title: Longer-term outcome of perventricular device closure of muscular ventricular septal defects in children.
abstract: OBJECTIVE
  To describe the longer-term clinical experience and follow-up with perventricular device closure of ventricular septal defects (VSD) in children.
  
  
  METHODS
  Between January 2005 and December 2013, muscular ventricular septal defect closure with the Amplatzer Muscular VSD Occluder was undertaken using a hybrid perventricular approach. Data including demographic, echocardiographic parameter, and clinical outcome were reviewed retrospectively.
  
  
  RESULTS
  Median age at the time of procedure was 8.9 months (range 1.9-31.0 months) and median weight was 6.6 kg (range 4.5-12.9 kg). All had a moderate to large muscular VSD, three had more than one VSD, four had previous coarctation repair, and five had previous pulmonary artery (PA) banding. A single Amplatzer muscular occluder (range 8-18 mm) was deployed in each patient without cardiopulmonary bypass under echocardiographic guidance. Two of ten patients subsequently required a short period of cardiopulmonary bypass for reconstruction of PA after de-banding and closure of atrial septal defect in one. Occluder removal was necessary in one patient due to entrapment of the tricuspid valve and progressive tricuspid regurgitation. This patient underwent surgical repair with a good result and no device-related valve damage. In the remaining nine patients, no severe complications such as device embolization, arrhythmia, or significant valve regurgitation were noted in the post-operative period or follow-up. At a median time of 6.5 years (range 0.9-8.4 years) post device implantation, complete closure was achieved in five patients and four had small residual leaks, which were not hemodynamically significant.
  
  
  CONCLUSIONS
  Perventricular muscular VSD closure is effective in small children with suitable muscular defects and may avoid the morbidity associated with cardiopulmonary bypass and conventional surgical repair. There have been no late complications with this approach.
authors.affiliation: Bristol Congenital Heart Centre, Bristol Royal Hospital for Children and Bristol Royal Infirmary, University Hospitals Bristol, NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Sok Leng
authors.initials: SL
authors.lastname: Kang
authors.forename: Andrew
authors.initials: A
authors.lastname: Tometzki
authors.forename: Massimo
authors.initials: M
authors.lastname: Caputo
authors.forename: Gareth
authors.initials: G
authors.lastname: Morgan
authors.forename: Andrew
authors.initials: A
authors.lastname: Parry
authors.forename: Robin
authors.initials: R
authors.lastname: Martin
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000379:methods; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016208:Databases, Factual; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D055989:Septal Occluder Device; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
keywords: cardiac surgery; hybrid; transcatheter