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

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

Segmented coronary artery aneurysms and kawasaki disease

Kawasaki disease [KD] is an acute vasculitis syndrome of unknown etiology. It occurs in infants and young children, affecting mainly small and medium-sized arteries, particularly the coronary arteries. Generalized microvasculitis occurs in the first 10 days, and the inflammation persists in the walls of medium and small arteries, especially the coronary arteries, and changes to coronary artery aneurysms. We report the case of a 10-month-old girl referred to our center three months after the onset of disease due to the aneurysms of the coronary arteries. During the acute phase of her illness, she received 2 gr/kg intravenous gamma globulin; and after her referral to us, the patient was treated by antiaggregant doses of acetylsalicylic acid [ASA] [5 mg/kg] and Warfarin [1 mg/daily]. At three months' follow-up, the aneurysms still persisted in the echocardiogram

Evaluation of exercise-induced hypertension post endovascular stenting of coarctation of aorta

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