Transcatheter closure of perimembranous ventricular septal defects with ductal occluders

• Published in: Cardiology in the young 2015-06, Vol.25 (5), p.918-926
• Main Authors: Mahimarangaiah, Jayaranganath, Subramanian, Anand, Kikkeri Hemannasetty, Srinivasa, Chandra, Subhash, Karur, Satish, Mandikal Kodandaramasastry, Usha, Cholenahally Nanjappa, Manjunath
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Cardiac Catheterization - methods; Child; Child, Preschool; Embolization, Therapeutic; Feasibility Studies; Female; Heart Septal Defects, Ventricular - surgery; Humans; Infant; Male; Original Articles; Postoperative Complications - therapy; Prospective Studies; Septal Occluder Device; Treatment Outcome
• ISSN: 1047-9511; 1467-1107
• DOI: 10.1017/S1047951114001255

Background: To study the feasibility and complications associated with the use of ductal occluders for closure of perimembranous ventricular septal defects. Methods: A total of 126 patients, ranging from 1 to 41 years of age (median – 8 years), underwent closure of ventricular septal defects from August 2010 to April 2013. Small- and moderate-sized defects were closed using first-generation Patent ductus arteriosus occluders or Amplatzer Duct Occluder-II. Patients were followed up for the development of complications such as heart block, aortic regurgitation, and tricuspid regurgitation. Results: Patent ductus arteriosus occluders were used in 81 patients, and the Amplatzer Duct Occluder-II device in 45 patients. The devices were successfully deployed in 99.2% of the cases. One patient had embolisation of an Amplatzer Duct Occluder-II device soon after deployment. There was one case of transient complete heart block (0.8%) needing temporary pacing, and two cases of isoarrhythmic atrioventricular dissociation (1.6%). One patient developed late-onset complete heart block 15 months after the procedure and underwent permanent pacemaker implantation. There were no instances of new-onset aortic regurgitation. New-onset mild tricuspid regurgitation was seen in two patients. Of the patients, three had small residual shunts on follow-up, without haemolysis. Conclusions: Duct occluders can be used to effectively close small- and moderate-sized ventricular septal defects. The incidence of complete heart block and valvular regurgitations are much less than reported with other devices, and they are cost-effective.