Transcatheter closure of VSD deficient aortic rim using ADO II device
VSD deficient aortic rim
Can VSD deficient aortic rim be
closed by device ?
How to use ADO II device to
close VSD deficient aortic rim?
Our study results
Tóm tắt nội dung Transcatheter closure of VSD deficient aortic rim using ADO II device, để xem tài liệu hoàn chỉnh bạn click vào nút "TẢI VỀ" ở trên
Transcatheter closure of VSD deficient aortic rim using ADO II device Nguyen Van Hieu Nguyen Lan Hieu Vietnam Heart Institue VSD deficient aortic rim Can VSD deficient aortic rim be closed by device ? How to use ADO II device to close VSD deficient aortic rim? Our study results Outline VSD deficient aortic rim What is VSD deficient aortic rim? How about treatment ? Ventricular septal defect (VSD) 1 2 3 4 VSD deficient aortic rim Perimembranous VSD without aortic rim Subarterial VSD illustration of VSD deficient aortic rim Subarterial VSD Perimembranous VSD without aortic rim Risk AR of VSD deficient aortic rim AR Natural history of subarterial VSD Study: 214 pts 1. 73% of 139 asymptomatic pts develop AVP 2. 80% of pts with AVP develop AR 3. AVP and AR: – 1 year: 8% – 5 years: 30% – 10 years: 64% – 15 years: 83% Lun K, Li H, Leung MP et al; Am J Cardiol 2001; 87(11): 1266-1270 Which choice for treatment ? Intervention VSD deficient aortic rim Surgical closure • Traditional method • Preferred in most centers • Indication for multiple VSDs or VSD associated anomalies Transcatheter closure • No guideline • Complications are aortic regurgitation and arrhythmia • The most sophisticated and challenged procedure. European heart journal 2010; doi:10.2093/eurhearj/ehq249 Can we close VSD deficient aortic rim by device ? Study in Thailand (2011) Study: • 116 pts. (83 perim VSD, 36 Doubly committed VSD) • Age: 1 - 29 yrs Results: • Successfully implanted in 94% • Small residual shunt: 12/16 (18.2%) • Moderate and large AR at 6 months: 0/33 (0%) • Complete heart block 6 cases (5.2%) Chungsomprasong P; Kritvikrom Durongpisitkul et al; Catheter Cardiovasc Interv. 2011 Dec 1; 78(7):1032-40 In Vietnam (2013) Do Nguyen Tin et al : 65 cases infundibular VSD Results: • Successful 61 cases (94%) • Hemolysis 2 cases: Due to residual shunt • Technical failure 2 cases: The devices were not stable due to: – Underestimated the sizes of defects – The device configuration was changed Systematic Review (2014) • 37 studies, 4,406 pts with VSD ( pm 3,758; doubly committed subarterial 36), Age: 3 days to 84 years • Results: – Successful device implantation: 96.6% – Most complication are residual shunt 25.5 %, valvular defects 4.9% and arrhythmias 10.6% – Similar to surgery results Linqi Yang et al; Journal of Interventional Cardiology Vol. 27, No. 3, 2014 In China (2015) Study: • 86 patients with doubly committed subarterial VSD • Age 7.0 ± 7.0 years, VSD size 4.8 ± 1.5 mm • Follow up: 4.5 ± 1.5 years Results: • Successfully done in 75 patients (87.2 %) -> 94.7 % at discharge and 96 % during follow-up. • No severe complications • Trivial-mild grade aortic valve regurgitation (AR): 16 (21.3 %) • Failure: 11 patients Zhanget; Da Zhu et al. Journal of Cardiothoracic Surgery (2015) 10:119 It means We can close VSD deficient aortic rim by device! How to use ADO II device to close VSD deficient aortic rim? Amplatzer duct occluder (ADO) II device Theory: The pm VSD form look like type A of PDA (Kritchenco classify) : like anatomy and physiology Using PDA device for VSD closure is reasonable ! ADO II - Advantages • Softer (No polyester patch) • Designed for flexibility • Retention disc: Raise aortic valve • Small delivery system • CHB has not been reported • Ease of deployment ADO II - Limitations • Close VSDs only up to 5 – 5.5 mm • Encroachment on the aortic valve and LVOT • Impairment of TV mechanism • Crossing catheter (soft tip) – JR 3.5; 4 – IMA – Cut Pigtail • Terumo exchange guide wire • Snare • Delivery catheter : 4 – 5 Fr • TOE or TTE. Instruments Device size selection Waist size of ADO II device ≥ B + 0.5 or 1 mm Our study results Indications for intervention • Significant VSD: Symptomatic without irreversible pulmonary HTN – Qp/Qs > 1.5 – PA systolic pressure > 50 mmHg – Increased LV and LA size – Deteriorating LV function – Perimembranous VSD with more than mild AR – History of IE • Subarterial VSD – high incidence of aortic valve prolapse / AR Exclusion criteria • Pts can’t adapt the criteria above • Active endocarditis or evidence of bacteremia. • Coagulation disorders • Presence of intra cardiac mass or vegetation • Pregnancy, allergic • Calculated pulmonary vascular resistance > 7 Wood units Our Study • 28 pts: 9 subarterial VSDs and 19 pm VSDs without aortic rim • Age: 2 – 47 yrs • Weight 36,9 ± 17,9 kg • Implanted in 2 centers (4/2015 – 6/2016) • Follow up: 3 months – 1 years Early results Results Pts (n = 28) % Successfully implanted 27 96,42 Failure 1 2,58 Severe complication 1 (ischemic stroke) Mild complication 1 PAC Failure: Unfixation ADO II 6-6 due to underestimated the sizes of defects Ischemic stroke: Lack of heparin Follow up Before procedure (n=28) After procedure (n=27) 6 months (n=24) 12 months (n=11) Shunt 48,15 % 12,5% 9,1% Minor AR 5 (17,86%) 4 (14,81%) 5 (20,83%) 2 (18,2%) Moderate AR 0 1 (3,7%) 0 0 Severe arrhythmia No No No No Conclusion • It is feasible to close VSD deficient aortic rim by device • Using ADO II device has demonstrated efficacy and safe in short – term outcome • Further data are necessary to assess the long term outcomes THANKS FOR YOUR ATTENTION !
File đính kèm:
transcatheter_closure_of_vsd_deficient_aortic_rim_using_ado.pdf
