title: Transcatheter closure of perimembranous ventricular septal defect using Amplatzer ductal occluder.
abstract: OBJECTIVE
  To show that transcatheter closure of perimembranous ventricular septal defect (PMVSD) with the Amplatzer ductal occluder (ADO, AGA Medical Corp, Plymouth, Minnesota) is a safe and effective treatment option.
  
  
  BACKGROUND
  Transcatheter closure of PMVSD is a challenging procedure. Recently, the Amplatzer PMVSD occluder (APMVSDO, AGA Medical Corp, Plymouth, Minnesota) has been shown to be effective in closing hemodynamically significant PMVSDs. However, the high incidence of complete atrioventricular block (CAVB) after device occlusion of a PMVSD has been a hot issue as well.
  
  
  METHODS
  Among several devices used in closing PMVSD percutaneously, we prefer the ADO because of the anatomic resemblance between PMVSD with aneurysm and patent ductus arteriosus, and it has no right ventricular disc which may contribute to the occurrence of CAVB.
  
  
  RESULTS
  Between August 2009 and May 2012, 21 patients (5 males and 16 females) underwent percutaneous PMVSD closure using ADO. The patients' ages ranged from 3 to 42 years (median: 7 years), and their weights ranged from 18 kg to 60 kg (median: 27 kg). All patients showed echocardiographic signs of left ventricular volume overload and trivial to small mitral regurgitation (Qp/Qs = 1.7 ± 0.4). The mean defect size of the right ventricular side was 4.3 ± 1.0 mm. Devices 2 mm larger than the measured narrowest VSD diameter were selected in most patients. The ADOs were successfully implanted in all patients without any significant complications except one transient CAVB, one case of delivery wire fracture, and one case of surgery due to significant residual leak. Small residual shunts were observed immediately after the device implantation, but they disappeared during follow-up for 18 of 20 patients. The mean follow-up period was 20 ± 9 months, and CAVB or aortic regurgitation was not observed in all patients.
  
  
  CONCLUSIONS
  Transcatheter closure of PMVSD with the ADO is a safe and promising treatment option, but long-term follow-up in a large number of patients would be warranted.
authors.affiliation: Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sang Mi
authors.initials: SM
authors.lastname: Lee
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Song
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Sang Yoon
authors.initials: SY
authors.lastname: Lee
authors.forename: Jae Sook
authors.initials: JS
authors.lastname: Paik
authors.forename: So Ick
authors.initials: SI
authors.lastname: Chang
authors.forename: Woo Seop
authors.initials: WS
authors.lastname: Shim
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D054537:Atrioventricular Block / Q000209:etiology; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome; D016276:Ventricular Function
keywords: complications pediatric cath/intervention; diagnostic cardiac catheterization; pediatric interventions