Transcatheter closure of perimembranous ventricular septal defect with immediate follow-up.
BACKGROUND
Surgical closure of membranous ventricular septal defect (VSD) is performed by open heart surgery with a small but significant morbidity and mortality. The authors reported here the first group of patients who underwent transcatheter closure of membranous VSD.


METHODS
Patients who had membranous VSD with significant left to right shunt as shown by echocardiogram were selected for closure. A standard right and left heart catheterization was done under general anesthesia. A complete arteriovenous wire loop from the aorta to the left ventricle and VSD out into right ventricle was formed in order to guide the delivery sheath into the VSD from the right ventricle. The authors used the new Amplatzer Membranous VSD Occluder (AGA Medical Corp., USA) to deploy in the VSD position.


RESULTS
There were 4 patients in the present study with age range of 2 to 24 years old (median: 4 years old). Their weight ranged from 10 to 45 kg (median: 12 kg). Qp:Qs ranged from 1.7-2.5 to 1. The device diameter selected was from 6 to 10 mm. All of them were placed without any residual shunt. At one month follow-up all the patients had echocardiographic examination which showed no evidence of residual shunt.


CONCLUSIONS
The authors demonstrated that transcatheter closure of membranous VSD could be safely and effectively performed in small children. This device also provided an opportunity for closure of VSD in patients with pulmonary hypertension.
Durongpisitkul
Kritvikrom
K
Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Soongswang
Jarupim
J
Laohaprasitiporn
Duangmanee
D
Nana
Apichart
A
Nutakul
Thitima
T
D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004864:Equipment and Supplies; D006345:Heart Septal Defects, Ventricular / Q000628:therapy*; D006801:Humans; D016896:Treatment Outcome