Premium
Percutaneous closure of perimembranous ventricular septal defects with the Amplatzer device: Technical and morphological considerations
Author(s) -
Pedra Carlos A.C.,
Pedra Simone R.F.,
Esteves Cesar A.,
Pontes Sérgio C.,
Braga Sérgio L.N.,
Arrieta S. Raul,
Santana M. Virgínia T.,
Fontes Valmir F.,
Masura Jozef
Publication year - 2004
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.10797
Subject(s) - medicine , percutaneous , regurgitation (circulation) , cardiology , aortic valve , catheter , ventricular outflow tract , embolization , cardiac catheterization , tricuspid valve , heart septal defect , surgery
Percutaneous closure of perimembranous ventricular septal defects (VSDs) has been feasible, safe, and effective with the new Amplatzer membranous septal occluder. We report further experience with this device with emphasis on morphological aspects of the VSDs and technical issues. Ten patients (median age and weight, 14 years and 34.5 kg, respectively) with volume‐overloaded left ventricles underwent closure under general anesthesia and transesophageal guidance (TEE). The VSD diameter was 7.1 ± 4.0 mm by angiography and 7.8 ± 3.7 mm by TEE. Three patients had defects associated with aneurysm‐like formations (two with multiple exit holes), four had defects shrouded by extensive tricuspid valve tissue, two had defects with little or no tricuspid valve involvement, and one had a right aortic cusp prolapse with trivial aortic regurgitation. Implantation was successful in all patients, although in two the initial device had to be changed for a larger one. Kinkings in the delivery sheath, inability to position the sheath near the left ventricular apex, and device prolapse through the VSD prompted modifications in the standard technique of implantation. Device orientation was excellent except in one case. Nine patients had complete occlusion within 1–3 months. Device‐related aortic or tricuspid insufficiency, arrhythmias, and embolization were not observed. Two patients had slight gradients across the left ventricular outflow tract, normalizing after 3 months. The Amplatzer membranous septal occluder was suitable to close a wide range of perimembranous VSD sizes and morphologies with good short‐term outcomes. Longer follow‐up is required. Catheter Cardiovasc Interv 2004;61:403–410. © 2004 Wiley‐Liss, Inc.