Percutaneous closure of perimembranous and postsurgical ventricular septal defects with Amplatzer Duct Occluder II Additional Sizes in paediatric patients – case series

Introduction

Perimembranous ventricular septal defect (pmVSD), one of the most frequent congenital heart defects, requires surgical (gold standard) or transcatheter closure in a considerable number of children. In general, the results of surgical correction are excellent; however, in 2.5% of patients residual postsurgical VSDs (psVSD) are reported [1]. There have been numerous attempts to close pmVSD with various devices, with different efficacy and safety rates [2]. The percutaneous closure of psVSD, sometimes of atypical anatomy, was also reported in the literature [3]. The transcatheter treatment of pmVSD remains a controversial problem. The main issues are the risk of embolization, early and late conduction disturbances, damage to the tricuspid valve apparatus or aortic insufficiency [4]. Numerous devices have been proposed for percutaneous pmVSD closure, including the off-label use of Amplatzer muscular VSD occluders, Amplatzer duct occluders type I and II (ADO I, II) or ADOII Additional Sizes (ADO II AS) [2, 5–7]. To the best of our knowledge, there have been only two previous publications from this and the previous year regarding this application of ADO II AS in children – 1 case report [6] and 1 presentation of a series of 4 cases [7].

Aim

To present our preliminary experience with ADO II AS used for the transcatheter closure of 4 pmVSDs and 2 psVSDs.

Material and methods

All patients were qualified for percutaneous VSD closure by a team of paediatric cardiologists and cardiac surgeons based on clinical symptoms of increased pulmonary flow (chest X-ray) and/or echocardiographic signs of LV volume overload. All patients had a Qp/Qs ratio > 1.5. Written informed consent was obtained from the parents prior to the procedures.

Device

ADO II AS (St. Jude Medical, Inc., USA) is a device originally designed for arterial duct closure. Briefly, it is a symmetrical, self-expanding, single mesh layer Nitinol occluder. There are three different waist-disc diameters available (3 mm – 4 mm, 4 mm – 5.25 mm, 5 mm – 6.5 mm), each available with three different waist lengths (2, 4 and 6 mm). A dedicated Amplatzer TorqVue LP 4 French catheter is recommended for the deployment procedure. ADO II AS and its dedicated delivery catheter are characterized by soft construction – this feature is of special importance due to procedural manoeuvres carried out in the proximity of the conduction system and tricuspid valve apparatus....


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