Perventricular Device Closure of Perimembranous Ventricular Septal Defect in Pediatric Patients: Technical and Morphological Considerations

Abstract

Background We report our experience of using perventricular device closure (PVDC) in treating perimembranous ventricular septal defect (pm-VSD) with emphasis on technical and morphological considerations.

Method Thirty-one pediatric patients with pm-VSD who underwent successful PVDC were enrolled in this study. The pm-VSDs were divided into three different types (type I: tunnel shape; type II: with subaortic rim < 2 mm; type III: membranous aneurysm formation). Four closure strategies were utilized, corresponding to the morphology of the pm-VSD.

Results Mean age of the patients was 2.1 years with mean VSD diameter 5.8 mm. Seven patients had type I VSD, nine presented with type II, and 15 had type III. Twenty-two concentric and nine eccentric devices were used with mean device size 7.3 mm. Complete closure was achieved in 97% of cases during follow-up. Procedure-induced tricuspid regurgitation (TR) was noted in nine patients at discharge; four resolved. Multivariable analysis showed that the procedure-induced TR was associated with the device size (odds ratio = 5.059; 95% confidence interval = 1.431–17.880).

Conclusion Different closure strategies allow for PVDC of various types of pm-VSDs in selected pediatric patients.

Keywords

perventricular device closure - ventricular septal defect - pediatric patients

Note

This article was presented at the 26th EACTS Annual Meeting, Barcelona, Spain.

• References

• 1 Gessler P, Schmitt B, Prètre R, Latal B. Inflammatory response and neurodevelopmental outcome after open-heart surgery in children. Pediatr Cardiol 2009; 30 (3) 301-305
• 2 Limperopoulos C, Majnemer A, Shevell MI , et al. Predictors of developmental disabilities after open heart surgery in young children with congenital heart defects. J Pediatr 2002; 141 (1) 51-58
• 3 Knauth AL, Lock JE, Perry SB , et al. Transcatheter device closure of congenital and postoperative residual ventricular septal defects. Circulation 2004; 110 (5) 501-507
• 4 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 (4) 508-515
• 5 Carminati M, Butera G, Chessa M, Drago M, Negura D, Piazza L. Transcatheter closure of congenital ventricular septal defect with Amplatzer septal occluders. Am J Cardiol 2005; 96 (12A) 52L-58L
• 6 Tao K, Lin K, Shi Y , et al. Perventricular device closure of perimembranous ventricular septal defects in 61 young children: early and midterm follow-up results. J Thorac Cardiovasc Surg 2010; 140 (4) 864-870
• 7 Xing Q, Pan S, An Q , et al. Minimally invasive perventricular device closure of perimembranous ventricular septal defect without cardiopulmonary bypass: multicenter experience and mid-term follow-up. J Thorac Cardiovasc Surg 2010; 139 (6) 1409-1415
• 8 Bacha EA, Cao QL, Galantowicz ME , et al. Multicenter experience with perventricular device closure of muscular ventricular septal defects. Pediatr Cardiol 2005; 26 (2) 169-175
• 9 Ho SY, McCarthy KP, Rigby ML. Morphology of perimembranous ventricular septal defects: implications for transcatheter device closure. J Interv Cardiol 2004; 17 (2) 99-108
• 10 Penny DJ, Vick III GW. Ventricular septal defect. Lancet 2011; 377 (9771) 1103-1112
• 11 Pedra CA, Pedra SR, Esteves CA , et al. Percutaneous closure of perimembranous ventricular septal defects with the Amplatzer device: technical and morphological considerations. Catheter Cardiovasc Interv 2004; 61 (3) 403-410
• 12 Xing Q, Wu Q, Pan S, Ren Y, Wan H. Transthoracic device closure of ventricular septal defects without cardiopulmonary bypass: experience in infants weighting less than 8 kg. Eur J Cardiothorac Surg 2011; 40 (3) 591-597
• 13 Amin Z, Gu X, Berry JM, Titus JL, Gidding SS, Rocchini AP. Perventricular [correction of Periventricular] closure of ventricular septal defects without cardiopulmonary bypass. Ann Thorac Surg 1999; 68 (1) 149-153 , discussion 153–154
• 14 Schreiber C, Vogt M, Kühn A , et al. Periventricular closure of a perimembranous VSD: treatment option in selected patients. Thorac Cardiovasc Surg 2012; 60 (1) 78-80
• 15 Pan S, Xing Q, Cao Q , et al. Perventricular device closure of doubly committed subarterial ventral septal defect through left anterior minithoracotomy on beating hearts. Ann Thorac Surg 2012; 94 (6) 2070-2075
• 16 Butera G, Carminati M, Chessa M , et al. Transcatheter closure of perimembranous ventricular septal defects: early and long-term results. J Am Coll Cardiol 2007; 50 (12) 1189-1195
• 17 Carminati M, Butera G, Chessa M , et al; Investigators of the European VSD Registry. Transcatheter closure of congenital ventricular septal defects: results of the European Registry. Eur Heart J 2007; 28 (19) 2361-2368
• 18 Butera G, Carminati M, Chessa M , et al. Percutaneous closure of ventricular septal defects in children aged <12: early and mid-term results. Eur Heart J 2006; 27 (23) 2889-2895
• 19 Rigby ML, Redington AN. Primary transcatheter umbrella closure of perimembranous ventricular septal defect. Br Heart J 1994; 72 (4) 368-371
• 20 Holzer R, de Giovanni J, Walsh KP , et al. 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 (4) 620-628
• 21 Gu X, Han YM, Titus JL , et al. Transcatheter closure of membranous ventricular septal defects with a new nitinol prosthesis in a natural swine model. Catheter Cardiovasc Interv 2000; 50 (4) 502-509