Page 34 - Journal of Structural Heart Disease Volume 5, Issue 5

227
New Technology
trapment with possible tricuspid regurgitation during follow-up, got more attention [2, 4]. The advantage of this approach is that it is also useful in patients with venous anomalies, such as interrupted inferior vena cava [11]. It has been reported that the trans-aortic approach causes a lower incidence of AVB than the antegrade approach [9, 12].
ADO I or its chinese counterparts were used in a few case reports by antegrade approach for the clo- sure of residual post-surgical VSDs [13, 14] and for the closure of multi-perforated perimembranous VSD with aneurysm [15]. Recently, Nguyen et al. published a multicenter case series of antegrade transvenous closure of PMVSD using ADO I with 95% success rate and with complications in 1.7% of cases. They had embolization of device in 1% of cases and AVB in 0.7% of cases [16].
The risk of embolization is inherant complication of any device closure but in our case, the non-pres- ence of disc on the LV side doesnot increase it further. Basically, device sits there as it fits snuggly and the LV pressure cannot push the device as the LV contracts circumferentially in systole by rotation and torsion [17]. In our small case series, there were no emboliza- tion and also no evidence of tricuspid regurgitation. One case had minimal residual shunt which resolved completely at the 1-month follow-up.
Study limitations
Our study had a small number of cases, and should be considered an initial feasibility study. More long-
References
1. Koneti NR, Sreeram N, Penumatsa RR, Ar- ramraj SK, Karunakar V, Trieschmann U. Transcatheter Retrograde Closure of Peri- membranous Ventricular Septal Defects in Children With the Amplatzer Duct Occluder II Device. J Am Coll Cardiol. 2012;60:2421- 2422. DOI: 10.1016/j.jacc.2012.08.1004
2. Suligoj B, Cernic N, Zorc M, Noc M, Kar S. Retrograde transcatheter closure of ven- tricular septal defect with Amplatzer Duct Occluder II. Postep w Kardiol Interwen- cyjnej. 2016;12:177-178. DOI: 10.5114/ aic.2016.59371
3. Pekel N, Ercan E, Özpelit ME, Özyurtlu F, Yılmaz A, Topaloğlu C, et al. Directly ven- tricular septal defect closure without us- ing arteriovenous wire loop: Our adult
term data with larger number of patients will be needed to draw more definitive conclusions. In this initial series, we did not attempt to close larger defect sizes, patients < 3 years of age or those with severe reversible pulmonary artery hypertension; hence our findings may not be applicable to these sub- sets. However the data from this early study appears promising and should prompt further evaluation in a wider spectrum of patients.
Conclusion
In this initial experience, retrograde trans-arterial closure of VSD using an ADO-I like device appears feasible and relatively more cost-effective. It can help further reduce radiation exposure and can be poten- tially applied in all cases even with deficient aortic rim. Further studies are required to document its effi- cacy, safety and long-term results in a larger number of patients.
Conflict of Interest
The authors have no conflict of interest relevant to this publication.
Comment on this Article or Ask a Question
septal defect occluder: Initial clinical ap- plications in children. J Am Coll Cardiol. 1999;33:1395-1399. DOI: 10.1016/S0735- 1097(99)00011-X
7. Szkutnik M, Kusa J, Białkowski J. Percutane- ous closure of perimembranous ventricu- lar septal defects with Amplatzer occlud- ers--a single centre experience. Kardiol Pol. 2008;66:941-949. PMID: 18924021
8. Carminati M, Butera G, Chessa M, Drago M, Negura D, Piazza L. Transcatheter clo- sure of congenital ventricular septal de- fect with Amplatzer septal occluders. Am J Cardiol. 2005;96:52L-58L. DOI: 10.1016/j. amjcard.2005.09.068
9. Muthusamy K. Retrograde closure of peri- membranous ventricular septal defect us-
transarterial retrograde J Cardiol. 2017;461-468.
case series using
approach. Anatol
DOI: 10.14744/AnatolJCardiol.2017.7507
4. Koneti NR, Penumatsa RR, Kanchi V, Arram- raj SK, S J, Bhupathiraju S. Retrograde tran- scatheter closure of ventricular septal de- fects in children using the Amplatzer Duct Occluder II. Catheter Cardiovasc Interv. 2011;77:252-259. DOI: 10.1002/ccd.22675
5. Lock JE, Block PC, McKay RG, Baim DS, Keane JF. Transcatheter closure of ventricu- lar septal defects. Circulation 1988;78:361- 368. DOI: 10.1161/01.CIR.78.2.361
6. Thanopoulos BD, Tsaousis GS, Konstado- poulou GN, Zarayelyan AG. Transcathe- ter closure of muscular ventricular septal defects with the Amplatzer ventricular
Jariwala P. et al.
VSD Device Closure Using ADO I Like Device.