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Transcatheter Closure of Perimembranous Ventricular Septal Defects Using the New Amplatzer Membranous VSD Occluder

Results of the U.S. Phase I Trial

Yun-Ching Fu, MD, PhD^_*, John Bass, MD, FACC, Zahid Amin, MD, FACC, Wolfgang Radtke, MD, FACC, John P. Cheatham, MD, FACC^||, William E. Hellenbrand, MD, FACC^¶, David Balzer, MD, FACC^#, Qi-Ling Cao, MD^_* and Ziyad M. Hijazi, MD, MPH, FACC^_*,_*

^_* Section of Pediatric Cardiology, Department of Pediatrics, University of Chicago Comer Children’s Hospital, Pritzker School of Medicine, Chicago, Illinois
Division of Pediatric Cardiology, University of Minnesota, Minneapolis, Minnesota
Joint Division of Pediatric Cardiology, University of Nebraska/Creighton University, Children’s Hospital of Omaha, Omaha, Nebraska
Section of Pediatric Cardiology, MUSC Children’s Hospital, Charleston, South Carolina, and Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
^|| Section of Pediatric Cardiology, Department of Pediatrics, Columbus Children’s Hospital, Columbus, Ohio
^¶ Section of Pediatric Cardiology, Department of Pediatrics, Columbia University, New York, New York
^# Section of Pediatric Cardiology, Department of Pediatrics, St. Louis Children’s Hospital, St. Louis, Missouri

View larger version (106K): [in a new window]   Figure 1 (A) Left ventriculography in the left anterior oblique view showing a 9-mm perimembranous ventricular septal defect (arrow) in a 22-month-old boy. (B) Cine image showing the arteriovenous loop. (C) Left ventricular disk has been deployed. (D) Left ventriculography showing good position of left ventricular disk. (E) Cine image immediately after the right ventricular disk has been deployed. (F) Left ventriculography showing good device position before its release. (G) Cine image after the device has been released. The platinum marker is pointed to the apex (arrow), indicating good device position. (H) Final left ventriculography indicating good device position and no residual shunt.

View larger version (102K): [in a new window]   Figure 2 Transesophageal echocardiographic images of the same patient as in Figure 1. (A) Four-chamber view showing the perimembranous ventricular septal defect (VSD) with aneurysm formation (arrow). (B) Short-axis view with color Doppler at the subaortic level showing the shunt. (C) The wire of the arteriovenous loop passing from the aorta through the VSD to the right atrium (RA). (D) Four-chamber view showing the delivery sheath in the left ventricular apex. (E) The left ventricular disk is deployed. (F) Short-axis view showing good device position before its release. (G) Final image in the four-chamber view indicates good device position. (H) Color Doppler mapping showing no residual shunt with a trivial tricuspid regurgitation. LA = left atrium; LV = left ventricle; RV = right ventricle.