title: Transcatheter trans-septal antegrade closure of muscular ventricular septal defects in young children.
abstract: BACKGROUND
  Surgical or transcatheter closure of muscular ventricular septal defects (mVSDs) in young children may be technically challenging and associated with significant complications.
  
  
  OBJECTIVE
  To assess the feasibility of trans-septal antegrade closure of mVSD in a selected subset of young children.
  
  
  METHODS
  This is a prospective study from a single centre from July 2011 to March 2013. Nine infants and children with single or multiple mVSDs were included in the study. The median age and weight were 6 months (range 4-18 months) and 4.5 kg (range 3.8-6.2 kg), respectively. Trans-femoral trans-septal antegrade technique was used in eight children. One child was excluded from the study because of abnormally tortuous anatomy of both the femoral veins and subsequently underwent VSD device closure by the trans-jugular approach. The follow-up evaluation included chest X-ray, ECG, and echocardiogram at 1 month, 3 months, 6 months, and 1 year.
  
  
  RESULTS
  The defects were closed successfully in all eight patients using Amplatzer mVSD device in 5 and Amplatzer Duct Occluder II in 3. Moderate mitral regurgitation due to entrapment of the anterior mitral leaflet occurred in one patient with a posteriorly located mVSD, necessitating removal of the device, and surgical closure of the mVSD. The small additional residual mVSD in one other patient closed spontaneously during the follow-up.
  
  
  CONCLUSIONS
  Transcatheter trans-septal antegrade closure of mVSD in young children is technically feasible and merits further consideration. Symptomatic relief in multiple mVSD can be achieved after closing larger defects.
authors.affiliation: Care Hospital, The Institute of Medical Sciences, Road No. 1, Banjara Hills, Hyderabad, 50034, Andhra Pradesh, India.
authors.forename: Nageswara Rao
authors.initials: NR
authors.lastname: Koneti
authors.forename: Sudeep
authors.initials: S
authors.lastname: Verma
authors.forename: Shweta
authors.initials: S
authors.lastname: Bakhru
authors.forename: Karunakar
authors.initials: K
authors.lastname: Vadlamudi
authors.forename: Pallavi
authors.initials: P
authors.lastname: Kathare
authors.forename: Raghava Raju
authors.initials: RR
authors.lastname: Penumatsa
authors.forename: Shakeel
authors.initials: S
authors.lastname: Qureshi
mesh_terms: D000367:Age Factors; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D018618:Echocardiography, Doppler, Color; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D008944:Mitral Valve Insufficiency / Q000209:etiology; D011446:Prospective Studies; D011474:Prosthesis Design; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome
keywords: congenital heart disease; left to right shunts; muscular ventricular septal defect; muscular ventricular septal occluder; transcatheter device closure