Device closure of muscular ventricular septal defects. Between the dates april 2011october 2014, 21 vsd closures with adoii device. Hijazi perimembranous ventricular septal defect pmvsd is the most common congenital heart disease. Dec 28, 2011 in our series, we used tte to guide the intraoperative device closure of the perimembranous vsd, which can provided a useful subcostal window to finish the procedure in the young children. See warnings and precautions in the physician labelingphysician manual and. Brief device description the amplatzer muscular vsd occluder is a selfexpandable, double disc device made from a nitinol wire mesh. In order to increase its closing ability, the discs. A delivery sheath is advanced over the wire across the vsd, via the right or left side of the heart.
Exclusion criteria included case series already included in multicentre studies, sample size vsd acquired following myocardial infarction. Even though surgery is the gold standard, percutaneous device closure is gaining popularity because of the short learning curve, cosmetic advantage and relative safety. However, a relatively high incidence of postprocedure heart blocks pphbs has also incurred attention, as they affect the safety of the procedure and the prognosis of. Materials and method material it was taken for analysis record of all patients diagnosed.
These properties may make it a suitable device for closure of large midmuscular defects in small children. Traditional percutaneous device closure of perimembranous ventricular septal defects pmvsds is a. Successful device closure of a postinfarction ventricular. A developmental defect of the heart occurs from which cyanosis does not ensue in spite of the fact that a communication exists between the cavities of the two ventricles and in spite of the fact that the admixture of venous bloo. D, deployment of a 16mm amplatzer postinfarction ventricular septal defect device sjm, plymouth, mn. Ventricular septal defect vsd is the most common congenital heart disease chd with the perimembranous vsd pmvsd being the most common subtype. The cosmetic results were impressive, which leads to less physical and psychological trauma, and the followup results were promising. Device closure of muscular ventricular septal defects using the amplatzer muscular ventricular septal defect occluder immediate and midterm results of a u. The device is indicated for use in patients with a complex ventricular septal defect of a significant size to warrant closure but that, based on location, cannot be closed with standard transatrial or transarterial approaches. Aug 27, 2010 the aim of this study was to evaluate the safety and efficacy of transcatheter closure for perimembranous ventricular septal defect pmvsd and its longterm results. To identify suitable cases and reduce failurecomplication rates for percutaneous ventricular septal defect vsd closure, we aimed to 1 study causes of device failure and 2 compare outcomes with different vsd types and devices in a highvolume single center with limited resources. Device description the amplatzer muscular vsd occluder is a selfexpanding, doubledisc device made from a nitinol wire mesh. To close the hole, the doctor will place a special device in your childs heart by catheterization.
Methods and results since 1989, 170 patients median age, 3. It fixes a hole between the left and right ventricles of the heart, without making an incision in the chest wall. Cardiac catheterization with vsd cooper university health care. During the procedure a device was attempted which was too small. Transcatheter closure of a midmuscular ventricular septal. Toe for percutaneous closure of septal defect asd, vsd.
An overview of device closure of ventricular septal. There are many reports on the use of transesophageal echocardiography tee for transcatheter guidance or periventricular placement of a vsd closure device 3,4,6. The device is deployed in an apical ventricular septal defect, and 2 additional ventricular septal defects are evident close to the mitral valve single arrow. This work is a single working group with longterm follow up. Transcatheter device matches surgery for closure of.
An atrial septal defect is a hole between the two upper chambers of the heart. A second attempt was made to reposition the device but failed. T1 transcatheter device closure of congenital ventricular septal defects. However, this serious event appears to be underrecognized and is worth being investigated further.
This leads to a shorter recovery, less pain and a quicker return to normal activities. Echocardiographyguided percutaneous closure of perimembranous ventricular septal defects without arterial access and fluoroscopy haisong bu1, yifeng yang1, qin wu2, wancun jin2 and tianli zhao1 abstract background. Transcatheter closure of a ventricular septal defect vsd with a prosthesis called the rashkind patent ductus arteriosis occluder system allows closure of the vsd without the possible. Transcatheter closure of ventricular septal defect and atrial septal. However, a relatively high incidence of post procedure heart blocks pphbs has also incurred attention, as they affect the safety of the procedure and the prognosis of.
Although surgical closure remains the mainstay of treatment for most ventricular septal defects vsds, some defects cannot be adequately approached without a. Percutaneous perventricular device closure of ventricular septal. The septum is a wall that separates the hearts left and right sides. Transcatheter closure of perimembranous ventricular septal. After the procedure, heart failure was controlled and the patient was discharged without complications. The experience of transcatheter closure of postoperative. This is the first report on device closure of postinfarction vsd in korea. Pdf transcatheter device closure of muscular ventricular septal. Intraoperative device closure of a perimembranous ventricular.
Vsd device was implanted via perventricular route after sternotomy. Eventually, it can work so hard that it starts to fail congestive heart failure. Background our purpose was to describe a year experience with patients undergoing transcatheter device closure of unrepaired congenital or postoperative residual ventricular septal defects vsds. Do not release the amplatzer postinfarct muscular vsd occluder from the delivery cable if the device does not. Ventricular septal defect vsd is a common congenital heart defect in both children and adults. Ventricular septal defect henri roger was the first man to describe a ventricular septal defect, in 1879 he wrote. Its the most common congenital heart defect in the newborn. Jan 04, 2014 apical muscular vsd patch closure via rvtomy a trabeculations overlying the vsd are taken down. Percutaneous device closure of perimembranous ventricular septal defect pmvsd has shown great promise since the year 2002 as a viable alternative to surgical closure. Pediatric pda closure devices childrens national hospital.
Ado ii in percutaneous vsd closure in pediatric patients. This technique avoids the injuries caused by cpb and radiograph exposure and is not limited by the diameter of blood vessels. Cardiac catheterization using a vsd closure device is a procedure to close a hole ventricular septal defect or vsd in the wall septum that separates the hearts left and right ventricles pumping chambers. Atrial septal defect asd is a common congenital cardiac anomaly. Ventricular septal defect vsd american heart association. The amplatzer muscular vsd occluder received fda approval through the pma process on september 7, 2007. Intraoperative device closure of perimembranous ventricular. Transcatheter closure of perimembranous ventricular septal defects using the new amplatzer membranous vsd occluder. Complications in atrial septal defect device closure. Atrial and ventricular septal defects device closure in a. Phase i trial yunching fu, john bass, zahid amin, wolfgang radtke, john p. The median size of the primary vsd was 7 mm range 3 to 16 mm and in 34 of 78 43.
Pediatric cardiothoracic surgery ventricular septal defect. The device is sterilized using ethylene oxide and is for singl e use only. A ventricular septal defect vsd is a hole in the part of the septum that separates the ventricles the lower chambers of the heart. A 5 year old girl with a haemodynamically significant midmuscular ventricular septal defect vsd had successful transcatheter closure using the amplatzer vsd occluder. Transcatheter closure of acute myocardial infarction vsd. While spontaneous closure rates are high, surgical repair may be indicated during early infancy in case of severe pulmonary hypertension, or failure to thrive despite optimal medical management. A ventricular septal defect vsd is a defect in the septum between the right and left ventricle. Since the first time when ventricular septal defect vsd was surgically closed by lillehei et al. Twentypatientswereincluded,agerangedbetween4months18years. Aga medical corporation amplatzer muscular vsd occluder.
Percutaneous closure of postinfarction ventricular septal defect. Percutaneous ventricular septal defect closure procedure the implantation procedure for these occluders has been described in detail previously. A pubmed and scopus search for studies in english on device closure of pmvsds published till endfebruary 2017 was performed. The 2 discs are linked together by a short waist corresponding to the size of the ventricular septal defect vsd. Device closure of muscular ventricular septal defects using. Transcatheter device closure of postoperative vsd can be. Double disk umbrella helex coils asd vsd amplatzer figulla. The majority of patients were perimembranous vsd n. In this paper perimembranous vsd closure with nit occlud device coil reported.
Complete atrioventricular block cavb has been deemed a rare complication after transcatheter closure for ventricular septal defect vsd. Table 1 basic clinical characteristics of cases sex weight kg age of operation age of device closure original chdoperation reasons of residual vsd closure indication devicesize combined procedure immediate leak fu period year last echo cardiac 1 m 55. However, this method has been challenged for the past 10 years by percutaneous transcatheter device closure. Attempts to resterilize the device may result in device malfunction, inadequate sterilization, or patient harm. Vsd can occur as a complication of acute myocardial infarction in approximately 1%2% of cases in the first week. Septal defects are sometimes called a hole in the heart. Research article open access intraoperative device closure of. Percutaneous device closure of congenital isolated. We limited the device closure to young patients weighing more than 5 kg, with perimembranous vsds of less than 10 mm diameter with a sufficient subaortic rim. If the hole is too big to close with the device or in the wrong position, the hole will be closed with surgery. Transcatheter closure of pmvsd is a recently described technique with limited results for mid to longterm followup. Minimally invasive transthoracic device closure of isolated.
Echocardiographic and fluoroscopic guidance are used to guide the occluder. Ventricular septal defect transcatheter repair for children. Holzer et al, device closure of post infarct vsd, catheter cardiovasc interv 2004. Using a catheterbased procedure, we are able to avoid surgery. The two discs are linked together by a short cylindrical waist corresponding to the size of the ventricular septal defect vsd. Device closure of secundum atrial septal defects is sometimes needed in young children. An overview of device closure of ventricular septal defects. Meanwhile, the procedure requires no advanced or expensive equipment, and the cost is acceptable in lowincome nations. Particularly in the treatment of doubly committed subarterial vsd, which has been a contraindication to percutaneous transcatheter device closure because of. The acute procedure success closure results by device is the number of devices with a less than or equal to a 2mm residual shunt immediately postprocedure.
Device closure of atrial septal defects with the amplatzer septal occluder. However, combining both of these procedures in one session has been described only by narin et al. A multicenter us trial involving 83 procedures in 75 patients who underwent muscular vsd device closure showed successful implantation in 86. Research article open access intraoperative device. Complete atrioventricular block after percutaneous device. Based on the clinical experience of a number of centers, we used the right thoracic minimal incision to right ventricle approach for intraoperative device closure of a perimembranous vsd pmvsd and compared the safety and effectiveness of this approach with that of the. An interventional approach using a device is a less invasive option for these patients. Standard treatment for pmvsd is open surgery, which is widely performed with minimal operative mortality but still carries risks, such as. N2 ventricular septal defects vsd are among the most commonly occurring congenital heart lesions. Ventricular septal defect transcatheter repair for. The hole allows oxygenrich blood to flow from the left ventricle into the right ventricle instead of flowing into the aorta and out to the body as it should. Intraoperative device closure of isolated ventricular septal. Ado ii in percutaneous vsd closure in pediatric patients nazmi narin, m.
Transcatheter membranous ventricular septal defect closure. About 10 min after deployment, the device displaced from the site and left to right shunt increased. Percutaneous device closure of asd and vsd has been well described in literature, and has now become a standard procedure. Retrospective data of 412 elective percutaneous vsd closure of isolated congenital vsds between 2003 and 2017. Transcatheter versus surgical closure of perimembranous. The two discs are linked together by a short cylindrical waist corresponding to the size of the ventricular septal.
The amplatzer device is the most advanced device of its type available in the united states. Percutaneous device closure of congenital vsds cardiac. Transcatheter device closure of perimembranous ventricular. Most common congenital heart disease in both adults and children prevalence.
While spontaneous closure rates are high, surgical repair may be indicated during early infancy in case of severe pulmonary hypertension, or failure to thrive despite optimal medical. Device closure of perimembranous ventricular septal defect. Current techniques and results for treating ventricular septal defects. Patients were selected for device closure if they had 1 1 or more vsds that were ascertained to result in sufficient hemodynamic derangement to warrant intervention and 2 either a type of vsd that was technically difficult to close surgically or an overall medical condition with associated surgical risks sufficient to justify the known and.
The most common congenital heart condition is pmvsd. Transcatheter device closure and surgical repair are effective interventions with excellent. Transcatheter device closure of congenital ventricular. Risk factors and outcomes of postprocedure heart blocks. B interrupted pledgetted sutures are placed full thickness at the superior margin of the defect, maintaining the pledgets on the left ventricular side c closure of the vsd with a dacron patch 68. This device passes through a small diameter sheath and can be easily retrieved or repositioned. Mar 26, 2018 in conclusion, the intraoperative device closure of a vsd on a beating heart is a safe and feasible alternative to conventional surgical repair and transcatheter device closure. Percutaneous closure of postinfarction ventricular septal. The appearance of a complete av block hours after the procedure was likely related with an inflammatory process related to the device. This hole causes the heart to work harder and pump more blood than normal. As it was being observed it gradually got detached and embolised into the right ventricle. Repeat procedure 2 1 30 day mortality 28% 28% 4 326 days 4 5 polish experience n. In our series, we used tte to guide the intraoperative device closure of the perimembranous vsd, which can provided a useful subcostal window to finish the procedure in the young children.
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