Abstract

TELLEZ, Manuel R et al. Colombian multicentric experience during three years for percutaneous closure of interventricular septal defect with different occluder devices. Proposal for technique simplification in selected patients. Rev. Colom. Cardiol. [online]. 2010, vol.17, n.5, pp.217-228. ISSN 0120-5633.

Objectives: we describe the experience of the endovascular closure of interventricular communication performed for three years in different centers of interventional cardiology and highlight its result in a group of selected patients in whom such procedure was made by the use of a last generation device designed for the closure of ductus arteriosus. Methodology: between June 2006 and October 2009, a total of 34 patients underwent endovascular occlusion for interventricular septal defect. Indication of this procedure included volume overload, pressure and volume overload, chronic congestive heart failure, aortic valve prolapse with insufficiency and traumatic injury. Mean age was 12,9 years old and mean weight was 36 kg. A prevalence in male gender (53%) was evidenced. Main blood flow calculation showed Qp / Qs of 1.71 to 1 and the pulmonary vascular resistance was 1.18 U Wood/m2. Materials and methods: PM VSD occluder device was implanted with the classic technique (62,5%) while the Duct Occluder II (28,1%) was used with the proposed simplified technique. General anesthesia was used in 98% cases; 60% were guided by fluoroscopy and transesophageal echocardiography and 40% with transthoracic echocardiography. Results: size of the defect varied from 4 to 12 mm. 91% of patients had an isolated septal defect. Mean surgical time was 56 min, being longer in the group in which the classic technique was used (85 min) compared with the group in which the technique used was the simplified one, with a mean duration of 36 min. Mean hospital stay was estimated in 36 hours. Follow up: complete closure was documented in 100% of patients at 30 days. There were three adverse events due to minor complications related to transient rhythm disturbances. A total of seven patients (21.9%) complained onset or exacerbation of vascular migraine headache episodes. There was one major complication due to complete atrioventricular block and embolization of the device. Conclusions: endovascular closure of interventricular septal defect is a feasible procedure in our country achieving a success closure in 100% of the patients. The latest generation device for closure of the ductus may be implanted with modifications in the technique that reduce surgical time (up to 60%), anesthesia, use of contrast media and hospital stay. Moreover, its profile makes possible the use of 4 French delivery systems that would make possible the inclusion of younger infants.

Keywords : interventricular septal defect; percutaneous closure; endovascular device; classic occlusion technique; arteriovenous loop; simplified technique; retrograde technique (arterial); anterograde technique (venous); conduction disorder.

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