Transcatheter closure of single muscular ventricular septal defects using the Amplatzer muscular VSD occluder: Initial results and technical considerations

Surgical closure of multiple muscular ventricular septal defects (MVSDs) is associated with mortality and morbidity; therefore, both surgeons and card iologists welcome a nonsurgical safe approach. We report our initial result s of catheter closure of MVSD using the new Amplatzer muscular VSD occluder delivered via the venous or arterial routes. Eight patients with MVSD unde rwent closure of their VSDs using the Amplatzer VSD occluder under general endotracheal anesthesia. The mean +/- SD of age was 5.4 +/- 3.1 years (2-10 years) and mean weight was 18.4 +/- 6.5 kg (11.5-29 kg). All patients had left ventricular volume overload with mean Qp/Qs ratio of 1.7 +/- 0.6 (1.4- 3). The location of the VSD was mid muscular in four, anterior in two, apic al in one, and posterior in one. The systolic pulmonary artery pressure ran ged from 25 to 85 mm Hg (mean, 39.9 +/- 18.8 mm Hg). The device was implant ed successfully in all eight patients. In five patients (four mid muscular and one apical), the deployment of the device was anterograde from the righ t internal jugular vein and in three patients (two anterior and one posteri or VSD), the initial attempt at anterograde deployment was unsuccessful due to kinking in the delivery sheath; therefore, retrograde deployment was at tempted successfully. The size of the device used ranged from 6 to 14 mm (t he size of the connecting waist). In patients with elevated pulmonary arter y pressure, repeat measurements immediately after closure revealed normaliz ation in all. There was immediate complete closure of the defect in two pat ients and six patients had trivial residual shunt (foaming through the devi ce), which disappeared completely within 24 hr in five and at 6-month follo w-up in the sixth patient. The mean fluoroscopy time was 37.1 +/- 13 min (1 1.7-55 min). Complications encountered included transient junctional rhythm in one patient. No blood transfusion was required. On follow-up evaluation , there has been no episode of endocarditis, thromboembolism, hemolysis, or wire disruption, we conclude that the Amplatzer MVSD occluder is a safe an d effective device for closure of MVSDs up to 12 mm in diameter. Further cl inical trials with this device are underway. (C) 2000 Wiley-Liss, Inc.