter closure of perimembranous and muscular ventricular septal defects: short and medium-term outcome

2020 ◽  
Author(s):  
Anh Binh Ho
Keyword(s):  
Success Rate ◽  
Transcatheter Closure ◽  
Central Hospital ◽  
Ventricular Septal Defects ◽  
Medium Term ◽  
Term Outcome ◽  
Surgical Closure ◽  
Septal Defects ◽  
First Choice

Transcatheter closure of perimembranous and muscular ventricular septal defects: short and medium-term outcome ABSTRACT Objective: This study attempted to report the initial results: the safety and efficacy of transcatheter closure of ventricular septal defects (VSDs) at Hue Central Hospital with the short and medium-term follow-up. Methods: From September 2012 to May 2017, a total of 36 patients with perimembranous or muscular VSD underwent an attempt of transcatheter closure at the Department of Interventional Cardiology, Hue Central Hospital. Results: 14 males and 26 females participated in this study, with the age of 17,29  13.72 and 24.23  12.32 respectively. Among these patients, 19.44% of them were under 6-year-old; 72.22% had perimembranous VSDs, 27.78% had muscular VSDs, and 33.33% had aneurysm. The distance to AV was 5.62 ± 4.32 mm. The device size was 15.31± 8.12 mm. Procedures lasted for 57.17 ± 26.5 min with 15.31± 8.12 min of exposure. The complete closure rates by transthoracic echocardiography after 24 hours, 1 month, 3 months and 6 months (transthoracic) were 94.44%; 94.44% ; 97.22% and 100%, respectively. Mean time of follow-up was 11.92 ± 8.36 (3-38) months. Success rate was 97.22% and no death occurred. There was 1 case of hematuria, lasting 1 month; no Atrioventricular (AV) block. Conclusions: Transcatheter closure of VSDs is a novel, feasible and safe technique with high success rate (97.22%). The transcather approach provides a less invasive alternative than surgical closure and might become the first choice treatment in selected patients. Key words: transcatheter closure, ventricular septal defects

The Amplatzer® Membranous VSD Occluder and the vulnerability of the atrioventricular conduction system

2007 ◽  
Vol 17 (5) ◽  
pp. 499-504 ◽  
Author(s):  
Gunther Fischer ◽  
Sotiria C. Apostolopoulou ◽  
Spyros Rammos ◽  
Martin B. Schneider ◽  
Per G. Bjørnstad ◽  
...  
Keyword(s):  
Transcatheter Closure ◽  
Complete Heart Block ◽  
Ventricular Septal Defects ◽  
Bundle Branch Block ◽  
Surgical Closure ◽  
Septal Defects ◽  
Amplatzer Occluder ◽  
Initial Results ◽  
Conduction Tissues

AbstractTranscatheter closure of ventricular septal defects with the Amplatzer® Membranous VSD Occluder has yielded promising initial results, but disturbances of conduction, including complete heart block, have been reported. We report our experience with the Amplatzer occluder in 35 patients with a median age 4.5 years, the defects being sized angiographically at 4.4 plus or minus 1.1 millimetres, with a range from 3 to 8 millimetres, and the size of the occluder varying from 4 to 12 millimetres. Over a median follow-up of 2.5 years, the rate of complete closure was 87% and 91%, at 1 and 2 years respectively, while 2 patients required surgical closure of the defect subsequent to the insertion of the device. Persistent regurgitation across the tricuspid valve related to the occluder was observed in 3 patients, and in 6 patients across the aortic valve. Abnormalities of conduction related to the procedure were noted in 7 patients, one-fifth of the cohort. The disturbances were transient in 1 patient, but permanent in 6, in one of the latter progressing after 6 months from left bundle branch block to intermittent Mobitz II second-degree atrioventricular block in association with expansion of the occluder. We conclude that transcatheter closure of perimembranous ventricular septal defects with the Amplatzer occluder is effective with limited complications, but the incidence of immediate and progressive disturbances of conduction related to the proximity of conduction tissues to the rims of the occluder stress the importance of larger and longer studies to assess the safety of this procedure.

Transcatheter closure of atrial septal defects within the oval fossa: medium-term results in children using the ‘ASDOS’-technique

1998 ◽  
Vol 8 (4) ◽  
pp. 462-471 ◽  
Author(s):  
Gerd Hausdorf ◽  
Martin Schneider ◽  
Christoph Fink ◽  
Ulrich Neudorf ◽  
Gunther Fischer ◽  
...  
Keyword(s):  
Transcatheter Closure ◽  
Medium Term ◽  
Residual Shunt ◽  
Surgical Closure ◽  
General Acceptance ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Transient Impairment ◽  
Term Data

AbstractObjectivesThe purpose of this study was to evaluate the safety and efficacy of the ASDOS-tech-nique (Sulzer-Osypka GmbH, Germany) for transcatheter closure of atrial septal defects within the oval fossa.BackgroundAlthough several attempts have been made to occlude defects within the oval fossa by transcatheter techniques, none of these has gained general acceptance.MethodsPatients with a defect in the oval fossa measuring equal to or less than 20 mm diameter, with a residual septal rim of 5mm or greater, body weight greater than 10 kg, with clinical indications for surgical closure were considered for transcatheter closure. Follow-up investigations were performed at discharge, after 1, 3, 6 and 9 months, as well as after 1 and 2 years.ResultsOf 78 patients considered for closure, a device was inserted in 41 patients (53%), with success being achieved in 40 patients (98%). The ages ranged from 1.1 to 15 years (7.8 ± 1.92 years), the ’stretched’ diameter of the defect from 10 to 20 mm (14.7 ± 2.60 mm), and the diameters of the inserted devices from 25 to 45 mm (33.2 ± 5.43 mm). Transient impairment of atrioventricular conduction occured in 4 patients. During the follow-up of 23.0 ± 5.6 months elective surgical closure of a residual shunt was performed 26 months after insertion of the devcie in one patient. None of the other patients required surgery, hospitalisation or medical treatment, and none is requiring further treatment of the defect within the oval fossa. Fracture of one arm of the device occurred in 4 patients, but the fractured arms are in an unchanged and stable position after a period of at least 19 months.ConclusionsOur medium-term data show that transcatheter closure in children of defects within the oval fossa can be performed with a high efficacy and safety using the ASDOS-device.

Transcatheter Closure of Residual and Iatrogenic Ventricular Septal Defects: Tertiary Center Experience and Outcome

2021 ◽  
Vol 23 (Supplement_D) ◽  
Author(s):  
Fatma A Taha ◽  
Fareed Alnozha ◽  
Osama Amoudi ◽  
Mansour Almutairi ◽  
Reda Abuelatta
Keyword(s):  
Transcatheter Closure ◽  
Ventricular Septal Defects ◽  
Post Intervention ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Septal Defects ◽  
Alternative Treatment Option ◽  
Tertiary Center ◽  
Device Deployment ◽  
Procedural Success

Abstract Aim This study aimed to review our center experience in transcatheter closure of post-surgical and post-intervention residual and iatrogenic VSDs and to report on their 12-month long-term outcome. Methods All patients who underwent transcatheter closure of residual ventricular septal defects (R-VSDs) and iatrogenic ventricular septal defects (I-VSDs) after either surgical corrections or transcatheter interventions for any congenital heart disease (CHD) between January 2015 and January 2020 were included in the study. Patients' medical records were reviewed and analyzed. Results Twenty-three patients with a mean age of 14.3 ± 8.8 years, a mean weight of 36.2 ± 20.4 Kg, and a mean body surface area of 1.18 ± 0.36 m2 were included. Thirteen (56.5%) patients were males. The VSD was residual in 18 (78.3%) patients and iatrogenic in 5 (21.7%) patients, post-operative in 19 (82.6%) patients and post-transcatheter in 4 (17.4%) patients. The remaining VSD site was peri-membranous in 9 (39.1%) patients, high-muscular in 6 (26.1%) patients, mid-muscular in 4 (17.4%) patients, and Gerbode shunt in 4 (17.4%) patients. The QP/QS ratio was 2.5 ± 0.7, and the VSD diameter was 6.1±2.1 mm with a VSD-aorta rim of 5.4 ± 2.0 mm. Most, 16 (71.43%) patients underwent antegrade device deployment, and 7 (28.57%) patients underwent retrograde transaortic device deployment, with only 3 (13.0%) patients required two devices/patient. Amplatzer™ Muscular VSD devices were used in 16 (69.6%) patients, Amplatzer™ Duct occlude-I devices were used in 4 (17.4%) patients, and Amplatzer™ Duct Occluder-II devices were used in 3 (13.0%) patients with a mean device size of 8.8 ± 2.8 mm. The mean procedural time was 55.1 ± 16.2 minutes, fluoroscopy time was 16.3 ± 4.0 minutes, and the contrast used was 33.8 ± 10.9 ml. Concomitant balloon pulmonary valvuloplasty was done at the same catheterization set in 2 (8.7%) patients. Acute procedural success, satisfactory immediate were achieved in all patients. During follow-up (23.3 ± 15.9 months), no patient required re-intervention or exhibited mortality. Conclusions Transcatheter closure of post-operative, and post-intervention residual and iatrogenic VSDs represents an attractive therapeutic approach. This approach is safe, feasible, effective, and less invasive alternative treatment option for such remaining VSDs.

Transcatheter closure of perimembranous ventricular septal defects with the Amplatzer Vascular Plug-II

2015 ◽  
Vol 26 (6) ◽  
pp. 1194-1201 ◽  
Author(s):  
Nancy Hua ◽  
Paolo Aquino ◽  
Carl Y. Owada
Keyword(s):  
Transcatheter Closure ◽  
Left Ventricular ◽  
Defect Size ◽  
Amplatzer Vascular Plug ◽  
Ventricular Septal Defects ◽  
Vascular Plug ◽  
Effective Treatment Option ◽  
Septal Defects ◽  
Amplatzer Vascular Plug Ii

AbstractObjectiveThe aim of this study was to evaluate the safety and efficacy of the Amplatzer Vascular Plug-II used for the closure of perimembranous ventricular septal defects.BackgroundThere are no FDA-approved transcatheter devices for the closure of perimembranous ventricular septal defects. Several studies have reported on the use of various devices either off-label or under clinical trial protocols. However these reports have described significant adverse events including residual shunts, complete heart block, arrhythmia, and new valve regurgitations. Thus far, no study on the Amplatzer Vascular Plug-II has been reported.MethodsWe conducted a 4-year retrospective chart review from August, 2010 to August, 2014, of patients with perimembranous ventricular septal defects associated with ventricular septal aneurysm who underwent transcatheter closure using the Amplatzer Vascular Plug-II.ResultsA total of 16 patients underwent Amplatzer Vascular Plug-II transcatheter closure of their perimembranous ventricular septal defects. The median age was 2.56 years (range: 0.5–27.3). Their median weight was 13.0 kg (range: 6.9–71.6). The left ventricular median defect size was 9.3 mm (range: 5.9–14.4). The right ventricular median defect size was 3.6 mm (range: 2.3–5.8). All the patients underwent successful device implantation with 83% of the patients having complete echocardiographic closure at the 1-year follow-up; however, one procedure was complicated by early device embolisation. The device was successfully retrieved and replaced with a larger device. There were no device-related outflow tract obstructions, rhythm abnormalities, or haemolysis.ConclusionApplication of the Amplatzer Vascular Plug-II for closure of perimembranous ventricular septal defects appears to be a safe and effective treatment option. Prospective clinical trials and longer follow-up periods are warranted.

scholarly journals Spontaneous Resolution of Residual Shunting in 2 Compromised Patients after Amplatzer Occlusion of Postinfarction Ventricular Septal Defects

2019 ◽  
Vol 46 (1) ◽  
pp. 44-47
Author(s):  
Takashi Yanagiuchi ◽  
Norio Tada ◽  
Taro Suchi ◽  
Yukiko Mizutani ◽  
Takashi Matsumoto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Severe Heart Failure ◽  
Effective Management ◽  
Ventricular Septal Defects ◽  
Surgical Closure ◽  
Septal Defects ◽  
Gradual Disappearance ◽  
Intensively Managed

Ventricular septal defect (VSD) is a rare, potentially fatal complication of acute myocardial infarction. When surgical closure is contraindicated, transcatheter closure may be an alternative. Residual shunting after transcatheter closure of postinfarction VSDs has been reported; however, we found few cases of this in patients who also had severe heart failure or hemolysis. We report 2 closures of postinfarction VSDs with use of the Amplatzer Septal Occluder. Both elderly patients—one with severe heart failure, one with persistent hemolysis, and neither a surgical candidate—had high-velocity residual shunting through the occluders. We intensively managed the patients' conditions and used angiography and transthoracic echocardiography to record the gradual disappearance of each shunt over 4 months—the first such serial monitoring of which we are aware. We think that even substantial shunting in the presence of severe heart failure or hemolysis can eventually resolve spontaneously, assuming effective management of the concomitant medical conditions.

Transcatheter closure of various types of defects within the oval fossa using the double umbrella device (CardioSEAL) – feasibility and echocardiographic follow-up

2001 ◽  
Vol 11 (2) ◽  
pp. 214-222 ◽  
Author(s):  
Renate Kaulitz ◽  
Matthias Peuster ◽  
Christian Jux ◽  
Thomas Paul ◽  
Gerd Hausdorf
Keyword(s):  
Transcatheter Closure ◽  
Right Atrial ◽  
Medium Term ◽  
Morphological Variations ◽  
Septal Defects ◽  
Long Term Follow Up ◽  
The Right ◽  
Echocardiographic Findings

Data on long-term follow-up for closure of so-called secundum type“ atrial septal defects within the oval fossa using recently developed devices are limited, and results focused on presence of residual shunting. The purpose of our study was to report the experience from a single center establishing the effectiveness of transcatheter closure in patients with various types of defect other than those located centrally within the oval fossa.A total of 72 patients was included in this study. On transesophageal echocardiography, the size of the defects varied from 6 to 18 mm, with estimation of the stretched diameter from 11 to 21 mm. The ratio of stretched diameter to the extent of the residual septum ranged from 0.28 to 0.54. Mean follow-up was 30.5+ 7.4 months, with a range from 13 to 42 months. The rate of closure using devices with diameters from 28 to 40 mm increased from 80% immediately after implantation to 93% in the 57 patients examined 24 months after implantation. For further analysis, we compared the 44 patients with a solitary, centrally located, defect to 28 having morphological variations, including superiorly located defects with deficient superior and aortic rims, multifenestrated and aneurysmal defects, or isolated additional defects. There was no incidence of formation of thrombus, sustained atrial arrhythmia, or infective endocarditis. Residual shunting was not influenced by location or morphology of the defects, but increased with size, stretched diameter, and the ratio of pulmonary to systemic flows. Serial transthoracic echocardiographic findings revealed malposition of one right-sided superior arm of the device in 8 patients, while protrusion of one leftsided arm onto the right atrial aspect was observed in 3 patients. Fluoroscopy showed fatigue fracture of a single arm in 7 patients (9.7%) within the first 6 months after implantation.These results demonstrate that transcatheter closure with the non self-centering double umbrella device was effective and safe on medium-term follow-up, and could be extended to defects within the oval fossa having various morphologies. Residual shunting resolved with time, and was not related to either morphology or the position of the device.

Transcatheter closure of doubly committed subarterial ventricular septal defects with the Amplatzer ductal occluder: initial experience

2019 ◽  
Vol 29 (5) ◽  
pp. 570-575
Author(s):  
Yu Huang ◽  
Xiaoping Yan ◽  
Linxiang Lu ◽  
Jun Fang ◽  
Xudong Sun ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Aortic Regurgitation ◽  
Transcatheter Closure ◽  
Ventricular Septal Defects ◽  
Residual Shunt ◽  
Septal Defects ◽  
Device Implantation ◽  
Limited Experience ◽  
New Onset

AbstractBackground:There is limited experience about transcatheter closure of doubly committed subarterial ventricular septal defects with Amplatzer ductal occluder.Methods:Between March, 2015 and July, 2017, a total of 22 patients with doubly committed subarterial ventricular septal defects received transcatheter closure using Amplatzer ductal occluder and underwent clinical follow-up for at least 6 months.Results:Device implantation was finally successful in 21 (95.4%) patients despite failed occlusion in one patient and intra-procedural replacement of unsuitable occluders in four (19.0%) patients. In mean 12.3 months of follow-up, there were no major complications (death, aortic valve or sinus rupture, device dislocation or embolisation, grade 2 new-onset aortic regurgitation, etc.), resulting in clinical occlusion success of 95.4%. Mechanical haemolysis occurred in one patient and resolved with medication. Residual shunt was observed in 11 (52.4%) patients (9 mild, 2 moderate-severe) post-procedurally, 14 (66.7%) patients (12 mild, 2 moderate-severe) in hospital stay, and 2 (9.5%) patients (2 mild, 0 moderate-severe) at the last follow-up. Device-induced new-onset aortic regurgitation was found in nine (42.8%) patients (9 mild, 0 moderate-severe) post-procedurally and in hospital stay, which was resolved in two (9.5%) patients and unchanged in seven (33.3%) patients at the last follow-up. Another four (19.0%) patients newly developed mild aortic regurgitation during follow-up.Conclusions:Transcatheter closure of doubly committed subarterial ventricular septal defects with Amplatzer ductal occluder is technically feasible in the selected patients. However, further study is needed to confirm its long-term clinical outcomes.

scholarly journals Transcatheter closure of muscular ventricular septal defects using the Cardi-O-Fix plug

2021 ◽  
pp. 1-4
Author(s):  
Zhisong Chen ◽  
Zhuo Yu ◽  
Li Su ◽  
Huasheng Zhang ◽  
Wei Hu
Keyword(s):  
Transcatheter Closure ◽  
Left Ventricular ◽  
Defect Size ◽  
Ventricular Septal Defects ◽  
Chordae Tendineae ◽  
Effective Treatment Option ◽  
Septal Defects ◽  
Device Implantation ◽  
The Right

Abstract Objective: The aim of this study was to evaluate the safety and efficacy of the Cardi-O-Fix plug used for the treatment of muscular ventricular septal defects. Methods: We retrospectively reviewed the medical records of five patients with muscular ventricular septal defects who underwent transcatheter closure using the Cardi-O-Fix Plug, from November 2017 to August 2019. The median age was 5.1 years (range: 3.2–6.5). Their median body weight was 18.1 kg (range: 13.4–21.8). All the patients underwent detailed two-dimensional Doppler and colour flow imaging by transthoracic echocardiography. The left ventricular median defect size of the muscular ventricular septal defects was 5.6 mm (range: 5.3–7.0). The right ventricular median defect size of the muscular ventricular septal defects was 3.9 mm (range: 3.3–4.7). All the procedures were performed on beating hearts. Results: All the patients underwent successful device implantation with no displacement or detachment, they have complete echocardiographic closure at the 1-year follow-up. There were no occluder-related arrhythmia, chordae tendineae rupture, tricuspid insufficiency, aortic regurgitation, haemolysis, or embolisation. Conclusions: Application of the Cardi-O-Fix plug appears to be a feasible, safe, and effective treatment option for patients with muscular ventricular septal defects. Longer follow-up periods are warranted to prove the conclusion for long-term outcomes.

Feasibility, Safety and Long-Term Follow-Up of Transcatheter Closure of Secundum Atrial Septal Defects with Deficient Rims

Cardiology ◽  
2016 ◽  
Vol 134 (2) ◽  
pp. 118-126 ◽  
Author(s):  
Chunhui Cao ◽  
Zhonghua Wang ◽  
Jun Huang ◽  
Lingxia Fan ◽  
Ren Li ◽  
...  
Keyword(s):  
Success Rate ◽  
Transcatheter Closure ◽  
Operation Time ◽  
Residual Shunt ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Heart Arrhythmia ◽  
Long Term Follow Up

Objective: The aim of this work was to evaluate the feasibility and safety of transcatheter closure procedures for the treatment of atrial septal defects (ASDs) with insufficient rims. Methods: A total of 507 secondary ASDs were divided into two groups based on whether they had deficient rims or not (152 vs. 355 cases, respectively). Any complications, including residual shunt, heart arrhythmia, occluder translocation, etc., were followed up for 1-3 years. Results: There were no differences in gender, weight, exposure time, ECG states, pulmonary pressure, the intervention success rate, occurrence of residual shunt, the operation time and occurrence of residual shunt during follow-up between the two groups (p > 0.05). However, the occurrence of rhythm disorders was significantly different between the two groups; ASDs with deficient rims were at an elevated risk (p < 0.05). Specifically, there was a significantly higher incidence in the occurrence of arrhythmia in the deficient rims group at 24 h postoperation, but no differences in arrhythmia incidence at any of the other follow-up time points (1, 3, 6, 12 and 36 months; p > 0.05). Conclusions: Patients with deficient rims experience a high success rate of ASD intervention and low rate of complications when the procedures are performed by experienced operators.

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