Transcatheter Retrograde Closure of Perimembranous Ventricular Septal Defects in Children With the Amplatzer Duct Occluder II Device

Overt heart failure, not improving with medications Failure to thrive, predominantly due to hemodynamic effects of the VSD Recurrent respiratory infections (defined as >6 events in the preceding 12 months) Mid-diastolic flow rumble at the apex on auscultation Electrocardiogram showing left atrial...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2012-12, Vol.60 (23), p.2421-2422
Main Authors: Koneti, Nageswara Rao, MD, Sreeram, Narayanswami, MD, Penumatsa, Raghava Raju, MD, Arramraj, Srinivas K., MD, Karunakar, Vadlamudi, MD, Trieschmann, Uwe, MD
Format: Article
Language:English
Subjects:
Adolescent
Age
Cardiac Catheterization - instrumentation
Cardiology
Cardiovascular
Catheters
Child
Child, Preschool
Defects
Electrocardiography
Equipment Design
Female
Follow-Up Studies
Heart Septal Defects, Ventricular - diagnostic imaging
Heart Septal Defects, Ventricular - therapy
Humans
Infant
Internal Medicine
Intubation
Male
Medical imaging
Pulmonary arteries
Radiography
Septal Occluder Device
Ultrasonic imaging
Veins & arteries
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Summary:Overt heart failure, not improving with medications Failure to thrive, predominantly due to hemodynamic effects of the VSD Recurrent respiratory infections (defined as >6 events in the preceding 12 months) Mid-diastolic flow rumble at the apex on auscultation Electrocardiogram showing left atrial enlargement and left ventricular hypertrophy with standard criteria for children Cardiothoracic ratio on chest x-ray of >0.55 Left atrial to aortic diameter ratio on long-axis echocardiogram >1.5 Left ventricular end-diastolic z-score on echocardiogram, indexed to body surface area of >2.0 Estimated pulmonary to systemic blood flow ratio >1.5 at cardiac catheterization Morphologic inclusion criteria Isolated pmVSD VSD size = 3 mm Morphologic exclusion criteria: VSD size >6.5 mm Perimembranous VSD with bidirectional or predominantly right to left shunt through the VSD on color Doppler echocardiography Perimembranous VSD associated with other structural heart defects requiring surgery Cardiac catheterization was performed under general anesthesia (n = 12) or intravenous sedation (n = 51), after informed consent was obtained. The VSDs larger than 6.5 mm diameter cannot be closed with the ADO II. Because the retention discs are symmetrical, a minimum distance of 3 mm is required between the upper margin of the VSD and the aortic valve.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2012.08.1004