title: Efficacy and Safety of Using Amplatzer Ductal Occluder for Transcatheter Closure of Perimembranous Ventricular Septal Defect in Pediatrics.
abstract: BACKGROUND
  Perimembranous Ventricular Septal Defect (PMVSD) is the most common subtype of ventricular septal defects. Transcatheter closure of PMVSD is a challenging procedure in management of moderate or large defects.
  
  
  OBJECTIVE
  The purpose of this study was to show that transcatheter closure of perimembranous ventricular septal defect with Amplatzer Ductal Occluder (ADO) is an effective and safe method.
  
  
  METHODS
  Between April 2012 and April 2013, 28 patients underwent percutaneous closure of PMVSD using ADO. After obtaining the size of VSD from the ventriculogram a device at least 2 mm larger than the narrowest diameter of VSD at right ventricular side was chosen. The device deployed after confirmation of its good position by echocardiography and left ventriculography. Follow up evaluations were done 1 month, 6 months, 12 months and yearly after discharge with transthoracic echocardiography and 12 lead electrocardiography.
  
  
  RESULTS
  The mean age of patients at procedure was 4.7 ± 6.3 (range 2 to 14) years, mean weight 14.7 ± 10.5 (range 10 to 40) kg. The mean defect size of the right ventricular side was 4.5 ± 1.6 mm. The average device size used was 7.3 ± 3.2mm (range 4 to 12 mm). The ADOs were successfully implanted in all patients. The VSD occlusion rate was 65.7% at completion of the procedure, rising up to 79.5% at discharge and 96.4% during follow-up. Small residual shunts were seen at completion of the procedure, but they disappeared during follow-up in all but one patient. The mean follow-up period was 8.3 ± 3.6 months (range 1 to 18 months). Complete atrioventricular block (CAVB), major complication or death was not observed in our study.
  
  
  CONCLUSIONS
  Transcatheter closure of PMVSD with ADO in children is a safe and effective treatment associated with excellent success and closure rates, but long-term follow-up in a large number of patients would be warranted.
authors.affiliation: Department of Pediatric Cardiology, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Ghaderian
authors.affiliation: Pediatric Cardiology Department, Shaheed Rajaiee Cardiovascular Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Mahmood
authors.initials: M
authors.lastname: Merajie
authors.affiliation: Pediatric Cardiology Department, Shaheed Rajaiee Cardiovascular Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Hodjjat
authors.initials: H
authors.lastname: Mortezaeian
authors.affiliation: Pediatric Cardiology Department, Shaheed Rajaiee Cardiovascular Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Moghadam
authors.initials: M
authors.lastname: Aarabi
authors.affiliation: Pediatric Cardiology Department, Shaheed Rajaiee Cardiovascular Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Yoosef
authors.initials: Y
authors.lastname: Mohammad
authors.affiliation: Pediatric Cardiology Department, Shaheed Rajaiee Cardiovascular Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Akbar
authors.initials: A
authors.lastname: Shah Mohammadi
keywords: CAVB Protocol; Septal Occluder Device; Ventricular Septal Defect