Published Online
on July 19, 2004

A more recent version of this article appeared on August 3, 2004

This Article Full Text (PDF) All Versions of this Article: 110/5/501    most recent 01.CIR.0000137116.12176.A6v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Knauth, A. L. Articles by Jenkins, K. J. Search for Related Content PubMed PubMed Citation Articles by Knauth, A. L. Articles by Jenkins, K. J. Related Collections Other Treatment

Submitted on July 1, 2003
Revised on April 1, 2004
Accepted on April 4, 2004

Transcatheter Device Closure of Congenital and Postoperative Residual Ventricular Septal Defects

Alison L. Knauth MD, PhD, James E. Lock MD, Stanton B. Perry MD, Doff B. McElhinney MD, Kimberlee Gauvreau ScD, Michael J. Landzberg MD, Jonathan J. Rome MD, William E. Hellenbrand MD, Carlos E. Ruiz MD, and Kathy J. Jenkins MD, MPH^*

From the Department of Cardiology, Children’s Hospital, Boston, Mass (A.L.K., J.E.L., S.B.P., D.B.M., K.G., M.J.L., K.J.J.); Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pa (J.J.R.); Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY (W.E.H.); and Department of Pediatrics, University of Illinois, Chicago (C.E.R.). Dr Perry is now at Stanford University Medical Center, Stanford, Calif. Dr Ruiz is now at the University of Illinois, Chicago.

^* To whom correspondence should be addressed. E-mail: kathy.jenkins{at}tch.harvard.edu.

Background--Our purpose was to describe a 13-year experience with patients undergoing transcatheter device closure of unrepaired congenital or postoperative residual ventricular septal defects (VSDs).

Methods and Results--Since 1989, 170 patients (median age, 3.9 years) have undergone catheterization for closure of 1 or more congenital (n=92) or postoperative (n=78) residual VSDs using successive generations of STARFlex-type devices. Outcomes included echocardiographic assessment of residual flow and device position, assessment of VSD shunt/severity, and adverse events. Among 168 patients in whom device implantation was performed, between 1 and 7 devices were placed per patient (median, 1), with multiple devices placed in 40%. There was a significant decrease in left-to-right shunting after device implantation (P<0.001) and significant improvement in VSD size/severity, and device position proved stable. Of 332 adverse events, 39 were related to the device and 261 were related to the catheterization; all but 5 occurred in the periprocedural period. At a median follow-up of 24 months (0 to 154 months), 14 patients had died and 18 had device(s) explanted.

Conclusions--Congenital and postoperative VSD closure using STARFlex-type devices resulted in stable improvement in clinical status and decreased interventricular shunting. Although periprocedural events occurred frequently, late events caused by the device were rare. Transcatheter device closure is an effective management option for patients with complex muscular VSDs that are difficult to approach surgically and for postoperative residual VSDs.

Key words: catheterization • heart septal defects • ventricles

This article has been cited by other articles:

				M.-B. Gu, Y. Bai, X.-X. Zhao, X. Zheng, W.-P. Li, and Y.-W. Qin Transcatheter closure of postoperative residual perimembranous ventricular septal defects. Ann. Thorac. Surg., November 1, 2009; 88(5): 1551 - 1555. [Abstract] [Full Text] [PDF]

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 2, 2008; 52(23): e143 - e263. [Full Text] [PDF]

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 2, 2008; 52(23): 1890 - 1947. [Full Text] [PDF]

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, December 2, 2008; 118(23): e714 - e833. [Full Text] [PDF]

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, December 2, 2008; 118(23): 2395 - 2451. [Full Text] [PDF]

				Z. M. Hijazi and S. M. Awad Pediatric Cardiac Interventions J. Am. Coll. Cardiol. Intv., December 1, 2008; 1(6): 603 - 611. [Abstract] [Full Text] [PDF]

				D. Predescu, R. R. Chaturvedi, M. K. Friedberg, L. N. Benson, A. Ozawa, and K.-J. Lee Complete heart block associated with device closure of perimembranous ventricular septal defects. J. Thorac. Cardiovasc. Surg., November 1, 2008; 136(5): 1223 - 1228. [Abstract] [Full Text] [PDF]

				P. Khairy and A. J. Marelli Clinical Use of Electrocardiography in Adults With Congenital Heart Disease Circulation, December 4, 2007; 116(23): 2734 - 2746. [Full Text] [PDF]

				M. Carminati, G. Butera, M. Chessa, J. De Giovanni, G. Fisher, M. Gewillig, M. Peuster, J. F. Piechaud, G. Santoro, H. Sievert, et al. Transcatheter closure of congenital ventricular septal defects: results of the European Registry Eur. Heart J., October 1, 2007; 28(19): 2361 - 2368. [Abstract] [Full Text] [PDF]

				G. Butera, M. Carminati, M. Chessa, L. Piazza, A. Micheletti, D. G. Negura, R. Abella, A. Giamberti, and A. Frigiola Transcatheter Closure of Perimembranous Ventricular Septal Defects: Early and Long-Term Results J. Am. Coll. Cardiol., September 18, 2007; 50(12): 1189 - 1195. [Abstract] [Full Text] [PDF]

				E. P. Walsh Interventional Electrophysiology in Patients With Congenital Heart Disease Circulation, June 26, 2007; 115(25): 3224 - 3234. [Full Text] [PDF]

				I. Inglessis and M. J. Landzberg Interventional Catheterization in Adult Congenital Heart Disease Circulation, March 27, 2007; 115(12): 1622 - 1633. [Full Text] [PDF]

				E. P. Walsh and F. Cecchin Arrhythmias in Adult Patients With Congenital Heart Disease Circulation, January 30, 2007; 115(4): 534 - 545. [Full Text] [PDF]

				I. A. Russell, K. Rouine-Rapp, G. Stratmann, and W. C. Miller-Hance Congenital heart disease in the adult: a review with internet-accessible transesophageal echocardiographic images. Anesth. Analg., March 1, 2006; 102(3): 694 - 723. [Full Text] [PDF]

				T. P. Graham Jr The Year in Congenital Heart Disease J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1887 - 1899. [Full Text] [PDF]