A novel surgical approach to close an acute ventricular septal defect using an occluder device (original) (raw)
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New Surgical Approach to Device Closure of Multiple Apical Ventricular Septal Defects
Revista Española de Cardiología (English Edition), 2004
We present an alternative technique for closing multiple ventricular septal defects difficult to access during surgery. A guidewire is advanced through the right ventricular free wall and through the main apical defect to the left ventricle, and this approach is used to place an Amplatzer device to occlude the ventricular septal defects. The procedure is performed in the beating heart, under intraoperative transesophageal echocardiographic guidance, and without extracorporeal circulation. It appears to be a simple and reproducible procedure with excellent short-term results.
Postepy w kardiologii interwencyjnej = Advances in interventional cardiology, 2016
Off-label use of different devices has been described for percutaneous closure of ventricular septal defects (VSD) because of the unacceptable rate of post-procedure heart block associated with special VSD devices. To describe the early single-center clinical experience with closure of a VSD using the Amplatzer Duct Occluder II (ADO II) device in children. Between May 2013 and June 2015, 26 patients between 13 days and 16 years of age underwent percutaneous closure of a VSD with an ADO II device at our institute. The decision to use the ADO II device was based primarily on lower risk of total atrioventricular block (TAVB) after VSD closure reported in the literature, reduction of the cost of the procedure and the need to close symptomatic VSDs in young patients. The location of the VSD was perimembranous in 21 patients, postsurgical residual in 2, midmuscular in 2 and apical muscular in 1. Complex procedures including newborn, combined procedures and postsurgical residual VSD were p...
Clarifying the Surgical Morphology of Inlet Ventricular Septal Defects
The Annals of Thoracic Surgery, 2013
Background. Different types of ventricular septal defects (VSD) open to the inlet of the right ventricle. The atrioventricular conduction axis is markedly different within these subtypes, a feature of great surgical importance. To clarify these relationships, we have studied hearts with such VSDs from the Idriss archive at Ann and Robert H. Lurie Children's Hospital of Chicago.
Device closure of ventricular septal defects by hybrid procedures: A multicenter retrospective study
Catheterization and Cardiovascular Interventions, 2011
Objective: This study reports on the feasibility, efficacy, and outcome of hybrid procedures to close ventricular septal defects (VSD), reflecting the experience of 11 centers in Germany, Austria, and Switzerland. Background: Beating heart closure of VSD has attracted interest in small infants, complex anomalies and postinfarction scenarios where patients are at high risk during surgery. Perventricular or intraoperative device placement allows access to the lesions where percutaneous delivery is limited. Methods: Between December 2001 and April 2009, placement of Amplatzer septal occluders was attempted in 26 patients. The defects were located in the perimembranous (n 5 5) and muscular septum (n 5 21). In 20 patients, a perventricular approach was used, and, in six, the occluders were placed under direct visualization being part of a complex heart surgery. Results: In 23 of 26 procedures, device placement was successful (88.5%). The mean defect size was 7.8 mm (range, 3.5-20). The occluder types were perimembranous VSD occluder (n 5 4), muscular VSD occluder (n 5 20), postinfarct VSD occluder (n 5 1), and ASD occluder (n 5 1) with a ratio device/defect of 0.9-2.4 (median 1.15). Device removal was necessary in three due to arrhythmia, malpositioning, and additional defects. Pericardial effusion occurred once. In the remaining 22 patients, there were no procedure or device-related complications. During mean follow up of 1.4 years (range, 1 day-3.9 years), a residual shunt that was more than trivial was observed in one patient out of 21 successful procedures. Conclusions: Perventricular and intraoperative device closure of VSD is as effective as a surgical patch and averts the increased morbidity of conventional surgical repair in a subgroup of highrisk patients. V C 2010 Wiley-Liss, Inc.
The American Journal of Cardiology, 2008
This multicenter study assessed the efficacy and safety of transcatheter closure of perimembranous ventricular septal defect (VSD) using a modified double-disk occluder. In 5 different centers in China, 412 patients with VSD, including 202 men and 210 women, underwent attempted transcatheter closure. The age range was 3 to 65 years (mean 16.4 ؎ 9.1). The diameter of defect was 3 to 15 mm by transthoracic echocardiography and 3 to 18 mm by left ventriculography. The ratio of pulmonary to systemic flow varied from 1.6 to 2.3 (1.9 ؎ 0.4). The device diameter was 4 to 20 mm (7.09 ؎ 3.60). The ventricular septal rim below the aortic valve was 0 to 5 mm. The immediate success rate was 96.6%; 6 cases had third degree atrioventricular block and recovered within 3 weeks. None needed a permanent pacemaker. Dislodgement of the device occurred in 3 patients but the device was recaptured and redeployed in 2 cases. During the follow-up period of 2 years, there was no evidence of residual shunt and device-related complications. In conclusion, transcatheter closure of VSD is safe and effective in most selected patients; the mid-term prognosis of patients with transcatheter closure is good.
Device Closure of Congenital Ventricular Septal Defects
Congenital Heart Disease, 2007
Ventricular septal defects (VSD), which cause volume overload, may be closed by interventional method. The success depends on the precise anatomic definition of the defect and its relation to other cardiac structures. We report our first experiences of transcatheter closure of perimembranous and muscular VSD. Between May 2005 and September 2006, transcatheter closure of VSD was attempted in 38 patients. Implantation was successful in 37 patients. In one patient, the procedure failed because of the long sheath kinking. We observed important complications in three patients: severe tricuspid valve regurgitation, residual VSD and tricuspid valve regurgitation and right bundle branch block in the short-term follow-up. Transcatheter device closure with Amplatzer device seems to be effective and safe in the treatment of perimembranous and muscular VSDs. Tricuspid valve incompetence may cause problems. Long-term results are required to determine the efficacy and safety.
Journal of Structural Heart Disease, 2017
Femoral venous access is the typical route for the antegrade approach to percutaneous closure of a perimemberanous ventricular septal defect (PM VSD). In this case report, we attempted percutaneous PM VSD closure in a five-year-old child with interrupted inferior vena cava (IVC) using a retrograde arterial approach. The Amplatzer Duct Occluder II was chosen due to its symmetrical design that can be deployed using either a retrograde or antegrade approach. We found the retrograde percutaneous PM VSD closure by off-label use of this device to be an easy and feasible option in this case of interrupted IVC, whereas the use of an antegrade approach would have been imprecise and potentially time-consuming.
Catheterization and Cardiovascular Interventions, 2019
Objectives: To evaluate the safety, efficiency, and midterm outcomes of transcatheter perimembranous ventricular septal defect (pmVSD) closure using the new KONAR-MF™ VSD occluder. Background: Off-label percutaneous pmVSD closure is a well-established procedure with promising results. Yet, interventionists are still searching for the ideal device. Methods: Between June 2018 and March 2019, 20 patients with hemodynamically significant but restrictive-type pmVSD underwent an attempted transcatheter closure using the new KONAR-MF™. All implantations were performed retrogradely under general anesthesia, transoesophageal echocardiography, and fluoroscopic guidance. Prospective follow-up using transthoracic echocardiography and electrocardiogram was done until August 2019. Results: The median age was 6.4 years (8 months to 43.4 years), and the median body weight was 17.3 (9-74) kg. The mean defect size on the left ventricular aspect was 11.7 ± 2.8 mm. All devices were successfully and rapidly implanted. One device embolized in the pulmonary artery, 24 hr after implantation and was percutaneously retrieved with no complication. Over a mean follow-up period of 8.2 ± 3.0 months, complete closure was achieved in 84.2% of patients. One new onset of mild aortic regurgitation was detected before discharge and remained stable. Tricuspid valve regurgitation, complete heart block, major complication, and death were not observed. Conclusions: Transcatheter pmVSD closure using the KONAR-MF™ can be successfully performed in adult and pediatric patients. It is a safe and promising device, designed to provide high conformability to septal defects with a lower risk of heart block. Retrograde implantation allows procedural flexibility, efficient deliverability, and control of valvular interferences.
Pediatric Cardiology, 2013
This report summarizes the authors' clinical experience with perventricular closure of the perimembranous ventricular septal defect (PmVSD) using the concentric occluder as a minimally invasive technique without cardiopulmonary bypass and following transesophageal echocardiography (TEE) guidance. Between July 2011 and March 2013, 61 patients with PmVSD underwent perventricular concentric device closure using a minimally invasive inferior sternotomy approach. The basal diameter of the PmVSD ranged from 2.5 to 7 mm. The diameter of the occlusion device waist ranged from 4 to 8 mm. A ventricular septal aneurysm or an adhesive tricuspid valve was present in 49 patients. Multiple orifices in the aneurysm were treated in ten patients, including dispersed orifices in four patients and comparatively concentrated orifices in the remaining six patients. The occlusion devices were deployed via the right ventricle with TEE guidance and no cardiopulmonary bypass. Complete shunt occlusion was achieved for all the patients in the operating room. The orifices of the ventricular septal aneurysm were closed in 46 patients, with the left disc of the concentric devices placed in the aneurysms, whereas the PmVSDs in the remaining 15 patients were closed from the ventricular septal defect (VSD) basal part following the rule that the upper rim of the PmVSD be more than 2 mm from the aortic valve. Ventricular premature beats occurred in one patient. The follow-up period ranged from 1 to 21 months (median 13.5 ± 8.2 months), and the patients had stable heart function postoperatively. None of the patients had more than mild valvular regurgitation, and no worsening regurgitation was observed in those who had tricuspid or aortic regurgitation before surgery. No complete atrioventricular block, position shift of the occlusion devices, thrombosis, or residual VSD occurred during the follow-up period. The perventricular concentric device closure of PmVSD with an inferior sternotomy in selected patients is a safe, feasible, and simple treatment. The concentric device is easier to anchor than the eccentric device and has proved to be a reasonable choice for PmVSD occlusion, especially in patients with a perimembranous aneurysm formation or PmVSD extending to the inflow tract.