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Transcatheter closure of muscular ventricular septal defects with the amplatzer ventricular septal defect occluder: initial clinical applications in children¹

^a Department of Pediatric Cardiology, "Aghia Sophia" Children’s Hospital, Athens, Greece

View larger version (113K): [in a new window]   Figure 1 Side view of the Amplatzer muscular ventricular septal defect occluder made of woven 0.004-in. (0.01 cm) Nitinol wires into two flat disks with a 7-mm connecting waist. The left ventricular disk is on the right and the right ventricular disk is on the left of the panel.

View larger version (179K): [in a new window]   Figure 2 Steps of transcatheter muscular ventricular septal defect closure with modified Amplatz device. (A) Long axial oblique left ventriculogram obtained from Patient 4, demonstrating a midmuscular ventricular septal defect (arrowheads). (B) Hand injection of contrast medium into the left ventricle showing an appropriately positioned left ventricular disk. (C)Deployment of the right ventricular disk. (D) Long axial oblique left ventriculogram after release of the device, showing complete closure of the defect.

View larger version (83K): [in a new window]   Figure 3 Left ventriculogram in a four-chamber view obtained from patient 1 with corrected transposition of the great arteries and an outlet ventricular septal defect (arrowheads), before (A) and after (B) device placement. Complete closure of the defect has been achieved.

View larger version (143K): [in a new window]   Figure 4 Transesophageal two-dimensional and color Doppler obtained from four-chamber view immediately after implantation of the Amplatzer prosthesis. Note good position of the device with no evidence of residual shunt. LA = left atrium; LV = left ventricle; LVD = left ventricular disk; RA = right atrium; RV = right ventricle; RVD = right ventricular disk.