ABSTRACT
Background: The ventricular septal defect [VSD] is the most common form of congenital heart defects. The purpose of this study was to evaluate the results of the early complications and mid-term follow-up of the transcatheter closure of the VSD using the Amplatzer VSD Occluder
Methods: Between April 2012 and October 2013, 110 patients underwent the percutaneous closure of the perimembranous VSD. During the procedure, the size and type of the VSD were obtained via ventriculography. A device at least 2 mm larger than the VSD diameter measured via ventriculography was deployed. The size of the VSD, size of the Amplatzer, and devicesize to VSD-size ratio were calculated. After the confirmation of the suitable position of the device via echocardiography and left ventriculography, the device was released. Follow-up evaluations were done at discharge as well as at 1, 6, and 12 months and yearly thereafter for the VSD occlusion and complete heart block
Results: The study population comprised 62 females and 48 males. The mean age and weight of the patients at procedure were 4.3 +/- 5.6 years [range: 2 to 14] and 14.9 +/- 10.8 kg [range: 10 to 43]. The average device size was 7.0 +/- 2.5 mm [range: 4 to 14]. The VSD occlusion rate was 72.8% at the completion of the procedure and rose up to 99.0% during the follow-up. The most serious significant complication was complete atrioventricular block, which was seen in 2 patients. The mean follow-up duration was 10.9 +/- 3.6 months
Conclusion: The transcatheter closure of the perimembranous VSD was a safe and effective treatment with excellent closure rates in our study population. This procedure had neither mortality nor serious complications
ABSTRACT
Coarctation of the aorta [COA] is a defect that accounts for 5-8% of all congenital heart diseases. Balloon angioplasty as a treatment for COA is increasingly performed, with endovascular stents having been proposed as a means of improving the efficacy and safety of the procedure. The aim of this study was to evaluate the systolic blood pressure gradient at rest and during maximal exercise at follow-up in patients post endovascular stenting of COA. Thirteen patients [4 native and 9 re-coarctation cases of COA after surgery or balloon angioplasty] with a mean age of 11.1 +/- 4.7 years underwent endovascular stenting between November 2007 and December 2009 via standard techniques for native COA as an alternative to surgical repair. Doppler echocardiography was performed pre and post stenting. Resting and exercise assessment of blood pressure was performed at follow-up. Post stent implantation, no angiographic major complications were evident. Systolic blood pressure gradient decreased from 42 +/- 8.8 mm Hg before stent placement to 7 +/- 10 mm Hg at follow-up [p value < 0.001]. Peak Doppler pressure gradient decreased from 30 +/- 14 mm Hg to 14 +/- 10 mm Hg at follow-up [p value < 0.007]. One case of exercise-induced hypertension was seen in patients. Endovascular stenting for native COA in older children and post-surgical COA repair in patients with residual COA and re-coarctation is a reasonable alternative to surgical correction. During early follow-up, stenting effectively alleviates the aortic arch obstruction with normalization of the systemic blood pressure both at rest and during maximal exercise