Hostname: page-component-76fb5796d-2lccl Total loading time: 0 Render date: 2024-04-26T11:45:28.829Z Has data issue: false hasContentIssue false
  • English
  • Français

Transcatheter device closure of perimembranous ventricular septal defect in children treated with prophylactic oral steroids: acute and mid-term results of a single-centre, prospective, observational study

Published online by Cambridge University Press:  24 June 2015

Bhavesh Thakkar ,
Nehal Patel ,
Shomu Bohora ,
Dharmin Bhalodiya ,
Tarandeep Singh ,
Tarun Madan ,
Saurin Shah ,
Vishal Poptani  and
Anand Shukla
Bhavesh Thakkar*
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research CentreAhmedabad, Gujarat, India
Nehal Patel
Affiliation:
Department of Pediatrics, GMERS Medical College, Ahmedabad, Gujarat, India
Shomu Bohora
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research CentreAhmedabad, Gujarat, India
Dharmin Bhalodiya
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research CentreAhmedabad, Gujarat, India
Tarandeep Singh
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research CentreAhmedabad, Gujarat, India
Tarun Madan
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research CentreAhmedabad, Gujarat, India
Saurin Shah
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research CentreAhmedabad, Gujarat, India
Vishal Poptani
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research CentreAhmedabad, Gujarat, India
Anand Shukla
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research CentreAhmedabad, Gujarat, India
*
Correspondence to: Dr B. Thakkar, Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Asarwa, Ahmedabad 380016, Gujarat, India. Tel: +91 9898022444; Fax: +91 (79) 22682092; E-mail: bthakkarin@yahoo.co.in
Get access Rights & Permissions [Opens in a new window]

Abstract

Background and Objective

Although transcatheter closure of perimembranous ventricular septal defect is emerging as an accepted, viable alternative, conduction disturbances still remain a major concern. Although steroid treatment has shown encouraging results with complete recovery, efficacy of prophylactic use of steroids is still speculative. We aim to study the mid-term outcome of perimembranous ventricular septal defect closure in children who received prophylactic oral steroids.

Materials and methods

A prospective study was designed and antegrade device closure was attempted in eligible children who met the following inclusion criteria: age 3–18 years and weight >10 kg, defect diameter ⩽12 mm, and symptomatic, haemodynamic changes or history of infective endocarditis. Prophylactic steroid protocol consisted of 2 weeks oral prednisolone (1 mg/kg/day) initiated immediately after the procedure, and in the event of bradyarrhythmia it was escalated to 2 mg/kg. Patients were regularly followed-up at 1, 6, and 12 months and then annually. Patients with post-procedure heart block underwent Holter monitoring after a minimum of 1 year interval.

Results

Between May, 2007 and August, 2012, successful device closure was accomplished in 290/297 patients. Mean age and weight were 9±3.12 years and 21±8.27 kg, respectively. The defect measured 5±1.38 mm on echocardiography. Mean fluoroscopy time was 12.98±8.64 minutes. Eight patients with major complications included one each with device embolisation, haemolysis, severe aortic regurgitation, and five with bradyarrhythmias, including complete atrioventricular block in three, Mobitz II in one, and bifascicular block in one. Patients with complete atrioventricular block responded to high-dose steroid and temporary pacemaker. Minor complications included post-procedure heart block (n=22) and blood loss (n=2). At 18.23±13.15 months follow-up, 8/27 (five major, 22 minor) with arrhythmia had persistent post-procedure heart block of no clinical consequences.

Conclusion

In our patient population, transcatheter device closure of the perimembranous ventricular septal defect with prophylactic oral steroid resulted in excellent closure rate and acceptably low incidence of conduction disturbances at mid-term follow-up.

Keywords

Perimembranous VSDsteroidstranscatheter closure
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 4 , April 2016 , pp. 669 - 676
Check for updates
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Hoffman, JIE. Incidence of congenital heart disease: I. Postnatal incidence. Pediatr Cardiol 1995; 16: 103–113.CrossRefGoogle ScholarPubMed
2. Yang, J, Li, F, Yang, YW. Transcatheter device closure of perimembranous ventricular septal defects: mid-term outcomes. Eur Heart J 2010; 31: 2238–2245.CrossRefGoogle ScholarPubMed
3. Zhou, D, Pan, W, Guan, L. Transcatheter closure of perimembranous and intracristal ventricular septal defects with the SHSMA occluder. Catheter Cardiovasc Interv 2012; 79: 666–674.CrossRefGoogle ScholarPubMed
4. Yang, R, Kong, XQ, Sheng, YH. Risk factors and outcomes of post-procedure heart blocks after transcatheter device closure of perimembranous ventricular septal defect JACC. Cardiovasc Interv 2012; 5: 424–427.Google Scholar
5. Masura, J, Gao, W, Gavora, P, et al. Percutaneous closure of perimembranous ventricular septal defects with the eccentric Amplatzer device: multicenter followup study. Pediatr Cardiol 2005; 26: 216–219.CrossRefGoogle Scholar
6. Pan, L, Zhao, X. Arrhythmias after transcather closure of perimembranous ventricular septal defect with a modified double disc occluder: early and long term results. Heart Vessels 2012; 27: 405–410.Google Scholar
7. William, YC, Zimmerman, F, Hijazi, ZM. Heart block and empirical therapy after transcatheter closure of perimembranous ventricular septal defect. Catheter Cardiovasc Interv 2005; 66: 436–441.Google Scholar
8. Yip, WC, Zimmerman, F. Heart block and empirical therapy after transcatheter closure of perimembranous ventricular septal defect. Catheter Cardiovasc Interv 2005; 66: 436–441.CrossRefGoogle ScholarPubMed
9. Gu, MB, You, XH, Zhao, XX. Transcatheter closure of perimembranous ventricular septal defects using a novel wire-maintaining technique. Catheter Cardiovasc Interv 2010; 75: 66–71.CrossRefGoogle ScholarPubMed
10. Anderson, RH, Ho, SY, Becker, AE. Anatomy of the human atrioventricular junctions revisited. Anat Rec 2000; 260: 81–91.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
11. Latham, RA, Anderson, RH. Anatomical variations in atrioventricular conduction system with reference to ventricular septal defect. Br Heart J 1972; 34: 185–190.CrossRefGoogle Scholar
12. Holzer, R, de Giovanni, J. Transcatheter closure of perimembranous ventricular septal defects using the Amplatzer membranous VSD occluder: immediate and midterm results of an international registry. Catheter Cardiovasc Interv 2006; 68: 620–628.CrossRefGoogle ScholarPubMed
13. Carminati, M, Butera, G. Transcatheter closure of congenital ventricular septal defects: results of the European registry. Eur Heart J 2007; 28: 2361–2368.CrossRefGoogle ScholarPubMed
14. Fischer, G, Apostolopoulou, SC. The Amplatzers membranous VSD occluder and the vulnerability of the atrioventricular conduction system. Cardiol Young 2007; 17: 499–504.CrossRefGoogle Scholar
15. Predescu, D, Chaturvedi, RR. Complete heart block associated with device closure of perimembranous ventricular septal defects. J Thorac Cardiovasc Surg 2008; 136: 1223–1228.CrossRefGoogle ScholarPubMed
16. Andersen, H, Leval, MR, Tsang, VT, et al. Is complete heart block after surgical closure of ventricular septum defects still an issue? Ann Thorac Surg 2006; 82: 948–957.CrossRefGoogle ScholarPubMed
17. Bol-Raap, G, Weerheim, J, Kappetein, AP, Witsenburg, M, Bogers, AJ. Follow-up after surgical closure of congenital ventricular septal defect. Eur J Cardiothorac Surg 2003; 24: 511–515.CrossRefGoogle ScholarPubMed
18. Chen, Q, Cao, H, Zhang, GC. Atrioventricular block of intra-operative device closure perimembranous ventricular septal defects; a serious complication BMC Cardiovasc Disord 2012; 12: 21.CrossRefGoogle Scholar
19. Holzer, R, de Giovanni, J, Walsh, KP, Tometki, A, Goh, T, Hakim, F. Transcatheter closure perimembranous ventricular septal defects using the Amplatzer membranous VSD occluder: immediate and mid-term results of an international registry. Catheter Cardiovasc Interv 2006; 68: 620–628.CrossRefGoogle Scholar
20. Qin, Y, Chen, J, Zhao, X. Transcatheter closure of perimembranous ventricular septal defect using a modified double-disk occluder. Am J Cardiol 2008; 101: 1781–1786.CrossRefGoogle ScholarPubMed
21. Zhou, T, Shen, XQ, Zhou, SH. Complications associated with transcatheter closure of perimembranous ventricular septal defects. Catheter Cardiovasc Interv 2008; 71: 559–563.CrossRefGoogle ScholarPubMed
22. Fischer, G, Apostolopoulou, SC, Rammos, S, Schneider, MB, Bjornstad, PG, Kramer, HH. The Amplatzer membranous VSD occluder and the vulnerability of the atrioventricular conduction system. Cardiol Young 2007; 17: 499–504.CrossRefGoogle ScholarPubMed
23. Li, X, Li, L, Wang, X. Clinical analysis of transcatheter closure of perimembranous ventricular septal defects with occluders made in China. Chin Med J 2011; 124: 2117–2122.Google ScholarPubMed
24. Walsh, MA, Bialkowski, J, Szkutnik, M, Pawelec-Wojtalik, M, Bobkowski, W, Walsh, KP. Atrioventricular block after transcatheter closure of perimembranous ventricular septal defects. Heart 2006; 92: 1295–1297.CrossRefGoogle ScholarPubMed