Early and mid-term results of transcatheter closure of perimembranous ventricular septal defect using Amplatzer Ductal Occluder type 1

Abstract

Objectives: To study the early and midterm results of transcatheter closure of perimembranous VSD using Amplatzer Ductal Occluder type 1. Methods: Prospective study of one hundred thirteen patients with perimembranous VSD (PMVSD) who referred to catheterization laboratory and underwent transcatheter closure of their defects by using Amplatzer Ductal Occluder type 1 device. Routine right and left heart catheterization was performed with evaluation of the pulmonary and systemic pressure. All the procedures were done under fluoroscopy and transthoracic echocardiography guide.  Follow up evaluations were done between 1 month and 12 months after discharge (mean 4.5 ± 1.13 months) with transthoracic echocardiography and 12 lead electrocardiography. Results: The age of patients range from 2 to 34 years at procedure (mean 10.60 ± 7.31 years), weight range from 10 to 85 kg (mean 32.38 ± 19.70 kg). The mean echocardiographic defect size was 5.69 ± 1.63 mm and the mean angiographic size was 5.89 ± 1.70 mm. The devices size used range from 6/4 – 16/14 mm. The most common device used was 10/8. The ADOs were successfully implanted in 108 patients (95.6 %). The VSD occlusion rate was 85.2% at completion of the procedure, rising up to 90.7 % next day at discharge, 93.5% at one month and 97.2% at 6 months during follow-up. Two patients (1.9%) developed CAVB, one case within 24 hours and the other case after 2 days of the procedure, they were admitted in hospital treated by temporary pacemaker implantation, steroids and NSAIDs (high dose aspirin) with complete remission within 5 days. Conclusion: Transcatheter closure of PMVSD with ADO1 in children is a safe and effective treatment associated with excellent success and closure rates and with no significant adverse events, but long-term follow-up in a large number of patients would be warranted.