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The hybrid perventricular closure of apical muscular ventricular septal defect with Amplatzer duct occluder
Soo Jin Kim1, June Huh, Jin Young Song
1Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
Hybrid perventricular closure using an Amplatzer duct occluder (ADO) effectively treated apical muscular ventricular septal defects (MVSDs) in infants. This minimally invasive approach offers a viable option for complex pediatric cardiac cases.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Interventional Cardiology
Background:
- Apical muscular ventricular septal defects (MVSDs) present management challenges, particularly in infants.
- Surgical and percutaneous closure methods can be difficult for small infants with apical MVSDs.
- Intraoperative perventricular procedures offer a promising alternative for apical MVSD closure in children.
Purpose of the Study:
- To evaluate the efficacy and outcomes of hybrid perventricular closure of apical MVSDs using an Amplatzer duct occluder (ADO).
Main Methods:
- Retrospective review of 5 pediatric patients who underwent hybrid perventricular closure of MVSDs with ADOs between March 2006 and May 2011.
- Patients' median age was 12 months (range, 25 days to 25 months) and median weight was 9.1 kg.
- Procedures were performed on beating hearts, with ADO size selected based on VSD dimensions.
Main Results:
- Successful closure of apical MVSDs was achieved in all 5 patients with well-positioned devices.
- A small residual VSD was observed in 2 patients with multiple defects; no leakage occurred in the remaining 3 patients.
- Median follow-up was 2.4 years, demonstrating sustained device efficacy.
Conclusions:
- Hybrid perventricular closure with an ADO is a feasible and effective treatment for apical MVSDs in pediatric patients.
- This technique provides a valuable option for complex cases, including those with associated cardiac anomalies.
- Careful procedural technique is crucial, especially when managing very young or small infants.
Purpose:
Apical muscular ventricular septal defects (MVSDs), especially in small infants, can be difficult to manage using surgical and percutaneous closure. An intraoperative perventricular procedure is a good option for closing apical MVSDs in small children with or without associated cardiac anomalies. We evaluated the results of hybrid perventricular closure of apical MVSDs performed using an Amplatzer duct occluder (ADO).
Methods:
We retrospectively reviewed the medical records of 5 patients who underwent hybrid perventricular closure of MVSDs with ADOs, from March 2006 to May 2011. The median patient age at the time of the procedure was 12 months (range, 25 days to 25 months), and the median body weight was 9.1 kg (range, 4.3 to 15 kg). Two patients had multiple ventricular septal defects (VSDs; additional perimembranous VSD in 1 patient and multiple MVSDs in the other) and 3 patients had associated cardiac anomalies; complete transposition of the great arteries in 1 patient and an atrial septal defect in 2 patients. All the procedures were performed on beating hearts, exception in 1 case. The ADO selected for the aortic side was at least 1 to 2 mm larger than the largest VSD in the left ventricle side.
Results:
The procedure was successful in all patients and each device was well positioned. During the median follow-up of 2.4 years, a small residual VSD was noted in 2 patients who had multiple VSDs and no leakage was seen in the other 3 patients.
Conclusion:
Perventricular closure of MVSD with an ADO is a good option for patients with apical MVSD. However, careful manipulation is important, especially in the case of small infants.
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