New design of the Amplatzer membranous VSD occluder: a step forward?

Closure of perimembranous ventricular septal defects (PmVSDs) [4] with the original Amplatzer membranous VSD occluder (mVSD1) has been associated with an increased risk of complications, the most notable of which has been complete heart block. This has led to the introduction of a new device to close PmVSDs. The authors describe their experience with the new Amplatzer membranous VSD occluder (mVSD2) in two patients and critique the new device design and delivery system, comparing it with the mVSD1 occluder. Two patients underwent attempted closure of PmVSDs with the new mVSD2 device. One patient had successful closure of the defect with no residual shunt and no evidence of heart block at follow-up evaluation. Trace to mild aortic insufficiency was observed at the time of closure and at the last follow-up visit. The rhythm remained sinus. In the second patient, the device was placed but removed before release because of inability to orient the device in optimal position. Percutaneous closure of PmVSD is feasible with the new mVSD2 occluder. The change in the design may reduce the incidence of complete heart block. It remains to be seen whether the device will be suitable for smaller patients.