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Trans catheter PMVSD Closure

Trans catheter PMVSD Closure. Alpay Çeliker M.D. Acıbadem Maslak Hospital. Trans catheter VSD closure : History. 1988: Lock  Bard PDA 1991: Lock Clamshell 1995: Rigby&Redington  Bard PDA 1997: Sideris  Buttoned device 1999: Amin  Amplatzer (Hibrid)

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Trans catheter PMVSD Closure

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  1. Transcatheter PMVSDClosure Alpay Çeliker M.D. Acıbadem Maslak Hospital

  2. Transcatheter VSD closure:History • 1988: Lock Bard PDA • 1991: Lock Clamshell • 1995: Rigby&Redington Bard PDA • 1997: Sideris  Buttoned device • 1999: Amin Amplatzer (Hibrid) • 1999: Thanapoulos Amplatzer (muscular) • 2002: Hijazi  Amplatzer (Perimembranöz)

  3. Amplatzer Perimembraneous VSD Device

  4. Patient Selection • LV volume increase due to left to right shunt • > 8 kg body weight • Enough subaortic rim > 2mm • Contrindication • Supracristal VSD • İnlet VSD

  5. Perimembraneous VSD (n= 186) BW= 43.5 kg( 12,5-77) Age= 15.9 year (3-51) 5,1 mm (2.8-12.8) Single PMVSD n=106 Single Aneurysmal VSD n=63 Multiple Aneurysmal VSD n=17 Perimembraneous VSDclosure • Closure Rates • Group I: 90  100 % • Group II: 98  98 % • Group III: 89  89 % • Left Anterior Hemiblock  9 • Inkomplete right bundle branch block  7 Masura et al. Ped Cardiol, 2005

  6. Atrioventricular Block • Temporary Block • May occur after the intervention • May resolve but with permanent left anterior hemiblock • Permanent Block • May occur early or late phase

  7. Major Arrhytmias Complete AV block Pull-back or reposition the catheter. If it recurs with unforced and appropriate catheter manipulation consider to abandone the procedure • Catheter/wire/ sheath/ device trauma to the conduction system • It is very important since it may be related with the early or late permanent AV block

  8. A 15 month old boy with a VSD underwent percutaneous device closure of the 12 mm MVSD with Amplatzer MVSD device. Five days later he collapsed; on arrival to hospital he was asystolic and received prolonged cardio-pulmonary resuscitation (CPR) with intermittent return of spontaneous circulation. Urgent removal of device and surgical patch closure of defect concomitant permanent VVI epicardial pacing.

  9. Chessa ve ark. Int J Cardiol 2008 (e-pub)

  10. Transcatheter closure of pmVSD with placement of the device into the VSA is safe and effective, and may result in fewer instances of AV block and valve problems. Small but persistent VSD’s and a seemingly increased rate of persistent BB blocks remain important issues that warrant further evaluation of this method.

  11. From 2009 to 2012, 21 patients underwent closure of PMVSD using ADO. There were 5 males and 16 females, and their median age was 7 (3–42) years. Their median weight was 27 (18–60) kg.

  12. Success rate: 29 of 31 procedures (93.5 %) In one patient the device (VSD 5 mm, ADOII 6/4 mm) had to be explanted. 2.2-year-old girl (12.6 kg) with a PMVSD (4 mm), a 4/4 mm ADO II was embolised in the RV occurred. The device was retrieved interventionally, and surgical closure. During 41 mos follow-up one patient (7 years, pmVSD) had AV rhythm (80/min) for 24 h postimplantation; this resolved spontaneously.

  13. Ventricular septal defects in selected patients may be closed percutaneously using an ADO II device, as an off- label therapy. It appears that ADO II may be the preferable device for the closure of defects of moderate size (2–5 mm), especially in infants and small children, because of its better profile and trackability. The incidence of complications is acceptably low. Its possible superiority in terms of less AVB development needs to be proven with longer follow-up periods, as late development has been described for other devices

  14. 75% reduction in radial force, 45% reduction in clamping force, and increased stability.

  15. Left Disc Elliptical and Concave Shape: Adapts to the LVOT and provides improved retention and stability. It is available in two configurations: Eccentric, with a 1 mm superior rim and a 3 mm inferior rim Concentric, with 3 mm superior and inferior rims. An eccentric device is used when the distance between the defect and the aortic valve is <3 mm. Dual Layer Configuration: Thin external layer, imparting minimal radial pressure, while the inner portion provides stability. Waist Lenght: Increased from 1.5 to 3 mm to reduce clamp force against the ventricular septum. Both versions of the device are available in 9 waist diameters (from 4 to 10 in 1 mm increments plus 12 and 14 mm). New TorqVue 4 Delivery System: Redesigned to facilitate better positioning in the LVOT.

  16. In this multicenter experience, device implantation was feasible, safe, and effective, with no more than mild residual shunting on follow-up. No patient experienced any degree of AV block or new onset complete bundle branch block at one-year follow-up. These initial favorable findings suggest that further studies should be pursued. Larger multicenter studies with even longer follow-up are required to vali-date and extend these initial results before widespread use.

  17. Conclusion • Alternative to surgery for perimembraneous VSD • There are several devices for PM VSD closure • The most important issue has been the AV conduction problems • There are research to eliminate this worrisome complication • Perfect device for PM VSD Closure: • Amplatzer PM VSD Closure Devices • Coils • ADO I and ADO II • Vascular plugs

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