Catheterization and Cardiovascular Interventions

Pediatric and Congenital Heart Disease

Outcomes of a modified approach to transcatheter closure of perimembranous ventricular septal defects

Corresponding Author

Geri Landman MD

Department of Pediatrics, Division of Pediatric Cardiology, University of California, San Francisco, California

Correspondence to: Geri O. Landman, 505 Parnassus Avenue, Box 0632 San Francisco, CA 94143-4144. E-mail: [email protected]Search for more papers by this author

Alaina Kipps MD,

Alaina Kipps MD

Department of Pediatrics, Division of Pediatric Cardiology, University of California, San Francisco, California

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Phillip Moore MD,

Phillip Moore MD

Department of Pediatrics, Division of Pediatric Cardiology, University of California, San Francisco, California

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David Teitel MD,

David Teitel MD

Department of Pediatrics, Division of Pediatric Cardiology, University of California, San Francisco, California

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Jeffery Meadows MD,

Jeffery Meadows MD

Department of Pediatrics, Division of Pediatric Cardiology, University of California, San Francisco, California

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Geri Landman MD,

Corresponding Author

Geri Landman MD

Department of Pediatrics, Division of Pediatric Cardiology, University of California, San Francisco, California

Correspondence to: Geri O. Landman, 505 Parnassus Avenue, Box 0632 San Francisco, CA 94143-4144. E-mail: [email protected]Search for more papers by this author

Alaina Kipps MD,

Alaina Kipps MD

Department of Pediatrics, Division of Pediatric Cardiology, University of California, San Francisco, California

Search for more papers by this author

Phillip Moore MD,

Phillip Moore MD

Department of Pediatrics, Division of Pediatric Cardiology, University of California, San Francisco, California

Search for more papers by this author

David Teitel MD,

David Teitel MD

Department of Pediatrics, Division of Pediatric Cardiology, University of California, San Francisco, California

Search for more papers by this author

Jeffery Meadows MD,

Jeffery Meadows MD

Department of Pediatrics, Division of Pediatric Cardiology, University of California, San Francisco, California

Search for more papers by this author

First published: 07 December 2012

https://doi.org/10.1002/ccd.24774

Citations: 17

Conflict of interest: Nothing to report.

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Abstract

Objectives

To describe the immediate and midterm results of a modified method for transcatheter closure of perimembranous ventricular septal defects (pmVSDs).

Background

Transcatheter closure of pmVSDs has been associated with development of heart block due to impingement on the ventricular conduction system. Ventricular septal aneurysms (VSAs) are common; the VSA tissue can serve as a target for the device without necessitating direct contact with the conduction system.

Methods

Between 2004 and 2011, 15 patients underwent transcatheter closure of a pmVSD utilizing a device implanted into a VSA. Catheterization reports were examined in addition to pre-closure, post-closure, and current clinical, ECG, and echocardiographic data.

Results

The median age was 20 years (4–61 years), and the most common indication for closure was increasing LV dilation. Four different Amplatzer devices were utilized. Following device implantation there was a decrease in Qp:Qs (1.7–1.1) and in RV:LV pressure ratio (0.36–0.31). There were no deaths, no device embolizations, and no new heart block or PR interval prolongation. Three patients developed a new right bundle branch block (RBBB). The median follow-up time was 1.5 years (4 months to 7.1 years). Two patients required further procedures for important residual shunting. Six continued to have a “trivial/small” residual leak, but only one had any degree (mild) of residual LV dilation. None of the complications were significantly associated with age or weight at the time of procedure, original size of the VSD, or size or type of the device used.

Conclusion

Transcatheter closure of pmVSD with placement of the device into the VSA is safe and effective, and may result in fewer instances of atrioventricular block and valve abnormalities than have been reported with alternative methods of pmVSD device closure. Persistent VSDs and new RBBBs remain an important issue. © 2013 Wiley Periodicals, Inc.

REFERENCES

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Volume82, Issue1

1 July 2013

Pages 143-149

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Outcomes of a modified approach to transcatheter closure of perimembranous ventricular septal defects

Abstract

Objectives

Background

Methods

Results

Conclusion

REFERENCES

Citing Literature

References

Information

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Outcomes of a modified approach to transcatheter closure of perimembranous ventricular septal defects

Abstract

Objectives

Background

Methods

Results

Conclusion

REFERENCES

Citing Literature

References

Related

Information