Long Term Single Centre experience with the Amplatzer Perimembranous Ventricular Septal Occluder

  • Dr Lucas Eastaugh, The Royal Children's Hospital, Melbourne, Australia
  • Ms Kate Briggs, The Royal Children's Hospital, Melbourne, Australia
  • A/Prof Andrew Davis, The Royal Children's Hospital, Melbourne/Murdoch Children's Research Institute, Australia
  • A/Prof Samuel Menahem, The Royal Children's Hospital, Melbourne, Australia
  • Dr TH Goh, The Royal Children's Hospital, Melbourne, Australia
  • Prof James Wilkinson, The Royal Children's Hospital, Melbourne, Australia
  • Dr Geoffrey Lane, The Royal Children's Hospital, Melbourne, Australia

    • Introduction
    The Amplatzer perimembranous ventricular septal occluder was developed as an alternative to open heart surgery. Appropriate device positioning and sizing are important factors for a successful outcome yet clinically significant atrio-ventricular block is known to occur.

    Methods
    We reviewed our institution’s experience of the patients who underwent percutaneous transcatheter closure of PmVSDs. Procedures were performed using general anaesthesia, with transoesophageal echocardiography guidance. Procedural success was defined as accurate placement of a device. Pre and post-procedure echocardiograms and electrocardiograms were reviewed. Additional data collected included 24 hour Holter monitors, exercise tests, and pacemaker interrogations.

    Results
    33 patients underwent device closure between Dec 2002 and May 2006, with excellent haemodynamic outcomes and appropriate device positioning. Age range at implantation was 1.95-15.9 yrs, weight range between 10.2-87.3 kg and median follow up time of 2.5 years. 13 patients had pre-procedure incomplete right bundle branch block (IRBBB), and one had a low atrial rhythm. Post-procedure, one patient developed first-degree AV block, three demonstrated new IRBBB and three have complete right bundle branch block. Three patients developed complete AV block (CHB), 6 days, 657 days (1.8 yrs) and 1191 days (3.3 yrs) respectively, post-procedure. One patient with CHB has returned to sinus rhythm.

    Conclusions
    Our experience has demonstrated excellent haemodynamic results but with a high incidence of post-procedure conduction abnormalities. For this reason we no longer advocate the use of these devices for closure of PmVSDs. The appearance of CHB greater than three years after implantation necessitates ongoing vigilance and regular clinical follow-up.