Transcatheter closure of congenital ventricular septal defects in adult: Mid-term results and complications

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Abstract

Introduction: Transcatheter treatment of congenital heart defects in adult patients is dramatically changing the way in which this population is being treated. This report outlines mid-term follow-up results and complications in adult patients that underwent transcatheter VSD closure. Methods: The data of 40 adult patients who underwent transcatheter closure of a VSD at our institution were collected prospectively between January 2000 and June 2006. The inclusion criteria for this study were clinical and/or echocardiographic evidence of a significant left-to-right shunt through a muscular VSD (mVSD) or a perimembranous VSD (pVSD). A shunt was considered significant when the following were found: (i) left atrial enlargement, defined as a left atrial-to-aortic ratio > 1.5; (ii) left ventricular enlargement (left ventricular overload), defined as a left ventricular end-diastolic diameter >+ 2 standard deviation (SD) above the mean for the patient's age. Another inclusion criterion was a previous episode of endocarditis. Results: 41 procedures were carried out in 40 patients; a mVSD-O was used in 22 patients and a pVSD-O in 18 patients (1 patient had two devices inserted). No deaths occurred; no procedure was aborted. A total of 6 (14.6%) complications occurred. The most frequent complication was a rhythm abnormality (n = 4). No device embolization occurred. The median follow-up duration was 36 months (range: 6-81 months). No deaths or cases of endocarditis occurred. One patient who had two devices implanted because of a residual defect after a tetralogy of Fallot repair, had to be operated again 3 months after the second device implantation because of a persistent significant residual leak. Conclusions: Greater experience, possibly of multicentre trials and long-term follow-up are required to better assess the safety and effectiveness of this procedure as an alternative to surgical approaches in adult patients.

Original languageEnglish
Pages (from-to)70-73
Number of pages4
JournalInternational Journal of Cardiology
Volume133
Issue number1
DOIs
Publication statusPublished - Mar 20 2009

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Ventricular Heart Septal Defects
Equipment and Supplies
Endocarditis
Tetralogy of Fallot
Congenital Heart Defects
Multicenter Studies
Safety

Keywords

  • Congenital heart defects
  • GUCH
  • Interventional cardiology
  • Ventricular septal defect

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{9da0d7c9ec164cc88193d016ae0cb472,
title = "Transcatheter closure of congenital ventricular septal defects in adult: Mid-term results and complications",
abstract = "Introduction: Transcatheter treatment of congenital heart defects in adult patients is dramatically changing the way in which this population is being treated. This report outlines mid-term follow-up results and complications in adult patients that underwent transcatheter VSD closure. Methods: The data of 40 adult patients who underwent transcatheter closure of a VSD at our institution were collected prospectively between January 2000 and June 2006. The inclusion criteria for this study were clinical and/or echocardiographic evidence of a significant left-to-right shunt through a muscular VSD (mVSD) or a perimembranous VSD (pVSD). A shunt was considered significant when the following were found: (i) left atrial enlargement, defined as a left atrial-to-aortic ratio > 1.5; (ii) left ventricular enlargement (left ventricular overload), defined as a left ventricular end-diastolic diameter >+ 2 standard deviation (SD) above the mean for the patient's age. Another inclusion criterion was a previous episode of endocarditis. Results: 41 procedures were carried out in 40 patients; a mVSD-O was used in 22 patients and a pVSD-O in 18 patients (1 patient had two devices inserted). No deaths occurred; no procedure was aborted. A total of 6 (14.6{\%}) complications occurred. The most frequent complication was a rhythm abnormality (n = 4). No device embolization occurred. The median follow-up duration was 36 months (range: 6-81 months). No deaths or cases of endocarditis occurred. One patient who had two devices implanted because of a residual defect after a tetralogy of Fallot repair, had to be operated again 3 months after the second device implantation because of a persistent significant residual leak. Conclusions: Greater experience, possibly of multicentre trials and long-term follow-up are required to better assess the safety and effectiveness of this procedure as an alternative to surgical approaches in adult patients.",
keywords = "Congenital heart defects, GUCH, Interventional cardiology, Ventricular septal defect",
author = "Massimo Chessa and Gianfranco Butera and Diana Negura and Claudio Bussadori and Alessandro Giamberti and Vlasta Fesslova and Mario Carminati",
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language = "English",
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T1 - Transcatheter closure of congenital ventricular septal defects in adult

T2 - Mid-term results and complications

AU - Chessa, Massimo

AU - Butera, Gianfranco

AU - Negura, Diana

AU - Bussadori, Claudio

AU - Giamberti, Alessandro

AU - Fesslova, Vlasta

AU - Carminati, Mario

PY - 2009/3/20

Y1 - 2009/3/20

N2 - Introduction: Transcatheter treatment of congenital heart defects in adult patients is dramatically changing the way in which this population is being treated. This report outlines mid-term follow-up results and complications in adult patients that underwent transcatheter VSD closure. Methods: The data of 40 adult patients who underwent transcatheter closure of a VSD at our institution were collected prospectively between January 2000 and June 2006. The inclusion criteria for this study were clinical and/or echocardiographic evidence of a significant left-to-right shunt through a muscular VSD (mVSD) or a perimembranous VSD (pVSD). A shunt was considered significant when the following were found: (i) left atrial enlargement, defined as a left atrial-to-aortic ratio > 1.5; (ii) left ventricular enlargement (left ventricular overload), defined as a left ventricular end-diastolic diameter >+ 2 standard deviation (SD) above the mean for the patient's age. Another inclusion criterion was a previous episode of endocarditis. Results: 41 procedures were carried out in 40 patients; a mVSD-O was used in 22 patients and a pVSD-O in 18 patients (1 patient had two devices inserted). No deaths occurred; no procedure was aborted. A total of 6 (14.6%) complications occurred. The most frequent complication was a rhythm abnormality (n = 4). No device embolization occurred. The median follow-up duration was 36 months (range: 6-81 months). No deaths or cases of endocarditis occurred. One patient who had two devices implanted because of a residual defect after a tetralogy of Fallot repair, had to be operated again 3 months after the second device implantation because of a persistent significant residual leak. Conclusions: Greater experience, possibly of multicentre trials and long-term follow-up are required to better assess the safety and effectiveness of this procedure as an alternative to surgical approaches in adult patients.

AB - Introduction: Transcatheter treatment of congenital heart defects in adult patients is dramatically changing the way in which this population is being treated. This report outlines mid-term follow-up results and complications in adult patients that underwent transcatheter VSD closure. Methods: The data of 40 adult patients who underwent transcatheter closure of a VSD at our institution were collected prospectively between January 2000 and June 2006. The inclusion criteria for this study were clinical and/or echocardiographic evidence of a significant left-to-right shunt through a muscular VSD (mVSD) or a perimembranous VSD (pVSD). A shunt was considered significant when the following were found: (i) left atrial enlargement, defined as a left atrial-to-aortic ratio > 1.5; (ii) left ventricular enlargement (left ventricular overload), defined as a left ventricular end-diastolic diameter >+ 2 standard deviation (SD) above the mean for the patient's age. Another inclusion criterion was a previous episode of endocarditis. Results: 41 procedures were carried out in 40 patients; a mVSD-O was used in 22 patients and a pVSD-O in 18 patients (1 patient had two devices inserted). No deaths occurred; no procedure was aborted. A total of 6 (14.6%) complications occurred. The most frequent complication was a rhythm abnormality (n = 4). No device embolization occurred. The median follow-up duration was 36 months (range: 6-81 months). No deaths or cases of endocarditis occurred. One patient who had two devices implanted because of a residual defect after a tetralogy of Fallot repair, had to be operated again 3 months after the second device implantation because of a persistent significant residual leak. Conclusions: Greater experience, possibly of multicentre trials and long-term follow-up are required to better assess the safety and effectiveness of this procedure as an alternative to surgical approaches in adult patients.

KW - Congenital heart defects

KW - GUCH

KW - Interventional cardiology

KW - Ventricular septal defect

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