title: [Efficacy of the transcatheter closure of perimembranous and muscular ventricular septal defects with the Amplatzer duct occluder II].
abstract: OBJECTIVE
  To evaluate the feasibility and efficacy of transcatheter closure of perimembranous ventricular septal defects (pmVSD) with aneurysmatic formation and muscular ventricular septal defects (mVSD) with Amplatzer duct occluder II.
  
  
  METHODS
  This retrospective analysis included 48 cases received transcatheter closure of pmVSD aneurysmatic formation or mVSD from February 2011 to March 2012 in our hospital (42 pmVSD with aneurysmatic formation and 6 mVSD). Median age was 5.2 years (range: 1.8 - 15 years), and median weight was 20.2 kg (range: 12 - 44 kg). Amplatzer duct occluder II was selected depending on the condition of ventricular septal defect. The device was implanted by antegrade or retrograde approach. Complications such as residual shunt, valvular regurgitation and arrhythmia were evaluated by echocardiography or angiography. Median follow-up was 9.5 months (range: 1 - 13 months).
  
  
  RESULTS
  The mean ratio of pulmonary (Qp) to systemic (Qs) blood flow was 1.35 ± 0.15 before transcatheter closure. The diameter of exit hole of ventricular septal defects was (2.46 ± 0.53) mm measured by transthoracic echocardiography, and (2.35 ± 0.40) mm by angiography. Successful implantation of the device was achieved in 46 patients (96%) and unsuccessful in two cases due to acute aortic insufficiency. Forty-two (92%) patients were closed successfully, and trivial residual leak was evidenced in four patients and remained unchanged during follow-up. One patient with mVSD still had trivial residual shunt at 6 months post procedure. New trivial tricuspid insufficiency was observed in 1 patient (2.1%) during follow-up. Two patients developed procedural related left anterior fascicular block and remained unchanged during follow-up.
  
  
  CONCLUSIONS
  pmVSD with aneurysm and mVSD could be successfully treated with Amplatzer duct occluder II. However, the long waist and large disc of the device could interfere with tricuspid valve function and cause tricuspid insufficiency.
authors.affiliation: Department of Cardiology, Shanghai Jiaotong University Medical College, Shanghai, China.
authors.forename: Peng-jun
authors.initials: PJ
authors.lastname: Zhao
authors.forename: Zhi-qing
authors.initials: ZQ
authors.lastname: Yu
authors.forename: Wei
authors.initials: W
authors.lastname: Gao
authors.forename: Fen
authors.initials: F
authors.lastname: Li
authors.forename: Li-jun
authors.initials: LJ
authors.lastname: Fu
authors.forename: Ting-liang
authors.initials: TL
authors.lastname: Liu
authors.forename: Yun
authors.initials: Y
authors.lastname: Li
authors.forename: Yu-qi
authors.initials: YQ
authors.lastname: Zhang
authors.forename: Mei-rong
authors.initials: MR
authors.lastname: Huang
authors.forename: Ying
authors.initials: Y
authors.lastname: Guo
mesh_terms: D000293:Adolescent; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D055989:Septal Occluder Device; D016896:Treatment Outcome