| Cardiology in the Young, October 2007 by Gunther Fischer, Sotiria C. Apostolopoulou,
Per G. Bj√∏rnstad, Hans Heiner Kramer, Spyros Rammos, Martin B.
Schneider
Summary:
Transcatheter closure of ventricular
septal defects with the Amplatzers Membranous VSD Occluder has yielded
promising initial results, but disturbances of conduction, including
complete heart block, have been reported. We report our experience with
the Amplatzer occluder in 35 patients with a median age 4.5 years, the
defects being sized angiographically at 4.4 plus or minus 1.1
millimetres, with a range from 3 to 8 millimetres, and the size of the
occluder varying from 4 to 12 millimetres. Over a median follow-up of
2.5 years, the rate of complete closure was 87% and 91%, at 1 and 2
years respectively, while 2 patients required surgical closure of the
defect subsequent to the insertion of the device. Persistent
regurgitation across the tricuspid valve related to the occluder was
observed in 3 patients, and in 6 patients across the aortic valve.
Abnormalities of conduction related to the procedure were noted in 7
patients, onefifth of the cohort. The disturbances were transient in 1
patient, but permanent in 6, in one of the latter progressing after 6
months from left bundle branch block to intermittent Mobitz II
second-degree atrioventricular block in association with expansion of
the occluder. We conclude that transcatheter closure of perimembranous
ventricular septal defects with the Amplatzer occluder is effective with
limited complications, but the incidence of immediate and progressive
disturbances of conduction related to the proximity of conduction
tissues to the rims of the occluder stress the importance of larger and
longer studies to assess the safety of this procedure.
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