Heart Views

Transcatheter Amplatzer device closure has been used to close muscular ventricular septal defects with satisfactory results. A new asymmetric Amplatzer perimembranous ventricular septal occluder has been specially designed for closure of perimembranous ventricular septal defects. We report our initial experience with ventricular septal defect (VSD) device closure from January 1, 2003 to August 31, 2003 using the new Amplatzer perimembranous and muscular ventricular septal occluders. During the eight-month period, we closed 13 VSDs percutaneously, 10 perimembranous and 3 muscular. The mean age was 9 years (range 3-17 yrs), mean weight of 33 kg (range from 10.6-69 kg). The mean VSD size by TEE was 9.7 mm (range 6-12 mm); Qp: Qs was a mean of 1.44:1 (range of 1.1:1 to 2.2: 1). The mean device size was 10.0 mm (6-14 mm). Immediate and complete closure was achieved in 11 patients (92%). One patient with a muscular defect had a residual shunt and multiple other smaller defects. In another patient, the device was retrieved because of device related aortic insufficiency (AI). Complications included LBBB in one patient; two patients developed tricuspid regurgitation (TR), one mild and the other moderate; two patients developed trivial AI, and one with pre-closure AI, improved after closure. On follow up, the LVEDD improved from a mean of 4.4 cm (3.4-5.9) to a mean of 4.0 cm (3.2-5.5cm) at three months. We conclude that transcatheter occlusion of perimembranous and muscular VSDs is safe, feasible and effective; however, this excellent immediate result and short term follow up need to be confirmed by large scale intervention trials and long term follow up.