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Percutaneous closure of moderate to large perimembranous ventricular septal defect in small children using left
Sanjiban Ghosh1, Aritra Mukherji1, Amitabha Chattopadhyay1
1Department of Pediatric Cardiology, Narayana Superspeciality Hospital, Howrah, India.
Insights
Transcatheter closure of perimembranous Ventricular Septal Defect (VSD) using the Amplatzer Duct Occlude-I device is effective in small children. The left ventricular mid-cavity approach offers advantages over standard techniques.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Perimembranous Ventricular Septal Defects (VSD) are common congenital heart abnormalities.
- Transcatheter closure is an alternative to surgical repair for VSD.
- Small children (<10 kg) present unique challenges for VSD closure.
Purpose of the Study:
- To evaluate the mid-term outcomes of transcatheter closure for perimembranous VSD in infants weighing less than 10 kg.
- To assess the efficacy and safety of the Amplatzer Duct Occlude-I (ADO-I) device using a left ventricular (LV) mid-cavity approach.
- To compare the LV mid-cavity approach with the standard technique in terms of procedural and clinical outcomes.
Main Methods:
- Retrospective review of 35 children (<10 kg) with moderate to large perimembranous VSD.
- Transcatheter closure performed using ADO-I via an LV mid-cavity approach.
- Data collected on procedural parameters, complications, and follow-up outcomes.
Main Results:
- Successful device closure achieved in 32 out of 35 patients (91.4%).
- One patient developed device-induced aortic regurgitation requiring surgery.
- One patient experienced complete heart block requiring pacemaker implantation.
- No residual VSD, rhythm disturbances, or significant hemodynamic issues were noted during follow-up.
Conclusions:
- Transcatheter closure of moderate to large perimembranous VSD is feasible and effective in small children using the LV mid-cavity approach with ADO-I.
- The LV mid-cavity approach demonstrates potential benefits including reduced hemodynamic instability, decreased fluoroscopy time, and a lower incidence of device-induced aortic regurgitation compared to the standard technique.
Aim & Objective:
To report mid-term follow-up result of transcatheter closure of perimembranous Ventricular septal defect (VSD) in children weighing less than 10 kg using Amplatzer Duct Occlude-I (ADO-I) by left ventricular (LV) mid-cavity approach.
Material & Method:
This is retrospective review of 35 children weighing less than 10 kg with moderate to large perimembranous VSD who were selected for transcatheter closure of VSD using ADO-I in between October 2016 to September 2018. Mean age was 2.08 ± 0.67 years (mean ± SD) and mean weight was 7.2 ± 1.2 kg (mean ± SD). Procedure was done by crossing the VSD from right ventricular side instead of using the standard approach by forming arterio-venous loop. Average fluoroscopic time was 9.2 ± 2.9 min (mean ± SD) and mean procedure time was 34.1 ± 13.1 min (mean ± SD). Mean follow-up period was 8.7 months (3-12 months) RESULT: Device closure was successfully done in 32 patients. There was device induced aortic regurgitation (AR) in one case who was sent for surgery. One child was found to have complete heart block on first post-procedure day requiring permanent pace-maker implantation. During follow up none of them had any residual VSD, rhythm disturbance, AR and left or right ventricular outflow obstruction.
Conclusion:
Device closure can be successfully done in moderate to large perimembranous VSD using left ventricular mid cavity approach in small children. LV mid-cavity approach has advantages in terms of lesser hemodynamic instability, lesser fluoroscopy and lesser chance of device induced AR than standard technique particularly in smaller children.
