title: Transcatheter closure of perimembranous ventricular septal defects with ductal occluders.
abstract: BACKGROUND
  To study the feasibility and complications associated with the use of ductal occluders for closure of perimembranous ventricular septal defects.
  
  
  METHODS
  A total of 126 patients, ranging from 1 to 41 years of age (median - 8 years), underwent closure of ventricular septal defects from August 2010 to April 2013. Small- and moderate-sized defects were closed using first-generation Patent ductus arteriosus occluders or Amplatzer Duct Occluder-II. Patients were followed up for the development of complications such as heart block, aortic regurgitation, and tricuspid regurgitation.
  
  
  RESULTS
  Patent ductus arteriosus occluders were used in 81 patients, and the Amplatzer Duct Occluder-II device in 45 patients. The devices were successfully deployed in 99.2% of the cases. One patient had embolisation of an Amplatzer Duct Occluder-II device soon after deployment. There was one case of transient complete heart block (0.8%) needing temporary pacing, and two cases of isoarrhythmic atrioventricular dissociation (1.6%). One patient developed late-onset complete heart block 15 months after the procedure and underwent permanent pacemaker implantation. There were no instances of new-onset aortic regurgitation. New-onset mild tricuspid regurgitation was seen in two patients. Of the patients, three had small residual shunts on follow-up, without haemolysis.
  
  
  CONCLUSIONS
  Duct occluders can be used to effectively close small- and moderate-sized ventricular septal defects. The incidence of complete heart block and valvular regurgitations are much less than reported with other devices, and they are cost-effective.
authors.affiliation: 1Department of Cardiology,Sri Jayadeva Institute of Cardiovascular Sciences and Research,Bengaluru,Karnataka,India.
authors.forename: Jayaranganath
authors.initials: J
authors.lastname: Mahimarangaiah
authors.affiliation: 1Department of Cardiology,Sri Jayadeva Institute of Cardiovascular Sciences and Research,Bengaluru,Karnataka,India.
authors.forename: Anand
authors.initials: A
authors.lastname: Subramanian
authors.affiliation: 1Department of Cardiology,Sri Jayadeva Institute of Cardiovascular Sciences and Research,Bengaluru,Karnataka,India.
authors.forename: Srinivasa
authors.initials: S
authors.lastname: Kikkeri Hemannasetty
authors.affiliation: 2Department of Cardiology,Manipal Hospitals,Bengaluru,Karnataka,India.
authors.forename: Subhash
authors.initials: S
authors.lastname: Chandra
authors.affiliation: 1Department of Cardiology,Sri Jayadeva Institute of Cardiovascular Sciences and Research,Bengaluru,Karnataka,India.
authors.forename: Satish
authors.initials: S
authors.lastname: Karur
authors.affiliation: 1Department of Cardiology,Sri Jayadeva Institute of Cardiovascular Sciences and Research,Bengaluru,Karnataka,India.
authors.forename: Usha
authors.initials: U
authors.lastname: Mandikal Kodandaramasastry
authors.affiliation: 1Department of Cardiology,Sri Jayadeva Institute of Cardiovascular Sciences and Research,Bengaluru,Karnataka,India.
authors.forename: Manjunath
authors.initials: M
authors.lastname: Cholenahally Nanjappa
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D005240:Feasibility Studies; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000628:therapy; D011446:Prospective Studies; D055989:Septal Occluder Device; D016896:Treatment Outcome
keywords: Perimembranous; duct occluders; ventricular septal defect