Perimembranous Ventricular Septal Defect Device Closure: Choosing Between Amplatzer Duct Occluder I and II

Area of Science:

• Interventional Cardiology
• Pediatric Cardiology
• Medical Device Technology

Background:

• Transcatheter closure is a standard treatment for perimembranous ventricular septal defects (pmVSDs).
• Amplatzer duct occluders (ADO) I and II are increasingly used off-label for pmVSD closure due to their cost-effectiveness, particularly in developing countries.
• Standard Amplatzer VSD occluders are more expensive than ADO devices.

Purpose of the Study:

• To evaluate the safety and efficacy of using ADO I and ADO II devices for transcatheter closure of symptomatic, hemodynamically significant pmVSDs.
• To determine if transthoracic echocardiography (TTE) findings can reliably predetermine the choice between ADOI and ADOII devices.
• To assess the cost-effectiveness of using ADO devices in low-budget programs.

Main Methods:

• A retrospective analysis of 30 patients with pmVSDs who underwent transcatheter closure using ADO I or ADO II devices between March 2013 and November 2014.
• Device selection (ADOI vs. ADOII) was guided by pre-procedural transthoracic echocardiography (TTE) findings.
• Echocardiographic and angiographic measurements of VSD size, fluoroscopy time, and patient demographics were recorded. Follow-up included clinical assessment and echocardiography.

Main Results:

• Both ADOI and ADOII devices demonstrated high closure rates (94% at last follow-up) and were safe, with no reported complications like heart block.
• ADOII use was limited to VSDs ≤6 mm and without large aneurysms, while ADOI was used in larger defects.
• The pre-determined device choice based on TTE was accurate in 84% of cases, with ADOI patients having significantly larger VSDs and longer fluoroscopy times.

Conclusions:

• Transcatheter closure of pmVSDs using ADO I and ADO II devices is safe and effective.
• ADOII is suitable for smaller pmVSDs, whereas ADOI is preferred for larger defects.
• Pre-procedural TTE assessment is a valuable tool for selecting the appropriate ADO device, facilitating cost-effective treatment in resource-limited settings.