CLINICAL RESEARCH: CONGENITAL HEART DISEASE
Transcatheter Closure of Perimembranous Ventricular Septal DefectsEarly and Long-Term Results
Gianfranco Butera, MD, PhD*,
Mario Carminati, MD,
Massimo Chessa, MD, PhD,
Luciane Piazza, MD,
Angelo Micheletti, MD,
Diana Gabriella Negura, MD,
Raul Abella, MD,
Alessandro Giamberti, MD and
Alessandro Frigiola, MD
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.
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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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