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Percutaneous closure of ventricular septal defects

Published online by Cambridge University Press:  20 April 2007

Gianfranco Butera ,
Massimo Chessa  and
Mario Carminati
Gianfranco Butera
Affiliation:
Pediatric Cardiology – IRCCS Policlinico San Donato, Milan, Italy
Massimo Chessa
Affiliation:
Pediatric Cardiology – IRCCS Policlinico San Donato, Milan, Italy
Mario Carminati
Affiliation:
Pediatric Cardiology – IRCCS Policlinico San Donato, Milan, Italy
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Abstract

Background: Surgical closure of ventricular septal defects has been performed for many years, and is considered as the gold standard for treatment. It remains associated with morbidity and mortality. Transcatheter techniques have been developed in the last 10 years as a possible alternative to conventional surgery. Methods: The procedure is performed under general anaesthesia, and with continuous fluoroscopic and transesophageal echocardiographic guidance. Devices of the Amplatzer family, two in particular, have achieved a large popularity in clinical practice, and are currently the devices most commonly used to close muscular and perimembranous ventricular septal defect percutaneously. Results: Data from literature show that successful closure of muscular defects is obtained in around 96% of patients, with a rate of major complication of around 2%. Pooling data from the literature shows that successful closure of perimembranous defects is also obtained in 96% of patients, again with major acute complications in around 2%. The major problem is the occurrence of complete atrioventricular block, reported in 1.7% of subjects. Acquired defects can occur as residual leaks after surgical closure, or as consequence of myocardial infarction. There are very few data concerning percutaneous closure of postoperative residual defects. As for the surgical approach, in patients with post-myocardial defects the success rate of percutaneous closure is around 88%, with a mortality of 22%. Conclusions: Nowadays, in experienced hands, percutaneous closure is a safe and effective procedure. In selected patients, closure of congenital or acquired muscular and perimembranous ventricular septal defects can be considered a real alternative to the standard surgical approach, with the advantage of a significantly reduced rate of mortality and complications.

Keywords

Interventricular communicationstreatmenttranscathetercongenitalacquired
Type
Review Article
Information
Cardiology in the Young , Volume 17 , Issue 3 , June 2007 , pp. 243 - 253
Copyright
© 2007 Cambridge University Press

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References

Rudolph AM. Ventricular septal defect. In: Rudolph AM (ed.). Congenital diseases of the heart: clinical-physiological considerations, 2nd ed. Futura Publishing Company, Armonk NY, 2001, pp. 197–244.
Lillehei CW, Cohen M, Warden HE, Ziegler NR, Varco RL. The results of direct vision closure of ventricular septal defects in eight patients by means of controlled cross circulation. Surg Gynecol Obstet 1955; 101: 446–466.Google Scholar
Kouchoukos NT, Blackstone EH, Doty DB, Hanley FL, Karp RB. Ventricular septal defect. In: Kirklin/Barratt-Boyes, 3rd ed. Elsevier Science (USA) 2003, pp 850–910.
Roos-Hesselink JW, Meijboom FJ, Spitaels SE, et al. Outcome of patients after surgical closure of ventricular septal defect at a young age: longitudinal follow-up of 22–34 years. Eur Heart J 2004; 25: 1057–1062.Google Scholar
Mavroudis C, Backer CL Jacobs JP. Ventricular septal defect. In: Mavroudis C, Backer CL (eds). Pediatric cardiac surgery, 3rd ed. Mosby Inc, St Louis, 2003, pp. 298–320.
Nygren A, Sunnegard J, Berggren H. Preoperative evaluation and surgery in isolated ventricular septal defects: a 21 years perspective. Heart 2005; 83: 198–204.Google Scholar
Monro JL, Alexiou C, Salmon AP, Keeton B. Follow-up and survival after primary repair if congenital heart defects in children. J Thorac Cardiovasc Surg 2003; 126: 511–520. Google Scholar
Hobbins SM, Izukawa T, Radford DJ, Williams WG, Trusler GA. Conduction disturbances after surgical correction of ventricular septal defect by the atrial approach. Br Heart J 1979; 41: 289–293.Google Scholar
Bol-Raap G, Weerheim J, Kappetein AP, Witsenburg M, Bogers AJ. Follow-up after surgical closure of congenital ventricular septal defect. Eur J Cardiothorac Surg 2003; 24: 511–515.Google Scholar
Visconti KJ, Bichell DP, Jonas RA, Newburger JW, Bellinger DC. Developmental outcome after surgical versus interventional closure of secundum atrial septal defect in children. Circulation 1999; 100 (Suppl II): II145–II150.Google Scholar
Lock JE, Block PC, McKay RG, Baim DS, Keane JF. Transcatheter closure of ventricular septal defects. Circulation 1988; 78: 361–368. Google Scholar
Janorkar S, Goh T, Wilkinson J. Transcatheter closure of ventricular septal defects using the Rashkind device: initial experience. Catheter Cardiovasc Interv 1999; 46: 43–48.Google Scholar
Kalra GS, Verma PK, Dhall A, Singh S, Arora R. Transcatheter device closure of ventricular septal defects: immediate results and intermediate follow-up. Am Heart J 1999; 138: 339–344.Google Scholar
Sideris EB, Walsh KP, Haddad JL, Chen C, Ren SG, Kulkarni H. Occlusion of congenital ventricular septal defects by the buttoned device. “Buttoned device” Clinical Trials International Register. Heart 1997; 77: 276–279.Google Scholar
Kalra GS, Verma PK, Singh S, Arora R. Transcatheter device closure of ventricular septal defects:using detachable steel coil. Heart 1999; 82: 395–396.Google Scholar
Bridges ND, Perry SB, Keane JF, et al. Preoperative transcatheter closure of congenital muscular ventricular septal defects. N Engl J Med 1991; 324: 1312–1317.Google Scholar
Latiff HA, Alwi M, Kandhavel G, Samion H, Zambahari R. Transcatheter closure of multiple muscular ventricular septal defects using Gianturco coils. Ann Thorac Surg 1999; 68: 1400–1401.Google Scholar
Chaudari M, Chessa M, Stumper O, De Giovanni JV. Transcatheter coils closure of muscular ventricular septal defects. J Invasive Cardiol 2001; 14: 165–168.Google Scholar
Knauth AL, Lock JE, Perry SB, et al. Transcatheter device closure of congenital and post-operative residual ventricular septal defect. Circulation 2004; 110: 501–507.Google Scholar
Amin Z, Gu X, Berry JM, et al. New device for closure of muscular ventricular septal defects in a canine model. Circulation 1999; 100: 320–328.Google Scholar
Gu X, Han YM, Titus JL, et al. Transcatheter closure of membranous ventricular septal defects with a new nitinol prosthesis in a nautural swine model. Catheter Cardiovasc Interv 2000; 50: 502–509.Google Scholar
Lee EM, Roberts DH, Walsh KP. Transcatheter closure of a residual post-myocardial infarction ventricular septal defect with the Amplatzer septal occluder. Heart 1998; 80: 522–524.Google Scholar
Crenshaw BS, Granger CB, Birnbaum Y, et al for the GUSTO-I Trial Investigators. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. Circulation 2000; 101: 27–32.Google Scholar
Holzer R, Balzer D, Amin Z, et al. Transcatheter closure of postinfarction ventricular septal defects using the new Amplatzer muscular ventricular septal defect occluder: results of a US registry. Cathet Cardiovasc Interv 2004; 61: 196–201.Google Scholar
Labrousse L, Choukroun E, Chevalier JM, et al. Surgery for post infarction ventricular septal defect: risk factors for hospital death and long term results. Eur J Cardiothorac Surg 2002; 21: 725–731. Google Scholar
Thanopoulos BD, Rigby ML. Outcome of transcatheter closure of muscular ventricular septal defects with the Amplatzer ventricular septal defect occluder. Heart 2005; 91: 513–516.Google Scholar
Hijazi ZM, Hakim F, Al Fadley F, Abdelhamid J, Cao QL. Transcatheter closure of single muscular ventricular septal defects using the Amplatzer muscular ventricular septal defect occluder: initial results and technical considerations. Cathet Cardiovasc Interv 2000; 49: 167–172.Google Scholar
Chessa M, Carminati M, Cao QL, et al. Transcatheter closure of congenital and acquired muscular ventricular septal defects using the Amplatzer device. J Invasive Cardiol 2002; 14: 322–327.Google Scholar
Holzer R, Balzer D, Qi-Ling Cao, Lock K, Hijazi ZM for the Amplatzer Muscular Ventricular Septal Defect Investigators. Device closure of muscular ventricular septal defects using the Amplatzer muscular ventricular septal defect occluder. J Am Coll Cardiol 2004; 43: 1257–1263.Google Scholar
Arora R, Trehan V, Thakur AK, Mehta V, Sengupta PP, Nigam N. Transcatheter closure of congenital muscular ventricular septal defect. J Interv Cardiol 2004; 17: 109–115.Google Scholar
Carminati M, Butera G, Chessa M, Drago M, Negra D, Piazza L. Transcatheter closure of congenital ventricular septal defects with Amplatzer occluders. Am J Cardiol 2005; 96 (12A): 52L–58L.Google Scholar
Hijazi ZM, Hakim F, Hawaleh AA, et al. Catheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous ventricular septal defect occluder: initial clinical experience. Cathet Cardiovasc Interv 2002; 56: 508–515.Google Scholar
Bass JL, Kalra GS, Arora R, et al. Initial human experience with the Amplatzer perimembranous ventricular septal occluder device. Cathet Cardiovasc Interv 2003; 58: 238–245.Google Scholar
Thanopoulos BD, Tsaousis GS, Karanasios E, Eleftherakis NG, Paphitis C. Transcatheterer closure of a perimembranous ventricular septal defects with the Amplatzer asymmetric ventricular septal defect occluder: preliminary experience in children. Heart 2003; 89: 918–922.Google Scholar
Hijazi ZM. Device closure of ventricular septal defects. Cathet Cardiovasc Interv 2003; 60: 107–114.Google Scholar
Arora R, Trehan V, Kumar A, Kalra GS, Nigam M. Transcatheter closure of congenital ventricular septal defects. Experience with various devices. J Interven Cardiol 2003; 16: 83–91.Google Scholar
Fu YC, Hijazi ZM, Amin Z, et al. Transcatheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous ventricular septal defect occluder: result of the U.S. phase I trial. J Am Coll Cardiol 2006; 47: 319–325.Google Scholar
Pedra CA, Pedra SR, Esteves CA, et al. Percutaneous closure of perimebranous ventricular septal defects with the Amplatzer device: technical and morphological considerations. Catheter Cardiovasc Interv 2004; 61: 403–410.Google Scholar
Holzer R, de Giovanni J, Walsh K, et al. Transcatheter closure of perimembranous ventricular septal defects using the Amplatzer membranous ventricular septal defect device occluder: immediate and midterm results of an international registry. Catheter Cardiovasc Interv 2006; 68: 620–628.Google Scholar
Goldstein JA, Casserly IP, Balzer DT, Lee R, Lasala JM. Transcatheter closure of recurrent postmyocardial infarction ventricular septal defects utilizing the Amplatzer postinfarction ventricular septal defect device: a case series. Catheter Cardiovasc Interv 2003; 59: 238–243.Google Scholar
Szkutnik M, Bialkowski J, Kusa J, et al. Postinfarction ventricular septal defect closure with Amplatzer occluders. Eur J Cardiothorac Surg 2003; 23: 323–327.Google Scholar
Amin Z, Gu X, Berry JM, Titus JL, Gidding SS, Rocchini AP. Perventricular closure of ventricular septal defects without cardiopulmonary bypass. Ann Thorac Surg 1999; 68: 149–154.Google Scholar
Bacha EA, Cao QL, Galantowicz ME, et al. Multicenter Experience with Perventricular Device Closure of Muscular Ventricular Septal Defects. Pediatr Cardiol 2005; 26: 169–175. Google Scholar