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Transcatheter closure of doubly committed subarterial ventricular septal defects with the Amplatzer ductal occluder: initial experience

Published online by Cambridge University Press:  10 April 2019

Yu Huang
Affiliation:
Department of Cardiology, Fujian Heart Center, Provincial Institute of Coronary Disease, Affiliated Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
Xiaoping Yan
Affiliation:
Department of Cardiology, Fujian Heart Center, Provincial Institute of Coronary Disease, Affiliated Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
Linxiang Lu
Affiliation:
Department of Cardiology, Fujian Heart Center, Provincial Institute of Coronary Disease, Affiliated Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
Jun Fang
Affiliation:
Department of Cardiology, Fujian Heart Center, Provincial Institute of Coronary Disease, Affiliated Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
Xudong Sun
Affiliation:
Department of Cardiology, Fujian Heart Center, Provincial Institute of Coronary Disease, Affiliated Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
Ling Zhong
Affiliation:
Department of Cardiology, Fujian Heart Center, Provincial Institute of Coronary Disease, Affiliated Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
Jinguo Li
Affiliation:
Department of Cardiology, Fujian Heart Center, Provincial Institute of Coronary Disease, Affiliated Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
Lianglong Chen*
Affiliation:
Department of Cardiology, Fujian Heart Center, Provincial Institute of Coronary Disease, Affiliated Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
*
Author for correspondence: Lianglong Chen, Professor, Department of Cardiology, Fujian Heart Medical Center, Provincial Institute of Coronary Disease, Affiliated Union Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China. Tel: 86-591-83357896, ext. 8466; Fax: 86-591-83342282; E-mail: lianglongchen@126.com

Abstract

Background:

There is limited experience about transcatheter closure of doubly committed subarterial ventricular septal defects with Amplatzer ductal occluder.

Methods:

Between March, 2015 and July, 2017, a total of 22 patients with doubly committed subarterial ventricular septal defects received transcatheter closure using Amplatzer ductal occluder and underwent clinical follow-up for at least 6 months.

Results:

Device implantation was finally successful in 21 (95.4%) patients despite failed occlusion in one patient and intra-procedural replacement of unsuitable occluders in four (19.0%) patients. In mean 12.3 months of follow-up, there were no major complications (death, aortic valve or sinus rupture, device dislocation or embolisation, grade 2 new-onset aortic regurgitation, etc.), resulting in clinical occlusion success of 95.4%. Mechanical haemolysis occurred in one patient and resolved with medication. Residual shunt was observed in 11 (52.4%) patients (9 mild, 2 moderate-severe) post-procedurally, 14 (66.7%) patients (12 mild, 2 moderate-severe) in hospital stay, and 2 (9.5%) patients (2 mild, 0 moderate-severe) at the last follow-up. Device-induced new-onset aortic regurgitation was found in nine (42.8%) patients (9 mild, 0 moderate-severe) post-procedurally and in hospital stay, which was resolved in two (9.5%) patients and unchanged in seven (33.3%) patients at the last follow-up. Another four (19.0%) patients newly developed mild aortic regurgitation during follow-up.

Conclusions:

Transcatheter closure of doubly committed subarterial ventricular septal defects with Amplatzer ductal occluder is technically feasible in the selected patients. However, further study is needed to confirm its long-term clinical outcomes.

Type
Original Article
Copyright
© Cambridge University Press 2019 

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References

Minette, MS, Sahn, DJ. Ventricular septal defects. Circulation 2006; 114: 21902197.CrossRefGoogle ScholarPubMed
Warnes, CA, Williams, RG, Bashore, TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Writing Committee to Develop Guidelines for the Management of Adults with Congenital Heart Disease). J Am Coll Cardiol 2008; 52: e143e263.CrossRefGoogle Scholar
Mavroudis, C, Baker, CL, Idriss, FS. Ventricular septal defect. In: Mavroudis, C, Baker, CL (eds.). Pediatric Cardiac Surgery, 3rd edn. Mosby, Philadelphia, PA, 2003: 298320.Google Scholar
Demirag, MK, Keceligil, HT, Kolbakir, F. Primary surgical repair of ventricular septal defect. Asian Cardiovasc Thorac Ann 2003; 11: 213216.CrossRefGoogle ScholarPubMed
Kenny, D, Tometzki, A, Martin, R. Significant aortic regurgitation associated with transcatheter closure of perimembranous ventricular septal defects with a deficient aortic rim. Catheter Cardiovasc Interv 2007; 70: 445449.CrossRefGoogle ScholarPubMed
Hijazi, ZM. Device closure of ventricular septal defects. Catheter Cardiovasc Interv 2003; 60: 107114.CrossRefGoogle ScholarPubMed
Zhou, D, Pan, W, Guan, L, Ge, J. Transcatheter closure of perimembranous and intracristal ventricular septal defects with the SHSMA occluder. Catheter Cardiovasc Interv 2012; 79: 666674.CrossRefGoogle ScholarPubMed
Zhao Yang, C, Hua, C, Yuan Ji, M, et al. Transfemoral and perventricular device occlusions and surgical repair for doubly committed subarterial ventricular septal defects. Ann Thorac Surg 2015; 99: 16641670.CrossRefGoogle ScholarPubMed
Gu, M, You, X, Zhao, X, Zheng, X, Qin, YW. Transcatheter device closure of intracristal ventricular septal defects. Am J Cardiol 2011; 107: 110113.CrossRefGoogle ScholarPubMed
Lee, SM, Song, JY, Choi, JY, et al. Transcatheter closure of perimembranous ventricular septal defect using Amplatzer ductal occluder. Catheter Cardiovasc Interv 2013; 82: 11411146.CrossRefGoogle ScholarPubMed
Hijazi, ZM, Hakim, F, Haweleh, AA, et al. Catheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: initial clinical experience. Catheter Cardiovasc Interv 2002; 56: 508515.CrossRefGoogle ScholarPubMed
Fu, YC, Bass, J, Amin, Z, et al. Transcatheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: results of the U.S. phase I trial. J Am Coll Cardiol 2006; 47: 319325.CrossRefGoogle ScholarPubMed
Zoghbi, WA, Adams, D, Bonow, RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr 2017; 30: 303371.CrossRefGoogle ScholarPubMed
Tweddell, JS, Pelech, AN, Frommelt, PC. Ventricular septal defect and aortic valve regurgitation: pathophysiology and indications for surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2006; 9: 147152.CrossRefGoogle Scholar
Mahimarangaiah, J, Subramanian, A, Kikkeri Hemannasetty, S, et al. Transcatheter closure of perimembranous ventricular septal defects with ductal occluders. Cardiol Young 2015; 25: 918926.CrossRefGoogle ScholarPubMed
Gu, MB, You, XH, Zhao, XX, Zheng, X, Li, WP, Qin, YW. Transcatheter closure of perimembranous ventricular septal defects using a novel wire-maintaining technique. Catheter Cardiovasc Interv 2010; 75: 6671.Google ScholarPubMed