Transcatheter Closure of Perimembranous Ventricular Septal Defects With Amplatzer Duct Occluders.

Inroduction: This study reports on our experience with transcatheter closure of perimembraneous ventricular septal defects (pm-VSDs) with Amplatzer duct occluder I (ADO I) and Amplatzer duct occluder II (ADO II) Methods: Transcatheter device implantation with ADO I and ADO II was attempted in 17 patients with pm-VSD between August 2014 to December 2015. We usually decided the appropriate type and size of device according to the measurements by left ventricular angiograms. We choose 1-2 mm larger device than the defect size in our first cases. Recently we prefered 2-4 mm larger device due to prevent the residuel leakage or device embolism. Results: Patient mean age was 10.59±3.55 years and mean weight was 37.12±16.36. The mean defect size was 5.17±1,66 mm , mean Qp/Qs was 1.88±0.5, mean PVR/SVR ratio was 0.042±0.028 and mean fluoroscopy time was 25.11±7.97 minutes. ADO I was used in 13 cases and ADO II used in remaining 4 patients. The Amplatzer duct occluders were succesfully implanted in 16 of 17 patients. In one patient, ADO I suddenly embolised into the left pulmonary artery soon after its release. This device was retrieved and the patient underwent surgical closure of the ventricular septal defect succesfully. One of 4 patients underwent pmVSD closure with ADO-II had residuel leakage and one of them had transient left bundle branch block after the procedure. In addition one of patient had residuel leakage after ADO I deployment. No atrioventricular block (AVB) was determined during follow-up.