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The Amplatzer® Membranous VSD Occluder and the vulnerability of the atrioventricular conduction system

Published online by Cambridge University Press:  01 October 2007

Gunther Fischer*
Affiliation:
Klinik für Kinderkardiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany
Sotiria C. Apostolopoulou
Affiliation:
Department of Paediatric Cardiology, Onassis Cardiac Surgery Centre, Athens, Greece
Spyros Rammos
Affiliation:
Department of Paediatric Cardiology, Onassis Cardiac Surgery Centre, Athens, Greece
Martin B. Schneider
Affiliation:
Deutsches Kinderherzzentrum, Sankt Augustin, Germany
Per G. Bjørnstad
Affiliation:
Paediatric Cardiology, Rikshospitalet – The National Hospital, University of Oslo, Oslo, Norway
Hans Heiner Kramer
Affiliation:
Klinik für Kinderkardiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany
*
Corresponence to: Dr. Gunther Fischer, Klinik für Kinderkardiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schwanenweg 20, D-24105 Kiel, Germany. Tel: +49 431 597 1622; Fax: +49 431 597 1828; E-mail: fischer@pedcard.uni-kiel.de

Abstract

Transcatheter closure of ventricular septal defects with the Amplatzer® Membranous VSD Occluder has yielded promising initial results, but disturbances of conduction, including complete heart block, have been reported. We report our experience with the Amplatzer occluder in 35 patients with a median age 4.5 years, the defects being sized angiographically at 4.4 plus or minus 1.1 millimetres, with a range from 3 to 8 millimetres, and the size of the occluder varying from 4 to 12 millimetres. Over a median follow-up of 2.5 years, the rate of complete closure was 87% and 91%, at 1 and 2 years respectively, while 2 patients required surgical closure of the defect subsequent to the insertion of the device. Persistent regurgitation across the tricuspid valve related to the occluder was observed in 3 patients, and in 6 patients across the aortic valve. Abnormalities of conduction related to the procedure were noted in 7 patients, one-fifth of the cohort. The disturbances were transient in 1 patient, but permanent in 6, in one of the latter progressing after 6 months from left bundle branch block to intermittent Mobitz II second-degree atrioventricular block in association with expansion of the occluder. We conclude that transcatheter closure of perimembranous ventricular septal defects with the Amplatzer occluder is effective with limited complications, but the incidence of immediate and progressive disturbances of conduction related to the proximity of conduction tissues to the rims of the occluder stress the importance of larger and longer studies to assess the safety of this procedure.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2007

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