Safety and efficacy of Amplatzer duct occluder II and konar-MF™ VSD occluder in the closure of perimembranous ventricular septal defects in children weighing less than 10 kg

IntroductionDevice closure of perimembranous ventricular septal defects (pmVSD) is a successful off-label treatment alternative. We aim to report and compare the outcomes of pmVSD closure in children weighing less than 10 kg using Amplatzer Duct Occluder II (ADOII) and Konar-MF VSD Occluder (MFO) devices.MethodsRetrospective clinical data review of 52 children with hemodynamically significant pmVSD, and sent for transcatheter closure using ADOII and MFO, between January 2018 and January 2023. Baseline, procedural, and follow-up data were compared according to the implanted deviceResultsADOII devices were implanted in 22 children with a median age of 11 months (IQR, 4.1–14.7) and weight of 7.4 kg (IQR, 2.7–9.7). MFO devices were implanted in 30 children with a median age of 11 months (IQR, 4.8–16.6) and weight of 8 kg (IQR, 4.1–9.6). ADOII were implanted (retrograde, 68.1%) in defects with a median left ventricular diameter of 4.6 mm (IQR, 3.8–5.7) and right ventricular diameter of 3.5 mm (IQR, 3.1–4.9) while MFO were implanted (antegrade, 63.3%) in defects with a median left ventricular diameter of 7 mm (IQR, 5.2–11.3) (p > 0.05) and right ventricular diameter of 5 mm (IQR, 2.0, 3.5–6.2) (p < 0.05). The procedural and fluoroscopy times were shorter with the MFO device (p < 0.05). On a median follow-up of 41.2 months (IQR, 19.7–49.3), valvular insufficiency was not observed. One 13-month-old child (6.3 kg) with ADOII developed a complete atrioventricular heart block (CAVB) six months postoperative and required pacemaker implantation. One 11-month-old child (5.9 kg) with MFO developed a CAVB 3 days postoperative and the device was removed. At 6 months post-procedure, only one child with MFO still experiences a minor residual shunt. There was one arterio-venous fistula that resolved spontaneously.ConclusionBoth the MFO and ADOII are effective closure devices in appropriately selected pmVSDs. CAVB can occur with both devices. The MFO is inherently advantageous for defects larger than 6 mm and subaortic rims smaller than 3 mm. In the literature, our series represents the first study comparing the mid-term outcomes of MFO and ADOII devices in children weighing less than 10 kg

Percutaneous closure of aorta-right atrial tunnel in a newborn

A tunnel between the aorta and right atrium in a newborn was occluded with 5x6 Amplatzer Duct Occluder II-Additional Size. Our case is different because of enlarged right atrium and atypical location of tunnel orifice

Coronary sinus atresia in a pediatric case: Review of literature

AbstractIntroductionCoronary sinus (CS) is the venous drainage system of the heart. Absence of the CS or CS ostium atresia is rarely seen cardiac malformations. Congenital absence of CS usually is found together with other cardiac malformations.CaseA one day old newborn was referred to our hospital for cyanosis. His saturation was 84% patient was referred to cardiology unit. In echocardiographic examination hypoplastic left heart syndrome was revealed. Prostoglandin infusion was started, catheterization was planned for ductal stent implantation. Catheterization revealed the presence of persistent left superior vena cava (LSVC). When radiocontrast was given to LSVC, it drained to the CS. However CS did not drain to right atrium at normal anatomy. Coronary sinus drained to the base of right atrium, where right superior vena cava opened, via a tunnel shaped vein (shown by arrow and schematically in Fig. 1).DiscussionAbsence of coronary sinus is an extremely rare condition, and in patients with other congenital cardiac malformations. Such malformations can be managed surgically or percutaneously. But either method may disrupt coronary venous drainage therefore it should be paid great attention to the anatomy before doing these procedures. Also it is important to inform the cardiac surgeons before the operation of associated cardiac lesions.ConclusionCoronary sinus atresia is a rare condition that should be kept in mind especially in complex heart defects; diagnosis is critical before starting surgical procedure

Syncope due to complete atrioventricular block and treatment with a transient pacemaker in acute rheumatic fever

Various rhythm and connection disorders can be seen in the acute phase of acute rheumatic fever. First degree atrioventricular block, one of the minor signs of acute rheumatic fever, is the most common connection disturbance in this disease. Complete atrioventricular block, which seriously affects the conduction pathways, is rare in the literature. A 15-year-old boy was admitted because of syncope caused by complete atrioventricular block and a temporary pacemaker was employed because of symptomatic complete atrioventricular block. The transient pacemaker treatment was terminated due to recovery of complete atrioventricular block on the third day of anti-inflammatory treatment. Acute rheumatic fever should be kept in mind as a possible cause of acquired complete atrioventricular block. Connection disturbances in acute rheumatic fever improve with anti-inflammatory treatment. Transient pacemaker treatment is indicated for patients with symptomatic transient complete atrioventricular block

Syncope due to complete atrioventricular block and treatment with a transient pacemaker in acute rheumatic fever

Various rhythm and connection disorders can be seen in the acute phase of acute rheumatic fever. First degree atrioventricular block, one of the minor signs of acute rheumatic fever, is the most common connection disturbance in this disease. Complete atrioventricular block, which seriously affects the conduction pathways, is rare in the literature. A 15-year-old boy was admitted because of syncope caused by complete atrioventricular block and a temporary pacemaker was employed because of symptomatic complete atrioventricular block. The transient pacemaker treatment was terminated due to recovery of complete atrioventricular block on the third day of anti-inflammatory treatment. Acute rheumatic fever should be kept in mind as a possible cause of acquired complete atrioventricular block. Connection disturbances in acute rheumatic fever improve with anti-inflammatory treatment. Transient pacemaker treatment is indicated for patients with symptomatic transient complete atrioventricular block

Pediatric cardiology Percutaneous atrial septal defect closure by using jugular venous access in a case with interrupted inferior vena cava

Femoral venous approach is the classical route of percutaneous atrial septal defect (ASD) closure. But in certain circumstances alternative routes are used. In this report percutaneous ASD closure in a case with interrupted vena cava by jugular venous approach is discussed. Percutaneous closure through femoral venous route was planned in a 6-year-old girl with ASD. Because of interrupted vena cava the jugular venous route was used. Having knowledge of this anatomical variation is important for interventionalists before performing femoral venous approach. Percutaneous transjugular venous access is a feasible alternative route in paediatric population for ASD closure

Percutaneous atrial septal defect closure by using jugular venous access in a case with interrupted inferior vena cava

Femoral venous approach is the classical route of percutaneous atrial septal defect (ASD) closure. But in certain circumstances alternative routes are used. In this report percutaneous ASD closure in a case with interrupted vena cava by jugular venous approach is discussed. Percutaneous closure through femoral venous route was planned in a 6-year-old girl with ASD. Because of interrupted vena cava the jugular venous route was used. Having knowledge of this anatomical variation is important for interventionalists before performing femoral venous approach. Percutaneous transjugular venous access is a feasible alternative route in paediatric population for ASD closure

Off-label Use of ADO II® in the Closure of Various Congenital Heart Defects

Devices may be used for special purposes different than their production purpose. For instance, Amplatzer Ductal Occluder is actually designed for duct closure and its usage for closing defects other than ductus is named as off-label. The aim of this study is to emphasize off-label use of device: not only for PDA and VSD but also for other various defects. This study is designed retrospectively, performed by the evaluation catheterization records of patients in whom ADO II and ADO II-AS devices were used in Erciyes University Medical Faculty Children Hospital, Pediatric Cardiology Department between 2011 and 2018. Patients’ demographic criteria: age, weight at the time of procedure was gathered. The diagnosis, size of device, follow-up period and complications were also noted. From April 2011 to March 2018, a total of 121 patients underwent transcatheter closure by ADO II and 66 patients by ADO II AS. The number of PDA closure with ADO II was 48; with ADO II AS were 62. Rest of the procedures were all off-label. Types of off-label procedures performed were: VSD closure, residual mitral cleft closure, Aorta-Right atrium tunnel closure, pulmonary arteriovenous fistula occlusion, aorta-pulmonary window closure, and occlusion of the artery feeding accessory lobe in scimitar syndrome, Gerbode defect occlusion. Up to our knowledge; this study includes the largest pediatric case series with various different congenital heart defects which were closed with ADO-II. Also our ADO-II occluded VSD case series is one of the largest series in the literature with almost 6 years’ follow-up. We believe in that ADO-II device may be an alternative in percutaneous closure of various rare heart defects. It is used successfully for non-ductal defects with low complication and high compliance rates.</jats:p