Middle and long-term follow-up of effectiveness and safety of transcatheter closure of perimembranous ventricular septal defects using Amplatzer duct occluder Ⅱ occluders in adults

  AIM  To determine the middle and long-term safety and efficacy of using the Amplatzer duct occluder Ⅱ (ADO Ⅱ) for perimembranous ventricular septal defect (pmVSD) closure in adults.

  METHODS  From June 2013 to June 2021, adult pmVSD patients were selected and treated through transcatheter intervention using ADOⅡoccluders. The closure results and complications were evaluated immediately, 1 d, 1 m, 3 m, 6 m and annual follow-up after procedures using electrocardiography and transthoracic echocardiography (TTE).

  RESULTS  A total of 44 patients with pmVSD, aged (38 ± 13) years, were enrolled, including 24 cases of membranous bulging tumor, 13 cases of tubular type, 4 cases of funnel type, and 3 cases of residual fistula after surgical repair of pmVSD. pmVSD occlusion was performed with ADO Ⅱ occluder. Under angiography, the average defect outlet size was (3.4 ± 1.1) mm, the average waist diameter of the occluder was (4.8 ± 1.5) mm, and the average length of the occluder was (4.3 ± 0.7) mm. The success rate of immediate occlusion was 100%, and the complete occlusion rate was 75.0%. The follow-up time of 23 patients was (38 ± 24) months, and the median follow-up time was 36 months. Compared with that before operation, at the 6-month follow-up after operation, the left ventricular EDV decreased from (97 ± 23) mL to (86 ± 22) mL (P<0.05), and the LVEDD decreased from (51 ± 5) mm to (46 ± 5) mm (P<0.05). There was no significant change in the EF value of the left ventricular ejection fraction. The incidence of serious complications was 2.3%. During the follow-up period, there were no deaths, infective endocarditis, cAVB, occluder embolism, valve regurgitation requiring surgical treatment and other serious complications. The overall incidence of arrhythmia was 6.8%, and the immediate residual shunt incidence after operation was 25.0%. The cardiac function of 43 patients during follow-up was NYHA grade I or II.

  CONCLUSION  Transcatheter closure of pmVSD and post-surgery residual shunts using ADO Ⅱ occluders in adults are both safe and effective and yields excellent middle and long-term results in selected patients. The potential benefits of this intervention include remodeling of the heart and reduced incidence of infective endocarditis.