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Postinfarction ventricular septal defect closure with Amplatzer occluders
M Szkutnik1, J Bialkowski, J Kusa
1Congenital Heart Defects and Pediatric Cardiology Department, Silesian Centre for Heart Diseases, ul. Szpitalna 2, 41-800 Zabrze, Poland. jabi_med@priv4.onet.pl
Insights
Transcatheter closure of postinfarction ventricular septal defect (PIVSD) using Amplatzer occluders offers a promising treatment option. This minimally invasive approach achieved significant clinical improvement in most patients with subacute PIVSD.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Postinfarction ventricular septal defect (PIVSD) is a rare but severe complication of myocardial infarction.
- Surgical and medical treatments for PIVSD carry high risks.
- Transcatheter closure presents an alternative therapeutic strategy.
Purpose of the Study:
- To evaluate the efficacy and safety of transcatheter closure for subacute PIVSD.
- To report outcomes using Amplatzer occluders for PIVSD treatment.
Main Methods:
- Seven patients (51-71 years) with subacute PIVSD underwent transcatheter closure.
- Procedures were performed 2-10 weeks post-myocardial infarction.
- Amplatzer atrial septal occluders (ASO) and one VSD occluder (VSO) were implanted via jugular or transfemoral venous access.
Main Results:
- Successful closure was achieved in five of seven patients.
- Immediate clinical improvement was observed in successfully treated patients.
- Complications included procedural difficulties, ventricular fibrillation, and one mortality due to multiorgan failure.
Conclusions:
- Transcatheter closure with Amplatzer occluders is an attractive option for subacute PIVSD.
- Despite technical challenges, the procedure offers significant benefits.
- Further investigation into optimizing this technique is warranted.
Objective:
Postinfarction ventricular septal defect (PIVSD) is a rare and life-threatening complication with high risk of both surgical and medical treatment. Another option available now is transcatheter closure. The purpose of this paper is to report the results of such treatment with Amplatzer occluders.
Method:
Seven patients aged from 51 to 71 years were included. The procedure was performed between 2 and 10 weeks after myocardial infarction. One patient had double residual VSD (2 months after previous surgery) and another, coexisting critical stenosis of right coronary artery (RCA). All patients were in III/IV NYHA class, on intropes, one patient on aortic balloon counterpulsation. Venous jugular approach was used to close the VSD in six patients, venous transfemoral in one patient. Implantation of six Ampaltzer atrial septal occluders (ASO) and one muscular Amplatzer VSD occluder (VSO) were performed.
Results:
All procedures but two were finished successfully. In one patient, the defect could not be entered neither from the venous nor the arterial side due to unusual oblique course (which was confirmed during subsequent operation). In the second patient (2 weeks after MI), the reason was unstable position of 24 mm ASO (probably due to necrotic borders of VSD). Immediate significant clinical improvement was achieved in all patients, in whom PIVSD was closed with Amplatzer occluders. In one postsurgical patient, two ASO were used; in another patient, prior to VSD closure, PTCA and stent implantation to RCA was performed. The stretched diameter of PIVSD ranged from 8 to 22 mm, the size of implanted Amplatzer occluders from 12 to 24 mm. Fluoroscopy time was 60 min (18-120). During the procedure, ventricular fibrillation requiring defibrillation was observed in three patients. One patient died 1 week after the procedure because of multiorgan failure and increasing mitral incompetence (MI).
Conclusions:
Despite some technical problems, implantation of Amplatzer occluders, is an attractive option of treatment of patients with subacute PIVSD.