Safety and efficacy of amplatzer duct occluder for percutaneous closure of ventricular septal defects with tunnel shape aneurysm: Medium term follow up

Muhammad Dilawar, Zaheer Ahmad

Hamad General Hospital, Doha, Qatar.
Southampton University Hospital, Southampton, UK.

DOI: 10.4236/wjcd.2013.32035                

Abstract

Objectives: Different devices including Amplatzer duct occluder has been used for percutaneous closure of ventricular septal defects. This study reports our medium term follow up of perimembranous and muscular ventricular septal defects with tunnel shape aneurysm closure using the Amplatzer duct occluder. Materials and Methods: From May 2006-December 2012, we used Amplatzer duct occluder in seven ventricular septal defect patients here atHamad General Hospital,Doha,Qatar. There were 4 male and 3 female patients with an age range of 4 - 32 years with a median of 8 years and weight range of 16 - 63 kgwith a median of33 kg. In this group, 6 were perimembranous and 1 muscular and all these ventricular septal defects had a tunnel shape aneurysm. Transesophageal echocardiographic diameter ranged from 4 - 8 mmand Qp/Qs was 1 - 1.6. Angiographically, the diameter on the left ventricular side measured 3.5 - 10 mmand on right ventricular side 2.4 - 5 mm. 8/6 mmAmplatzer duct occluder was used to close these ventricular septal defects. Results: There were no major complications and immediately after the procedure there was no residual shunt in any of these patients and all the patients remained in normal sinus rhythm. One patient was expatriate and no further follow up was available. The rest of the 6 patients had 1 - 80 months with a median of 54 months follow up and none of these patients had any residual shunt and all remained in normal sinus rhythm. Two patients developed trivial aortic valve regurgitation immediate post procedure, one remained unchanged and the 2^nd has progressed to mild at this latest follow up. Conclusion: Amplatzer duct occluder is feasible and a safe device for percutaneous closure of selective tunnel shape aneurysmal perimembranous and muscular ventricular septal defects.

Keywords

Ventricular Septal Defect; Amplatzer Duct Occluder; Aneurysm

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Mavroudis, C., Backer, C.L. and Jacobs, J.P. (2003) Ventricular septal defect. 3rd Edition, Pediatric Cardiac Surgery, Mosby, Philadelphia, 298-320.
[2]	Ross-Hesselink, J.W., Mejiboom, F.J., Spitaels, S.E.C., et al. (2004) Outcome of patients after surgical closure of ventricular septal defect at young age: Longitudinal follow-up of 22 34 years. European Heart Journal, 25, 1057-1062.
[3]	Lillehei, C.W., Cohen, M., Warden, H.E. and Varco, R.L. (1955) The results of direct vision closure of ventricular septal defects in eight patients by means of controlled cross circulation. Surgery Gynecology & Obstetrics, 101, 447.
[4]	Nygren, A., Sunnegardh, J. and Berggren, H. (2000) Preoperative evaluation and surgery in isolated ventricular septal defects: A 21 year perspective. Heart, 83, 198-204. doi:10.1136/heart.83.2.198
[5]	Bol-Raap, G., Weerheim, J., Kappetein, A.P., Witsenburg, M. and Bogers, A.J. (2003) Follow-up after surgical closure of congenital ventricular septal defect. The European Journal of Cardio-Thoracic Surgery, 24, 511-515. doi:10.1016/S1010-7940(03)00430-5
[6]	Lock, J.E., Block, P.C., McKay, R.G., Baim, D.S. and Keane, J.F. (1988) Transcatheter closure of ventricular septal defects. Circulation, 78, 361-368. doi:10.1161/01.CIR.78.2.361
[7]	Fu, Y.C., Bass, J., Amin, Z., Radtke, W., Cheatham, J.P., Hellenbrand, W.E., Balzer, D., Cao, Q.L. and Hijazi, Z.M. (2006) Transcatheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: Results of the US phase I trial. Journal of the American College of Cardiology, 47, 319325. doi:10.1016/j.jacc.2005.09.028
[8]	Pinto, R.J., Dalvi, B.V. and Sharma, S. (2006) Transcatheter closure of perimembranous ventricular septal defects using Amplatzer asymmetric ventricular septal defect occluder: Preliminary experience with 18-month follow up. Catheterization and Cardiovascular Interventions, 68, 145-152.
[9]	Pedra, C.A., Pedra, S.R., Esteves, C.A., Pontes, S.C., Braga, S.L., Arrieta, S.R., Santana, M.V., Fontes, V.F. and Masura, J. (2004) Percutaneous closure of perimembranous ventricular septal defects with the Amplatzer device. Technical and morphological considerations. Catheterization and Cardiovascular Interventions, 61, 403-410. doi:10.1002/ccd.10797
[10]	Dilawar, M., Numan, M., El-Sisi, A., Gendi, S.M. and Ahmad, Z. (2008) Percutaneous closure of ventricular septal defects associated with tunnel shape aneurysm using Amplatzer duct occluder. Pediatric Cardiology, 29, 366-370. doi:10.1007/s00246-007-9092-0
[11]	Hobbins, S.M., Izukawa, T., Radford, D.J., Williams, W.G. and Trusler, G.A. (1979) Conduction disturbances after surgical correction of ventricular septal defect by the atrial approach. British Heart Journal, 41, 289-293. doi:10.1136/hrt.41.3.289
[12]	Bol-Raap, G., Weerheim, J., Kappetein, A.P., Witsenburg, M. and Bogers, A.J. (2003) Follow-up after surgical closure of congenital ventricular septal defects. European Journal Cardio-Thoracic Surgery, 24, 511-515. doi:10.1016/S1010-7940(03)00430-5
[13]	Bian, C., Ma, J., Wang, J., Xu, G., Jiang, J., Yao, S. and Liu, Y. (2011) Perimembranous ventricular septal defect with aneurysm: Two options for transcatheter closure. Texas Heart Institute Journal, 38, 528-532.
[14]	Yilmaz, A.T., Ozal, E., Arslan, M., Tatar, H., Ozturk, O.Y. (1997) Aneurysm of the membranous septum in adult patients with perimembranous ventricular septal defect. The European Journal of Cardio-Thoracic Surgery, 11, 307-311. doi:10.1016/S1010-7940(96)01058-5
[15]	Knauth, A.L., Lock, J.E., Perry, S.B., McElhinney, D.B., Gauvreau, K., Landzberg, M.J., Rome, J.J., Hellenbrand, W.E., Ruiz, C.E. and Jenkins, K.J. (2004) Transcatheter device closure of congenital and postoperative residual ventricular septal defects. Circulation, 110, 501. doi:10.1161/01.CIR.0000137116.12176.A6
[16]	Butera, G., Carminati, M., Chessa, M., Piazza, L., Micheletti, A., Negura, D.G., Abella, R., Giamberti, A. and Frigiola, A. (2007) Transcatheter closure of perimembranous ventricular septal defects: Early and long-term results. Journal of the American College of Cardiology, 50, 1189. doi:10.1016/j.jacc.2007.03.068
[17]	Sullivan, I.D. (2007) Transcatheter closure of perimembranous ventricular septal defect: Is the risk of heart block too high a price? Heart, 93, 284-286. doi:10.1136/hrt.2006.103671
[18]	Predescu, D., Chaturvedi, R.R., Friedberg, M.K., Benson, L.N., Ozawa, A. and Lee, K.J. (2008) Complete heart block associated with device closure of perimembranous ventricular septal defects. The Journal of Thoracic and Cardiovascular Surgery, 136, 1223-1228. doi:10.1016/j.jtcvs.2008.02.037
[19]	Walsh, M.A., Bialkowski, J., Szkutnik, M., Pawelec-Wojtalik, M., Bobkowski, W. and Walsh, K.P. (2006) Atrioventricular block after transcatheter closure of perimembranous ventricular septal defects. Heart, 92, 1295-1297. doi:10.1136/hrt.2005.084988
[20]	Yip, W.C., Zimmerman, F. and Hijazi, Z.M. (2005) Heart block and empirical therapy after transcatheter closure of perimembranous ventricular septal defect. Catheterization and Cardiovascular Interventions, 66, 436-441. doi:10.1002/ccd.20512
[21]	Tan, C.A., Levi, D.S. and Moore, J.W. (2005) Percutaneous closure of perimembranous ventricular septal defect associated with a ventricular septal aneurysm using the Amplatzer ductal occluder. Catheterization and Cardiovascular Interventions, 66, 427-431. doi:10.1002/ccd.20499
[22]	Chojnicki, M., Haponiuk, I., Jaworski, R., Jusciński, J., Steffek, M., Sroka, M. and Palkowska, L. (2011) [Intraoperative imaging of hybrid procedure for muscular ventricular septal defects closure with Amplatzer duct occluder II]. Kardiologia Polska, 69, 1280-1281.
[23]	Ramakrishnan, S., Saxena, A. and Choudhary, S.K. (2011) Residual VSD closure with an ADO II device in an infant. Congenital Heart Disease, 6, 60-63. doi:10.1111/j.1747-0803.2010.00468.x
[24]	Ergene, O., Nazli, C., Kocabas, U., Duygu, H., Akyildiz, Z.I. and Hijazi, Z.M. (2011) Percutaneous closure of perimembranous ventricular septal defect with an Amplatzer duct occluder in a dextrocardia patient. The International Journal of Cardiology, 150, e77-e80. doi:10.1016/j.ijcard.2009.11.016
[25]	Stapleton, G.E., Carlson, K.M. and Justino, H. (2006) Transcatheter occlusion of a residual muscular ventricular septal defect using an Amplatzer duct occluder in a child with congenitally corrected transposition of the great arteries. Catheterization and Cardiovascular Interventions, 68, 296-300. doi:10.1002/ccd.20850
[26]	Michel-Behnke, I., Le, T.P., Waldecker, B., Akintuerk, H., Valeske, K. and Schranz, D. (2005) Percutaneous closure of congenital and acquired ventricular septal defects-Considerations on selection of the occlusion device. Journal of Interventional Cardiology, 18, 89-99. doi:10.1111/j.1540-8183.2005.04051.x