Percutaneous Device-Based Closure Successful in Children with Ventricular Septal Defects

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Percutaneous closure of symptomatic ventricular septal defects in children can be achieved with off-label use of an occluder device. A research letter published online November 7, 2012, ahead of print in the Journal of the American College of Cardiology details a high rate of success with the device in a series of children under age 15 from a single institution in India.

Investigators led by Nageswara Rao Koneti, MD, of CARE Hospital (Hyderabad, India), undertook retrograde single catheter closure of perimembranous ventricular septal defects with the Amplatzer duct occluder II (ADO II; St. Jude Medical, St. Paul, Minnesota) in 57 children (median age, 3.7 years). The device, while not FDA approved, is commercially available for closure of patent ductus arteriosus in some international markets. The diameter of the device selected was either equal to (± 0.5 mm) or 1 mm greater than the smallest defect diameter.

Successful Closure, Few Complications

Overall, the complete closure rate was 78% immediately after the procedure, 92% at 24 hours, and 94% at last follow-up. Closure was verified by left ventricular angiography and transthoracic echocardiography.

One incidence of device embolization to the pulmonary artery was seen 2 hours after the procedure. The device was retrieved and the defect was successfully closed with a 10-mm Amplatzer muscular ventricular septal defect occluder. There was no incidence of femoral pulse loss.

Tricuspid regurgitation was present in 15 children prior to the procedure. Following defect closure, a reduction by at least 2 grades was noted in 11 children and in the other 4, conversion to a normotensive tricuspid regurgitation was achieved. Two children developed new trivial aortic regurgitation.

At follow-up, there was no incidence of left bundle branch block, P-Q prolongation, or complete heart block. In addition, most children (n = 46) were underweight before the procedure (less than the 3rd percentile for age and sex) and demonstrated appropriate weight gain after septal defect closure. Of 45 children who were followed for more than 6 months, 38 achieved weights greater than the 10th percentile for age and sex.

The authors say the procedure has the advantage of being relatively inexpensive (about $1,500) compared with surgical closure.

“The ADO II device is cheap and effective for closing [perimembranous] VSDs,” they write. “Availability of larger-sized ADO II devices might increase its applicability, allowing percutaneous closure of a wider range of VSDs.”

Study Details

Median fluoroscopic time for the entire cohort was 8.8 min. The median VSD diameter was 5 mm and the devices used (device diameter/length in mm) were 4/4 (n = 3), 5/4 (n = 21), 5/6 (n = 3), 6/4 (n = 29), and 6/6 (n = 1).

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Source:
Koneti NR, Sreeram N, Penumatsa RR, et al. Transcatheter retrograde closure of perimembranous ventricular septal defects in children with the Amplatzer duct occluder II device. J Am Coll Cardiol. 2012;Epub ahead of print.

 

 

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