title: Retrograde transcatheter closure of ventricular septal defects in children using the Amplatzer Duct Occluder II.
abstract: OBJECTIVE
  To describe the technique and results of transcatheter closure of ventricular septal defects (VSDs) by a modified retrograde transarterial approach using the new Amplatzer Duct Occluder II (ADO II).
  
  
  BACKGROUND
  Transcatheter device closure of ventricular septal defects (VSDs) by antegrade method is well established, but a challenging procedure. We describe a retrograde technique that obviates the need for arteriovenous looping.
  
  
  METHODS
  This is a prospective study from a single center. Between April 2009 and February 2010 13 children were identified for closure of various types of perimembranous and muscular VSDs using the ADO II device. All had met the criteria for surgical closure. Following left ventricular angiogram two were excluded as technically nonfeasible. The median age was 48 months (range 15-78). The median weight was 14 kg (range 7.5-20). The device was successfully deployed in the 11 selected children by the method described. The follow-up evaluation included chest roentgenogram, ECG, and echocardiogram on day 1, at 6 weeks, at 3, 6, and 12 months.
  
  
  RESULTS
  The immediate and follow up complete closure rates were 73 and 82%, respectively. The median fluoroscopic time was 14 min (range 8.2-45). There were no procedure related complications. All patients were doing well at median follow up of 10 months; none showing any conduction abnormality.
  
  
  CONCLUSIONS
  Transcatheter retrograde device closure of selected cases of Ventricular Septal Defects using the Amplatzer Duct Occluder II is simple and appears safe in the short term and can be completed within a short fluoroscopic time.
authors.affiliation: Department of Pediatric Cardiology, The Institute of Medical Sciences, Care Hospital, Banjara Hills, Hyderabad, Andhra Pradesh, India. drkoneti@yahoo.com
authors.forename: Nageswara Rao
authors.initials: NR
authors.lastname: Koneti
authors.forename: Raghava Raju
authors.initials: RR
authors.lastname: Penumatsa
authors.forename: Vasudevan
authors.initials: V
authors.lastname: Kanchi
authors.forename: Srinivas Kumar
authors.initials: SK
authors.lastname: Arramraj
authors.forename: Jaishankar
authors.initials: J
authors.lastname: S
authors.forename: Somaraju
authors.initials: S
authors.lastname: Bhupathiraju
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D002932:Cineangiography; D015150:Echocardiography, Doppler; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D018579:Patient Selection; D011446:Prospective Studies; D011474:Prosthesis Design; D018570:Risk Assessment; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome