Hostname: page-component-7dd5485656-dk7s8 Total loading time: 0 Render date: 2025-10-31T09:24:57.363Z Has data issue: false hasContentIssue false
  • English
  • Français

The Amplatzer® Membranous VSD Occluder and the vulnerability of the atrioventricular conduction system

Published online by Cambridge University Press:  01 October 2007

Gunther Fischer ,
Sotiria C. Apostolopoulou ,
Spyros Rammos ,
Martin B. Schneider ,
Per G. Bjørnstad  and
Hans Heiner Kramer
Gunther Fischer*
Affiliation:
Klinik für Kinderkardiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany
Sotiria C. Apostolopoulou
Affiliation:
Department of Paediatric Cardiology, Onassis Cardiac Surgery Centre, Athens, Greece
Spyros Rammos
Affiliation:
Department of Paediatric Cardiology, Onassis Cardiac Surgery Centre, Athens, Greece
Martin B. Schneider
Affiliation:
Deutsches Kinderherzzentrum, Sankt Augustin, Germany
Per G. Bjørnstad
Affiliation:
Paediatric Cardiology, Rikshospitalet – The National Hospital, University of Oslo, Oslo, Norway
Hans Heiner Kramer
Affiliation:
Klinik für Kinderkardiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany
*
Corresponence to: Dr. Gunther Fischer, Klinik für Kinderkardiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schwanenweg 20, D-24105 Kiel, Germany. Tel: +49 431 597 1622; Fax: +49 431 597 1828; E-mail: fischer@pedcard.uni-kiel.de
Get access Rights & Permissions [Opens in a new window]

Abstract

Transcatheter closure of ventricular septal defects with the Amplatzer® 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, one-fifth 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.

Keywords

Interventional catheterizationdisturbance of cardiac rhythmnitinol

Information

Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 5 , October 2007 , pp. 499 - 504
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1.Lock, JE, Block, PC, McKay, RG, Baim, DS, Keane, JF. Transcatheter closure of ventricular septal defects. Circulation 1988; 78: 361–368.Google Scholar
2.Bridges, ND, Perry, SB, Keane, JF, et al. . Preoperative transcatheter closure of congenital muscular ventricular septal defects. N Engl J Med 1991; 324: 1312–1317.Google Scholar
3.Knauth, AL, Lock, JE, Perry, SB, et al. . Transcatheter device closure of congenital and postoperative residual ventricular septal defects. Circulation 2004; 110: 501–507.Google Scholar
4.Sideris, EB, Walsh, KP, Haddad, JL, Chen, CR, Ren, SG, Kulkarni, H. Occlusion of congenital ventricular septal defects by the buttoned device. “Buttoned device” Clinical Trials International Register. Heart 1997; 77: 276–279.Google Scholar
5.Chaudhari, M, Chessa, M, Stumper, O, De Giovanni, JV. Transcatheter coil closure of muscular ventricular septal defects. J Interv Cardiol 2001; 14: 165–168.Google Scholar
6.Holzer, R, Balzer, D, Cao, QL, Lock, K, Hijazi, ZM. Device closure of muscular ventricular septal defects using the Amplatzer muscular ventricular septal defect occluder: immediate and mid-term results of a US registry. J Am Coll Cardiol 2004; 43: 1257–1263.Google Scholar
7.Bass, JL, Kalra, GS, Arora, R, et al. . Initial human experience with the Amplatzer perimembranous ventricular septal occluder device. Catheter Cardiovasc Interv 2003; 58: 238–245.Google Scholar
8.Carminati, M, Butera, G, Chessa, M, Drago, M, Negura, D, Piazza, L. Transcatheter closure of congenital ventricular septal defect with Amplatzer septal occluders. Am J Cardiol 2005; 96: 52L–58L.Google Scholar
9.Anderson, RH, Becker, AE. The anatomy of ventricular septal defects and their conduction tissues. In: Stark, J, deLeval, M (eds) Surgery for Congenital Heart Defects. Saunders W.B., Philadelphia, 1994, pp 115–138.Google Scholar
10.Pedra, CA, Pedra, SR, Esteves, CA, et al. . Percutaneous closure of perimembranous ventricular septal defects with the Amplatzer device: technical and morphological considerations. Catheter Cardiovasc Interv 2004; 61: 403–410.Google Scholar
11.Fu, YC, Bass, J, Amin, Z, et al. . Transcatheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: results of the US phase I trial. J Am Coll Cardiol 2006; 47: 319–325.Google Scholar
12.Hobbins, SM, Izukawa, T, Radford, DJ, Williams, WG, Trusler, GA. Conduction disturbances after surgical correction of ventricular septal defect by the atrial approach. Br Heart J 1979; 41: 289–293.CrossRefGoogle ScholarPubMed
13.Houyel, L, Vaksmann, G, Fournier, A, Davignon, A. Ventricular arrhythmias after correction of ventricular septal defects: importance of surgical approach. J Am Coll Cardiol 1990; 16: 1224–1228.CrossRefGoogle ScholarPubMed
14.Fukuda, T, Nakamura, Y, Iemura, J, Oku, H. Onset of complete atrioventricular block 15 years after ventricular septal defect surgery. Pediatr Cardiol 2002; 23: 80–83.Google Scholar
15.Fukuda, T, Suzuki, T, Kashima, I, Sato, M, Morikawa, Y. Shallow stitching close to the rim of the ventricular septal defect eliminates injury to the right bundle branch. Ann Thorac Surg 2002; 74: 550–555.Google Scholar
16.Yip, WC, Zimmerman, F, Hijazi, ZM. Heart block and empirical therapy after transcatheter closure of perimembranous ventricular septal defect. Catheter Cardiovasc Interv 2005; 66: 436–441.Google Scholar
17.Masura, J, Gao, W, Gavora, P, et al. . Percutaneous closure of perimembranous ventricular septal defects with the eccentric Amplatzer device: multicenter follow-up study. Pediatr Cardiol 2005; 26: 216–219.Google Scholar
18.Bonatti, V, Agnetti, A, Squarcia, U. Early and late postoperative complete heart block in pediatric patients submitted to open-heart surgery for congenital heart disease. Pediatr Med Chir 1998; 20: 181–186.Google Scholar