Retrograde transcatheter closure of perimembranous aneurysmal ventricular septal defects using amplatzer vascular plug II

Abstract

Introduction Retrograde transcatheter closure of perimembranous aneurysmal ventricular septal defects (pmVSD) can be a better option for transcatheter closure of ventricular septal defect with device placement into ventricular septal aneurysm with fewer complications. Also, a retrograde approach might decrease procedure time and radiation exposure time. Aim The purpose of this study was to report off-label experience using Amplatzer Vascular Plug II (AVPII) for the trans catheter closure of perimembranous aneurysmal VSD. Comparison of haemodynamic effects of ketamine and sevofluorane as in induction of anesthesia. Materials and methods Our series consists of a fifteen child with pmVSD. The mean age was 4.9 years (range: 1.2–10 years), mean left ventricular end-diastolic dimension 38.3 mm. Maximum and minimum defect sizes were 4 and 8 mm by transthoracic echocardiography (mean defect size: 5.2 mm). The procedure was performed under general anesthesia with left heart catheterization for retrograde closure of the defect. The study was done on 15 children from 2016 to 2018 for retrograde transcatheter closure of aneurysmal perimembrance VSDs using an Amplatzer vascular plug II Baseline characteristics of the study patients are set in Table I. All the children who had aneurysmal perimembrance outlet ventricular septal defect with left to right shunt were included for assessment of closure. The children eligiable underwent clinical evaluation that also included electrocardiogram (ECG), and standard echocardiography assessment. Results All participants who met the inclusion criteria were sent to the catheterization laboratory. Following left ventricular angiogram, three patients were excluded as technically nonfeasible. Failure to cannulate the defect in one patient and deficient aneurysmal tissue during left ventricular angiography in two cases. The device was successfully deployed in 12 children with the retrograde technique. In two patients antegrade approach was used using the ADO I device due to deficient aneurysmal tissue. The complete VSD closure rate was 84% immediately, 92% at 24 h, and 92% at the last follow-up. Atrioventricular conduction system was not affected by the procedure in any patients. Arterial complication developed in two patients. There was no device embolization; no aortic regurge developed in any patient. According to children had ketamine in induction of anesthesia HR recorded (122±16) beats /min but the children had sevofuran in indnction of anestherin re corded (108±12) beats/min but not significant different howevere the (MBP) inth children had ketamin had (68±14) mm Hg but the children had sevofluran in induction (60±8) mm Hg but not significant different. Conclusions Retrograde transcatheter closure of pmVSDs using AVPII is a safe and effective alternative method which allow closure of a wider range of VSDs due to availability of wide ranges of AVPII sizes of up to 22 mm in diameter. The retrograde approach can also simply the procedure with less fluoroscopy time and anesthesia time.

Keywords

• perimembranous
• septal aneurysm
• transcatheter