Re-evaluation of the criteria for asymmetric amplatzer occluders in the closure of perimembranous ventricular septal defects: A case series report

Gang Li, Hongyu Liao, Jinlin Wu, Kaiyu Zhou, Yimin Hua, Chuan Wang, Hongyu Duan, Xiaoqing Shi, Gang Wu, Yifei Li, Gang Li, Hongyu Liao, Jinlin Wu, Kaiyu Zhou, Yimin Hua, Chuan Wang, Hongyu Duan, Xiaoqing Shi, Gang Wu, Yifei Li

Abstract

Rationale: To discuss suitable criteria for the application of asymmetric Amplatzer occluders for perimembranous ventricular septal defects (pmVSDs).

Patients concerns and diagnoses: We retrospectively studied 18 children with perimembranous VSDs who underwent attempted asymmetric occluder closure between January 2015 and December 2018 in our center.

Interventions: Asymmetric Amplatzer occluders were attempted to be placed to all the enrolled patients. We analyzed the diameter of the defects with the receiver operating characteristic curve (ROC) values, the size of the occluders attempted, the presence of aneurysm and the presence of aortic valve prolapse for each patient. Then, for patients who experienced successful device implantation, the therapeutic efficiency was evaluated by follow-up.

Outcomes: Only 5 out of a total of 18 patients completed successful device implantation. Compared with failed cases, successful cases demonstrated a significantly smaller VSD size (5.46 ± 1.03 mm vs. 8.73 ± 2.33 mm, P = 0.012) and had a low ratio of aortic valvar prolapse (20% vs. 76.92%, P = 0.026). Four out of 5 successful cases involved arrhythmia complications, but the rhythm of the heart recovered after drug treatment. According to the ROC and Youden analyses, the cut-off value of the defect size for successful asymmetric Amplatzer occluder implantation was no larger than 5.7 mm.

Lessons: The application of an asymmetric Amplatzer occluder expands the range of indications for patients with superior localized VSD but is largely limited in cases with aortic valvar prolapse and large VSD sizes. All successful cases recovered from arrhythmia postprocedure.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
The flow chart of all the attempted cases for asymmetric Amplatzer occluder.

References

    1. Lock JE, Block PC, McKay RG, et al. Transcatheter closure of ventricular septal defects. Circulation 1988;78:361–8.
    1. Thanopoulos BV, Rigby ML, Karanasios E, et al. Transcatheter closure of perimembranous ventricular septal defects in infants and children using the Amplatzer perimembranous ventricular septal defect occluder. Am J Cardiol 2007;99:984–9.
    1. Wang C, Zhou K, Luo C, et al. Complete left bundle branch block after transcatheter closure of perimembranous ventricular septal defect. JACC Cardiovasc Interv 2019;12:1631–3.
    1. Xie L, Zhang H, Zhang R, et al. Management of late-onset complete atrioventricular block post transcatheter closure of perimembranous ventricular septal defects. Front Pediatr 2019;7:545.
    1. Tzikas A, Ibrahim R, Velasco-Sanchez D, et al. Transcatheter closure of perimembranous ventricular septal defect with the Amplatzer((R)) membranous VSD occluder 2: initial world experience and one-year follow-up. Catheter Cardiovasc Interv 2014;83:571–80.
    1. Chen GL, Li HT, Li HR, et al. Transcatheter closure of ventricular septal defect in patients with aortic valve prolapse and mild aortic regurgitation: feasibility and preliminary outcome. Asian Pac J Trop Med 2015;8:315–8.
    1. Ghosh S, Sridhar A, Solomon N, et al. Transcatheter closure of ventricular septal defect in aortic valve prolapse and aortic regurgitation. Indian Heart J 2018;70:528–32.
    1. Li Y, Hua Y, Fang J, et al. Identification of risk factors for arrhythmia post transcatheter closure of perimembranous ventricular septal defect. J Invasive Cardiol 2015;27:E158–66.
    1. Han Y, Li H, Zhu H, et al. Aortic regurgitation after closure of ventricular septal defect by transcatheter device: the long-term complication. Cardiol Young 2020;30:577–9.
    1. Wang J, Zuo J, Yu S, et al. Effectiveness and safety of transcatheter closure of perimembranous ventricular septal defects in adults. Am J Cardiol 2016;117:980–7.
    1. Yang R, Sheng Y, Cao K, et al. Transcatheter closure of perimembranous ventricular septal defect in children: safety and efficiency with symmetric and asymmetric occluders. Catheter Cardiovasc Interv 2011;77:84–90.
    1. Li P, Zhao XX, Zheng X, et al. Arrhythmias after transcatheter closure of perimembranous ventricular septal defects with a modified double-disk occluder: early and long-term results. Heart Vessels 2012;27:405–10.
    1. Bialkowski J, Szkutnik M, Kusa J, et al. Few comments regarding transcatheter closure of congenital perimembranous and muscular ventricular septal defects. Int J Cardiol 2010;145:69.
    1. Li Y, Zhou K, Hua Y. Whether heart blocks post perimembranous ventricular septal defect device closure remain threatening: how could Chinese experiences impact the world? J Evid Based Med 2017;10:5–10.

Source: PubMed

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