Spanish registry of percutaneous VSD closure with NitOcclud Lê VSD Coil device: lessons learned after more than a hundred implants.

INTRODUCTION AND OBJECTIVES: The NitOcclud Lê VSD Coil was specifically designed for transcatheter occlusion of ventricular septal defects (VSD) and became available for this purpose in August 2010. Our objective was to describe the Spanish experience of this technique and analyze its reliability and short- to mid-term efficacy. METHODS: National multicenter observational study, which retrospectively recruited all patients (of any age) with VSD (of any location or type) who underwent percutaneous NitOcclud occlusion, using an intention-to-treat analysis, until January 2019. RESULTS: A total of 117 attempts were made to implant at least 1 NitOcclud in 116 patients in 13 institutions. The median [range] age and weight was 8.6 [0.4-69] years and 27 [5.8-97] kg, respectively. In 99 patients (85%), the VSD was an isolated congenital defect. The location was perimembranous in 95 (81%), and 74 (63%) of them were aneurysmatic. The mean fluoroscopy time was 34 [11.4-124] minutes. Of the 117 attempts, 104 were successful (89%) with a follow-up of 31.4 [0.6-59] months. At the last review, final complete occlusion of the defect without residual shunt or with only a minimal shunt was achieved in 92.3% (no shunt, n=73; trivial shunt, n=23). Four patients required a second procedure for residual shunt occlusion. Two devices had to be surgically explanted due to severe hemolysis. There were no deaths or other major complications. CONCLUSIONS: The NitOcclud device can be used successfully for a wide anatomical spectrum of VSD. The main issue is residual shunt, but its incidence decreases over time. The incidence of hemolysis was very low and no permanent changes were detected in atrioventricular conduction.

Cateterismo cardíaco esquerdo por via transeptal / Transeptal Left Cardiac Catheterization

Objetivo - Analisar a técnica do cateterismo transeptal, suas indicaçöes e possíveis complicaçöes. Métodos - O cateterismo transeptal foi realizado em 233 pacientes, sendo 202 crianças (idade de 0,1 a 16 anos) com cardiopatias congênitas e 31 adultos (37 a 73 anos), submetidos a valvoplastia mitral. Foi empregada a técnica de Mullins para ter acesso ás câmaras cardiacas esquerdas. Resultados - No grupo pediátrico, as principais indicaçöes para o cateterismo transeptal foram a coartaçäo e estenose aórtica, valvar e subvalvar. Diversos procedimentos diagnósticos e terapêuticos, como a atrio-septostomia com lâmina e a valvoplastia mitral tornaram-se exeqüíveis por essa técnica. Dentre as complicaçöes apresentadas em ambos os grupos, a perfuraçäo pericárdica foi a mais freqüente, dependente, sobretudo, da experiência da equipe que realiza a técnica. Conclusäo - O cateterismo cardíaco transeptal contitui técnica segura e eficaz para a investigaçäo hemodinâmica em diversas cardiopatias congênitas, além de ser imprescindível para a realizaçäo de diversos procedimentos terapêuticos. A técnica apresenta baixa incidência de complicaçöes quando empregada por grupo experiente