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Journal of Structural Heart Disease, October 2019, Volume 5, Issue 5:221-228
DOI: 10.12945/j.jshd.2019.002.19
Transcatheter Trans-aortic Retrograde Approach for the Closure of Perimembranous Ventricular Septal Defects using Cocoon [Amplatzer Duct Cccluder I Like] Device – An Initial Experience from a Single Centre
Pankaj Jariwala, MD, DNB, DNB, MNAMS, FICPS, FACC*, Kumar Narayanan, MD, DM, Edla Arjun Padma Kumar, MD, DM
Department of Cardiology, Maxcure-Mediciti Hospitals, Hyderabad, Telangana, India
Abstract
Aims & Objective: Transcatheter ventricular septal defect (VSD) device closure is usually performed using the antegrade approach [1–3]. A few case series of a retrograde technique using the Amplatzer duct occluder (ADO) II device have been reported [4, 5]. We aimed to assess the feasibility and safety of a retrograde closure technique using an ADO I like device, which is used for the closure of patent ductus arteriosus (PDA).
Methods: Between June 2015 and January 2018, eight consecutive, consenting cases with congenital perimembranous VSDs underwent trans-aortic device closure using an ADO I like device in a single tertiary care center.
Results: The median age was 17.1 years (5-32, SD 17.125 years) with 3 males and 5 females. Mean defect size was 6.6 mm (4.5 - 8.6 mm, SD 6.6125), with a median aortic rim of 3.4 mm (2-5, SD 3.4125). Median Qp/Qs and right ventricular systolic pressure was 1.8 (1.6-2.1, SD 1.825) and 41.3 mm Hg (33-50, SD 41.25) respectively. Median fluoroscopy and procedure times were 13.3 (10.6-15.7, SD 13.275) and 23.5 (18.2-27.2, SD 22.722) minutes respectively. The defects were successfully closed with no residual shunt in all 8 patients (100%). There was no semilunar or atrioventricular valve leaflet entrapment or regurgitation. There were no instances of acute device dislodgement or Atrioventricular (AV) block. Over a median follow up of 18 months, all eight patients remained symptom-free with no residual shunt or late complications.
Conclusion: In this initial experience, trans-aortic, retrograde VSD device closure using an ADO I like device appears feasible and safe in patients with perimembranous VSDs which a cost-effective alternative to routine use of the ADO II device.
Cite this article as: Jariwala P, Narayanan K, Kumar EAP. Transcatheter Trans-aortic Retrograde Approach for the Closure of Perimembranous Ventricular Septal Defects using Cocoon [Amplatzer Duct Cccluder I Like] Device – An Initial Experience from a Single Centre. Structural Heart Disease 2019;5(5):221-228. DOI: 10.12945/j.jshd.2019.002.19
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New Technology
Journal of Structural Heart Disease, October 2019, Volume 5, Issue 5:221-228
DOI: 10.12945/j.jshd.2019.002.19
Transcatheter Trans-aortic Retrograde Approach for the Closure of Perimembranous Ventricular Septal Defects using Cocoon [Amplatzer Duct Cccluder I Like] Device – An Initial Experience from a Single Centre
Pankaj Jariwala, MD, DNB, DNB, MNAMS, FICPS, FACC*, Kumar Narayanan, MD, DM, Edla Arjun Padma Kumar, MD, DM
Department of Cardiology, Maxcure-Mediciti Hospitals, Hyderabad, Telangana, India
Abstract
Aims & Objective: Transcatheter ventricular septal defect (VSD) device closure is usually performed using the antegrade approach [1–3]. A few case series of a retrograde technique using the Amplatzer duct occluder (ADO) II device have been reported [4, 5]. We aimed to assess the feasibility and safety of a retrograde closure technique using an ADO I like device, which is used for the closure of patent ductus arteriosus (PDA).
Methods: Between June 2015 and January 2018, eight consecutive, consenting cases with congenital perimembranous VSDs underwent trans-aortic device closure using an ADO I like device in a single tertiary care center.
Results: The median age was 17.1 years (5-32, SD 17.125 years) with 3 males and 5 females. Mean defect size was 6.6 mm (4.5 - 8.6 mm, SD 6.6125), with a median aortic rim of 3.4 mm (2-5, SD 3.4125). Median Qp/Qs and right ventricular systolic pressure was 1.8 (1.6-2.1, SD 1.825) and 41.3 mm Hg (33-50, SD 41.25) respectively. Median fluoroscopy and procedure times were 13.3 (10.6-15.7, SD 13.275) and 23.5 (18.2-27.2, SD 22.722) minutes respectively. The defects were successfully closed with no residual shunt in all 8 patients (100%). There was no semilunar or atrioventricular valve leaflet entrapment or regurgitation. There were no instances of acute device dislodgement or Atrioventricular (AV) block. Over a median follow up of 18 months, all eight patients remained symptom-free with no residual shunt or late complications.
Conclusion: In this initial experience, trans-aortic, retrograde VSD device closure using an ADO I like device appears feasible and safe in patients with perimembranous VSDs which a cost-effective alternative to routine use of the ADO II device.
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Cite this article as: Jariwala P, Narayanan K, Kumar EAP. Transcatheter Trans-aortic Retrograde Approach for the Closure of Perimembranous Ventricular Septal Defects using Cocoon [Amplatzer Duct Cccluder I Like] Device – An Initial Experience from a Single Centre. Structural Heart Disease 2019;5(5):221-228. DOI: 10.12945/j.jshd.2019.002.19
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