[II-JCKAP5-2-5] Transcatheter closure of ventricular septal defect in children
Transcatheter VSD closure, as opposed to surgical closure, can be considered in patients with muscular, perimembranous and infundibular defects. The first generation of Amplatzer peri-membranous VSD occluder was recorded with the high risk of complete heart block, at 5–6%, but recent data, transcatheter closure for pm VSD becomes feasible in most of cases. Besides VSD Coil (from Pfm) and perimembranous VSD device (from Occlutech) designed for VSD closure, some modified devices such as ADO I, ADO II, Vascular plug, MFO have been used for transcatheter VSD closure and brought many advantages and sucessful.In our center, we performed transcatheter VSD closure for about 800 cases (145 subpulmonic, 575 perimembranous, 70 muscular VSDs) with many different types of devices. The technical successful rate was 97.9%. The complications happened in 14 cases (5 hemolysis, 3 embolization, 3 TR, 1 RVOT stenosis, 1 transient AV block, 1 AR), estimated 1.75%. The morphologic features of VSD is essential part of possibility of device closure, especially if the VSD is remote from the tricuspid and aortic valves. We avoided doing for inlet extension type and large doubly committed VSD (size of VSD > 6 mm). We preferred to use Pfm coil, MFO and ADOII for subpulmonic VSD while ADOI, ADOII, Pfm coil for perimembranous and muscular VSD. Gentle and caution in manipulation of catheter, sheath and device deplying are always required to avoid the damages of aortic valve, tricuspid valve, AV node, RBBB and LBBB. Post procedure follow-up is very improtant for the compliactions of hemolysis, AR, TR, AV block...Conclusion: Transcathter VSD closure is feasible and effective for some selected cases. Understanding the morphology of VSD and devices will help to get the successful procedure. All avoidable complications must be avoided.