ABSTRACT
BACKGROUND: High incidence of atrioventricular (AV) block has been the major limitation of percutaneous closure of perimembranous ventricular septal defect (PMVSD). METHODS: Prospective, multicenter, nonrandomized study including 55 patients who were submitted to 56 procedures from March 2010 to November 2010. Inclusion criteria were PMVSD with diameter ≥ 5 mm or if ≤5 mm with hemodynamic significance and age ≥ 1 year. Exclusion criteria were fixed pulmonary arterial hypertension and associated congenital heart disease needing surgical repair. Procedures were performed under general anesthesia and monitored by transthoracic echocardiography (TTE). The device choice was based on left ventricle (LV) angiography and on TTE images. PMVSDs were crossed by retrograde approach. RESULTS: Mean age was 9.3 ± 7.5 years, and mean weight was 29.1 ± 15.9 kg. Thirty-five (63.6%) patients were females. Mean pulmonary arterial mean pressure, mean LV diastolic diameter, and mean Q(p) /Q(s) were 24.0 ± 6.5 mm Hg, 43.0 ± 5.9 mm, and 2.2 ± 0.8, respectively. Associated nonsurgical malformations were present in 9 (16.3%) patients, and PMVSDs were multifenestrated in 16 (46.2%) cases. Mean PMVSDs diameter was 5.8 ± 1.8 mm by angiography and 6.8 ± 2.3 mm by TTE. New rhythm disturbance without clinical significance was observed in 29% of the patients and was reversible in 87.5%. After procedure, trivial residual shunt was present in 5 (8.9%) patients and moderate residual shunt in other 5 (8.9%). At late FU (mean of 298.7 ± 88.9 days), 91% of the patients had no residual shunts. Third-degree AV block and severe aortic regurgitation occurred in one patient each. CONCLUSIONS: In this experience, PMVSD closure with CERA® devices showed to be safe and effective with low incidence of complications at immediate and mid-term FU.
Subject(s)
Cardiac Catheterization/instrumentation , Heart Septal Defects, Ventricular/therapy , Septal Occluder Device , Adolescent , Adult , Aortic Valve Insufficiency/etiology , Atrioventricular Block/etiology , Brazil , Cardiac Catheterization/adverse effects , Child , Child, Preschool , Feasibility Studies , Female , Heart Septal Defects, Ventricular/diagnostic imaging , Heart Septal Defects, Ventricular/physiopathology , Hemodynamics , Humans , Infant , Male , Middle Aged , Prospective Studies , Prosthesis Design , Radiography , Treatment Outcome , Ultrasonography , Young AdultABSTRACT
Background: High incidence of atrioventricular (AV) block has been the major limitationof percutaneous closure of perimembranous ventricular septal defect (PMVSD). Methods:Prospective, multicenter, nonrandomized study including 55 patients who weresubmitted to 56 procedures from March 2010 to November 2010. Inclusion criteriawere PMVSD with diameter 5 mm or if 5 mm with hemodynamic significance andage 1 year. Exclusion criteria were fixed pulmonary arterial hypertension and associatedcongenital heart disease needing surgical repair. Procedures were performedunder general anesthesia and monitored by transthoracic echocardiography (TTE). Thedevice choice was based on left ventricle (LV) angiography and on TTE images.PMVSDs were crossed by retrograde approach. Results: Mean age was 9.3 6 7.5years, and mean weight was 29.1 6 15.9 kg. Thirty-five (63.6%) patients were females.Mean pulmonary arterial mean pressure, mean LV diastolic diameter, and mean Qp/Qswere 24.0 6 6.5 mm Hg, 43.0 6 5.9 mm, and 2.2 6 0.8, respectively. Associated nonsurgicalmalformations were present in 9 (16.3%) patients, and PMVSDs were multifenestratedin 16 (46.2%) cases. Mean PMVSDs diameter was 5.8 6 1.8 mm by angiographyand 6.8 6 2.3 mm by TTE. New rhythm disturbance without clinical significance wasobserved in 29% of the patients and was reversible in 87.5%. After procedure, trivialresidual shunt was present in 5 (8.9%) patients and moderate residual shunt in other 5(8.9%). At late FU (mean of 298.7 6 88.9 days), 91% of the patients had no residualshunts. Third-degree AV block and severe aortic regurgitation occurred in one patienteach. Conclusions: In this experience, PMVSD closure with CERAVR devices showed tobe safe and effective with low incidence of complications at immediate and mid-termFU.
