Background/Aim of the work:
Amplatzer duct occluder I (ADO I) devices appear to be an attractive option in perimembranous (pmVSD) type.
The design of the device with absent bulk on RV side appears to be suitable for pmVSDs having tricuspid tissue at the edge. In developing countries, the lack of early available and affordable surgery, and the relatively high cost of currently devices designed for VSD closure create additional problems.
We report the immediate and mid-term follow-up results of using ADOI devices to close pmVSDs in a consecutive series of young patients.
Patients & Methods:
Retrospective case study for all children referred for transcatheter closure of pm VSD using the ADO I device from February 2016 to March 2017.
Clinical inclusion criteria: at least 3 of the following had to be present: overt heart failure, failure to thrive, recurrent respiratory infections, LVEDD BSA z-score ≥2, QP/QS >1.5 at cardiac catheterization, history of IE related to the VSD.
Morphologic inclusion criterion: Isolated pm VSD, up to 10 mm minimum diameter by TTE.
TEE: to describe the anatomical position of the VSD.
Results:: Clinical findings of the included patients; their median age was 4years( 13months to 12years), their median body weight 15 (6.5-51) Kg, failure to thrive: 8/28 (28.6%), pulmonary hypertension 10/28 (35.7%), history of IE 1/28 (3.5%), recurrent chest infections 10/28 (35.7%). Median angiographic minimum VSD diameter was 5.2 (3.75-9)mm, fluoro time was 55(34.5–99)min. The majority device size (diameter/ length) used was 10/8 (13/28, 46.4%) followed by 10/8 (8/28, 28.6%). Success rate of the procedure was 85.7% (24/28), causes of failure were; unstable device (10.7%, 3/28), embolized to RV and percutaneous retrieval (3.5%, 1/28). Immediate closure was achieved in 91.7% (22/24) and raised to 95% (23/24) at 3months follow-up. Conclusion: the transcatheter closure of pm VSD with Amplatzer ductal occluder I was successful in 95% without any residual flow or heart block. ADOI is safe and effective for transcatheter closure of pmVSDs in symptomatic infants and children. The device is affordable and widely available.