Mid-term follow-up of the transcatheter closure of Perimembranous Ventricular Septal defects in children using the amplatzer

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

Aortic runoff as a sign of intracranial arteriovenous malformation: report of two cases

Intracranial arteriovenous malformation rarely causes pulmonary hypertension and congestive heart failure in the newborn. Its diagnosis is challenging because cardiomegaly may suggest an intra-cardiac structural lesion. We present two newborns, one 2-day-old male and the other 11-day-old female, with intracranial arteriovenous malformation and misdiagnosis of congenital heart disease. Precise echocardiography revealed the secondary signs of cranial arteriovenous malformation and had the major role in early diagnosis

When can we release the Amplatzer Ductal Occluder [ADO] safely?

The ductus arteriosus connects the main pulmonary trunk to the descending aorta. The incidence of isolated patent ductus arteriosus [PDA] in full-term infants is about 1 in 2000. The Amplatzer Ductal Occluder [ADO] is recommended for PDAs with sizes larger than 2 mm. In this procedure, we must confirm the ADO position in PDA by aortogram from the arterial line. The purpose of this study was to determine the optimal release time of the ADO in the PDA closure procedure, especially in the absence of an arterial line for post-PDA aortography. This study recruited all patients scheduled to undergo PDA transcatheter closure with the ADO between September 2009 and September 2012 in our center. Age, weight, PDA diameter, systolic and diastolic pulmonic pressures, fluoroscopy time, and total angiographic time were studied. Major complications such as mortality and vascular complications were considered. We studied 237 patients in our investigation. We had 130 female and 107 male patients at a mean age of 34.3 +/- 40.6 months and mean weight of 14.2 +/- 7.8 kg. PDA sizes ranged from 2.1 to 6.2 mm and its mean was 3.7 +/- 1.8 mm. Mean of fluoroscopy time was 11.4 +/- 9.7 min and mean of total angiographic time was 42.0 +/- 12.3 min. There were no significant complications. We herein describe a new sign, which proved extremely helpful during our PDA closure procedures with the ADO. By considering the angle between the ADO and the cable during the procedure, the operator can release the ADO safely

Complications of aortic stenting in patients below 20 years old: immediate and intermediate follow-up

Optimal timing and mode of treatment for patients with coarctation of the aorta [COA] remain controversial, particularly in children. Surgery, balloon dilatation, and stent implantation have all proven effective in the treatment of moderate or severe obstruction. The aim of this study was to investigate the complications of COA stenting angioplasty in pediatric patients. This retrospective, descriptive study was conducted on patients less than 20 years of age who underwent aortic stenting angioplasty because of congenital COA in the pediatric catheterization laboratory of Rajaie cardiovascular, medical and research Center, Tehran between 2005 and 2010. A total of 26 patients [18 [65.4%] males and 9 [34.6%] females] with congenital COA who had undergone aortic stenting angioplasty were recruited. Nineteen [73.1%] of these patients had native COA and 7 [26.9%] had recurrent COA. Most of the early complications were minor and temporary; only one patient developed early major complications. During the follow-up, whereas none of the native group patients developed late complications, in the re-COA group 28.57% of the patients had re-stenosis and 14.28% had chronic systemic hypertension, requiring drug therapy. Our investigation into post-stenting complications in patients with native COA and re-COA showed that endovascular stenting could be an effective and safe method, even in young patients with native COA