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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Transcatheter Closure of Perimembranous Ventricular Septal Defects

Early and Long-Term Results

Department of Pediatric Cardiology and GUCH Unit, Policlinico San Donato, Instituto Ricerca e Cura a Carattere Scientifico, San Donato Milanese, Italy.

Manuscript received September 22, 2006; revised manuscript received February 15, 2007, accepted March 21, 2007.

^_* Reprint requests and correspondence: Dr. Gianfranco Butera, Pediatric Cardiology, Policlinico San Donato, IRCCS, Via Morandi, 30-20097 San Donato Milanese (MI), Italy. (Email: gianfra.but{at}lycos.com).

Objectives: We sought to analyze safety, efficacy, and follow-up results of percutaneous closure of perimembranous ventricular septal defects (pmVSD).

Background: Results of pmVSD transcatheter closure have been reported in the literature; however, follow-up data are still limited.

Methods: Between January 1999 and June 2006, 104 patients underwent percutaneous closure of a pmVSD at our institution. An Amplatzer VSD device (muscular or eccentric) (AGA Medical Corp., Golden Valley, Minnesota) was used in all subjects.

Results: The mean age at closure was 14 years (range 0.6 to 63 years). The attempt to place a device was successful in 100 patients (96.2%). The median device size used was 8 mm (range 4 to 16 mm). No deaths occurred. Total occlusion rate was 47% at completion of the procedure, rising to 84% at discharge and 99% during the follow-up. A total of 13 early complications occurred (11.5%), but in all but 2 subjects (1.9%) these were transient. The median follow-up was 38.5 months. The most significant complication was complete atrioventricular block (cAVB), which required pacemaker implantation in 6 subjects (5.7%; 2 in the early phase and 4 during the follow-up). Cox proportional hazards regression analysis showed that the only variable significantly associated with the occurrence of this complication was age at the time of the procedure (p = 0.028; relative risk 0.25). All subjects experiencing this problem were <6 years old.

Conclusions: In the current era and in experienced hands, pmVSD closure can be performed safely and successfully. The major concern is the occurrence of cAVB; therefore, very careful monitoring of rhythm is mandatory during follow-up.

Abbreviations and Acronyms   cAVB = complete atrioventricular block   MVSD-O = muscular ventricular septal defect occluder   pmVSD = perimembranous ventricular septal defect   PMVSD-O = perimembranous ventricular septal defect occluder   TEE = transesophageal echocardiography   TTE = transthoracic echocardiography

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