Transcatheter closure of congenital ventricular septal defects in adult: mid-term results and complications.
BACKGROUND
Transcatheter treatment of congenital heart defects in adult patients is dramatically changing the way in which this population is being treated. This report outlines mid-term follow-up results and complications in adult patients that underwent transcatheter VSD closure.


METHODS
The data of 40 adult patients who underwent transcatheter closure of a VSD at our institution were collected prospectively between January 2000 and June 2006. The inclusion criteria for this study were clinical and/or echocardiographic evidence of a significant left-to-right shunt through a muscular VSD (mVSD) or a perimembranous VSD (pVSD). A shunt was considered significant when the following were found: (i) left atrial enlargement, defined as a left atrial-to-aortic ratio >1.5; (ii) left ventricular enlargement (left ventricular overload), defined as a left ventricular end-diastolic diameter >+2 standard deviation (SD) above the mean for the patient's age. Another inclusion criterion was a previous episode of endocarditis.


RESULTS
41 procedures were carried out in 40 patients; a mVSD-O was used in 22 patients and a pVSD-O in 18 patients (1 patient had two devices inserted). No deaths occurred; no procedure was aborted. A total of 6 (14.6%) complications occurred. The most frequent complication was a rhythm abnormality (n=4). No device embolization occurred. The median follow-up duration was 36 months (range: 6-81 months). No deaths or cases of endocarditis occurred. One patient who had two devices implanted because of a residual defect after a tetralogy of Fallot repair, had to be operated again 3 months after the second device implantation because of a persistent significant residual leak.


CONCLUSIONS
Greater experience, possibly of multicentre trials and long-term follow-up are required to better assess the safety and effectiveness of this procedure as an alternative to surgical approaches in adult patients.
Chessa
Massimo
M
Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS-Policlinico San Donato Hospital, San Donato Milanese, Milan, Italy. massimo.chessa@grupposandonato.it
Butera
Gianfranco
G
Negura
Diana
D
Bussadori
Claudio
C
Giamberti
Alessandro
A
Fesslova
Vlasta
V
Carminati
Mario
M
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D006328:Cardiac Catheterization; D004452:Echocardiography; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome