Transcatheter Closure of Perimembranous Ventricular Septal Defects Using Different Generations of Amplatzer Devices: Multicenter Experience

Roberto Mijangos-Vázquez, Amal El-Sisi, Juan P Sandoval Jones, José A García-Montes, Rogelio Hernández-Reyes, Rodina Sobhy, Antoine Abdelmassih, Mohammed M Soliman, Safaa Ali, Tatiana Molina-Sánchez, Carlos Zabal, Roberto Mijangos-Vázquez, Amal El-Sisi, Juan P Sandoval Jones, José A García-Montes, Rogelio Hernández-Reyes, Rodina Sobhy, Antoine Abdelmassih, Mohammed M Soliman, Safaa Ali, Tatiana Molina-Sánchez, Carlos Zabal

Abstract

Objectives: To demonstrate safety and efficacy of using different generations of softer Amplatzer™ devices for ventricular septal defect (VSD) closure to avoid serious complications at follow-up.

Background: Transcatheter closure of perimembranous ventricular septal defects (PmVSD) is a well-established procedure; however, it is associated with unacceptable incidence of complete heart block. Great advantages have been achieved by using softer devices for VSD transcatheter closure. The first and second generation of Amplatzer™ occluders (AVP II, ADO, and ADO II) seem to offer a safe and attractive alternative for this procedure. These devices can be delivered using either an arterial (retrograde) or venous (prograde) approach.

Methods and results: Patients with congenital PmVSD who underwent transcatheter closure using ADO, ADO II, and AVP II devices were included. Primary end point was to determine efficacy and safety of these generations of devices and to determine the incidence of complications at follow-up (complete AV block and aortic/tricuspid/mitral regurgitation). One hundred and nineteen patients underwent VSD closure at a median age of 5 years (8 months-54 years). During the catheterization, there were only minor complications and at follow-up of 36 ± 25.7 months (up to 99 months), the closure rate was high of 98.3% and freedom from AV block was 100%.

Conclusions: The use of softer Amplatzer™ devices is a good alternative to achieve PmVSD closure safely with no risk of AVB during the procedure or at midterm follow-up.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2020 Roberto Mijangos-Vázquez et al.

Figures

Figure 1
Figure 1
Initial four chambers angiography. (a) The arrow shows aneurysmal membranous VSD. (b) The arrowhead shows VSD. VSD = Ventricular septal defect.
Figure 2
Figure 2
Four chambers fluoroscopy, once the ADO device has been placed inside the aneurysmal sac (arrow) by the prograde approach. ADO = Amplatzer duct occluder.
Figure 3
Figure 3
Four chambers fluoroscopy (a) once the ADO II device has been placed by the retrograde approach. (b) Arrowhead showing proper position of the AVP II with no residual shunt. ADO II = Amplatzer duct occluder II. AVP II = Amplatzer vascular plug II.

References

    1. Mavroudis C., Backer C. L., Jacobs J. P. Pediatric Cardiac Surgery. 3rd. Philadelphia, PA, USA: Mosby; 2003. Ventricular septal defect; pp. 298–320.
    1. Bol-Raap G., Weerheim J., Kappetein A. P., Witsenburg M., Bogers A. J. J. C. Follow-up after surgical closure of congenital ventricular septal defect. European Journal of Cardio-Thoracic Surgery. 2003;24(4):511–515. doi: 10.1016/s1010-7940(03)00430-5.
    1. Arora R., Trehan V., Kumar A., Kalra G. S., Nigam M. Transcatheter closure of congenital ventricular septal defects: experience with various devices. Journal of Interventional Cardiology. 2003;16(1):83–91. doi: 10.1046/j.1540-8183.2003.08006.x.
    1. Lock J. E., Block P. C., McKay R. G., Baim D. S., Keane J. F. Transcatheter closure of ventricular septal defects. Circulation. 1988;78(2):361–368. doi: 10.1161/01.cir.78.2.361.
    1. Sideris E. B., Walsh K. P., Haddad J. L., Chen C. R., Ren S. G., Kulkarni H. Occlusion of congenital ventricular septal defects by the buttoned device. “Buttoned device” clinical trials international register. Heart. 1997;77(3):276–279. doi: 10.1136/hrt.77.3.276.
    1. Janorkar S., Goh T., Wilkinson J. Transcatheter closure of ventricular septal defects using the rashkind device: initial experience. Catheterization and Cardiovascular Interventions. 1999;46(1):43–48. doi: 10.1002/(sici)1522-726x(199901)46:1<43::aid-ccd12>;2-t.
    1. Kalra G. S., Verma P. K., Dhall A., Singh S., Arora R. Transcatheter device closure of ventricular septal defects: immediate results and intermediate-term follow-up. American Heart Journal. 1999;138(2):339–344. doi: 10.1016/s0002-8703(99)70122-5.
    1. Ramaciotti C., Keren A., Silverman N. H. Importance of (perimembranous) ventricular septal aneurysms in the natural history of isolated perimembranous ventricular septal defect. The American Journal of Cardiology. 1986;57(4):268–272. doi: 10.1016/0002-9149(86)90903-3.
    1. Pedra C. A., Pedra S. R., Esteves C. A., et al. Percutaneous closure of perimembranous ventricular septal defects with the Amplatzer device: technical and morphological considerations. Catheterization and Cardiovascular Interventions. 2004;61(3):403–410. doi: 10.1002/ccd.10797.
    1. Thanopoulos B. D., Tsaousis G. S., Karanasios E., et al. Transcatheter closure of perimembranous ventricular septal defects with the Amplatzer asymmetric ventricular septal defect occluder: preliminary experience in children. Heart. 2003;89(8):918–922. doi: 10.1136/heart.89.8.918.
    1. Hijazi Z. M., Hakim F., Haweleh A. A., et al. Catheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: initial clinical experience. Catheterization and Cardiovascular Interventions. 2002;56(4):508–515. doi: 10.1002/ccd.10292.
    1. Butera G., Carminati M., Chessa M., et al. Transcatheter closure of perimembranous ventricular septal defects: early and long-term results. Yearbook of Cardiology. 2007;50:1189–1195.
    1. Holzer R., de Giovanni J., Walsh K. P., et al. Transcatheter closure of perimembranous ventricular septal defects using the amplatzer membranous VSD occluder: immediate and midterm results of an international registry. Catheterization and Cardiovascular Interventions. 2006;68(4):620–628. doi: 10.1002/ccd.20659.
    1. Hieu N. L. Transcatheter closure of ventricular septal defects with new devices in Vietnam. Proceedings from China Interventional Therapeutics Conference; March 2010; Beijing, China.
    1. Anderson R. H., Becker A. E., Tynan M. Description of ventricular septal defects—or how long is a piece of string? International Journal of Cardiology. 1986;13(3):267–278. doi: 10.1016/0167-5273(86)90114-2.
    1. Amin Z., Gu X., Berry J. M., et al. New device for closure of muscular ventricular septal defects in a canine model. Circulation. 1999;100(3):320–328. doi: 10.1161/01.cir.100.3.320.
    1. Thanopoulos B. D., Tsaousis G. S., Konstadopoulou G. N., et al. Transcatheter closure of muscular ventricular septal defects with the amplatzer ventricular septal defect occluder: initial clinical applications in children. Journal of the American College of Cardiology. 1999;33(5):1395–1399. doi: 10.1016/s0735-1097(99)00011-x.
    1. Carminati M., Butera G., Chessa M., Drago M., Negura D., Piazza L. Transcatheter closure of congenital ventricular septal defect with amplatzer septal occluders. The American Journal of Cardiology. 2005;96(12):52–58. doi: 10.1016/j.amjcard.2005.09.068.
    1. Behnke I. M., Le T. P., Waldecker B., Akintuerk H., Valeske K., Schranz D. Percutaneous closure of congenital and acquired ventricular septal defects-considerations on selection of the occlusion device. Journal of Interventional Cardiology. 2005;18(2):89–99. doi: 10.1111/j.1540-8183.2005.04051.x.
    1. Dilawar M., Ahmad Z. Safety and efficacy of Amplatzer duct occluder for percutaneous closure of ventricular septal defects with tunnel shape aneurysm: medium term follow up. World Journal of Cardiovascular Diseases. 2013;3(2):228–233. doi: 10.4236/wjcd.2013.32035.
    1. Diab K. A., Cao Q.-L., Mora B., Hijazi Z. M. Device closure of muscular ventricular septal defects in infants less than one year of age using the amplatzer devices: feasibility and outcome. Catheterization and Cardiovascular Interventions. 2007;70(1):90–97. doi: 10.1002/ccd.21142.
    1. Ebeid M. R., Batlivala S. P., Salazar J. D., et al. Percutaneous closure of perimembranous ventricular septal defects using the second-generation amplatzer vascular occluders. The American Journal of Cardiology. 2016;117(1):127–130. doi: 10.1016/j.amjcard.2015.10.010.
    1. El Said H. G., Bratincsak A., Gordon B. M., Moore J. W. Closure of perimembranous ventricular septal defects with aneurysmal tissue using the amplazter duct occluder I: lessons learned and medium term follow up. Catheterization and Cardiovascular Interventions. 2012;80(6):895–903. doi: 10.1002/ccd.23074.
    1. Koneti N. R., Sreeram N., Penumatsa R. R., Arramraj S. K., Karunakar V., Trieschmann U. Transcatheter retrograde closure of perimembranous ventricular septal defects in children with the amplatzer duct occluder II device. Journal of the American College of Cardiology. 2012;60(23):2421–2422. doi: 10.1016/j.jacc.2012.08.1004.
    1. Ghaderian M., Merajie M., Mortezaeian H., Aarabi M., Mohammad Y., Shah Mohammadi A. Efficacy and safety of using amplatzer ductal occluder for transcatheter closure of perimembranous ventricular septal defect in pediatrics. Iranian Journal of Pediatrics. 2015;25(2):p. e386. doi: 10.5812/ijp.386.
    1. El-Sisi A., Sobhy R., Jaccoub V., Hamza H. Perimembranous ventricular septal defect device closure: choosing between amplatzer duct occluder I and II. Pediatric Cardiology. 2017;38(3):596–602. doi: 10.1007/s00246-016-1553-x.
    1. Hua N., Aquino P., Owada C. Y. Transcatheter closure of perimembranous ventricular septal defects with the amplatzer vascular plug-II. Cardiology in the Young. 2016;26(6):1194–1201. doi: 10.1017/s1047951115002206.
    1. Kanaan M., Ewert P., Berger F., Assa S., Schubert S. Follow-up of patients with interventional closure of ventricular septal defects with amplatzer duct occluder II. Pediatric Cardiology. 2015;36(2):379–385. doi: 10.1007/s00246-014-1017-0.
    1. Zhao L.-J., Han B., Zhang J.-J., Yi Y.-C., Jiang D.-D., Lyu J.-L. Transcatheter closure of congenital perimembranous ventricular septal defect using the Amplatzer duct occluder 2. Cardiology in the Young. 2017;28(3):447–453. doi: 10.1017/s1047951117002396.
    1. Knop M. T., Litwin L., Szkutnik M., Białkowski J., Galeczka M., Fiszer R. Percutaneous closure of perimembranous and postsurgical ventricular septal defects with amplatzer duct occluder II additional sizes in paediatric patients-case series. Advances in Interventional Cardiology. 2018;14(4):429–432. doi: 10.5114/aic.2018.79874.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj