Percutaneous closure of post-traumatic and congenital muscular ventricular septal defects with the Amplatzer Muscular VSD Occluder

Abstract

Background: Muscular ventricular septal defects (VSD) are an important and difficult surgical problem. In the last few years a new alternative has emerged - possibility of VSD closure using percutaneous approach.

Aim: To present our experience in percutaneous closure of congenital muscular and one posttraumatic VSD.

Methods: We treated 10 patients - 7 children (age 0.8-7 years) and 2 adults (43 and 46 years) with congenital VSD, and one 18-year-old patient with posttraumatic VSD (knife stab). All the patients had a large haemodynamic shunt (Qp:Qs 1.9) and in all cases percutaneous closure attempt with an Amplatzer Muscular VSD Occluder (MVSDO) implant was undertaken. Five of 6 children with multiple muscular VSDs had in infancy previous pulmonary artery banding and one patient had complex heart disease: transposition of great arteries (dTGA), pulmonary stenosis (PS) and perimembranous VSD. All procedures were performed using the standard technique.

Results: Eleven procedures were performed in 10 patients (one child had 2 attempts). Seven procedures were successful. In all cases a considerable reduction in flow or complete closure was achived. In one case, despite multiple attempts, VSD caniulation was ineffective and the procedure was abandoned. The patient had oblique VSD - morphology confirmed was later by the operating surgeon. The reason for the other 3 failures was early embolisation to the left ventricle and aorta. This complication was noted in 2 adult patients - one with congenital and one with post-traumatic VSD. In both cases the interventricular septum was thick (10 and 11 mm) and implants were removed with a bioptome or vascular lasso. Another embolisation occurred in a child with TGA - in this case the cardiac surgeon removed the implant from the aortic arch during Rastelli operation.

Conclusion: Our experience acquired during muscular VSD closure with MVSDO indicates that the method is useful in children with isolated defects. Adult patients and children with a complex form of congenital defects should have morphology of MVSDO carefully evaluated and width of the interventricular septum measured to avoid potential implant embolisation.