Ali Houeijeh1, François Godart2, Zakaria Jalal3, Caroline Ovaert4, François Heitz5, Pierre Mauran6, Alban-Elouen Baruteau7, Lisa Guirguis8, Khaled Hadeed5, Jean-Benoit Baudelet9, Xavier Iriart3, Philippe Aldebert4, Philippe Acar5, Alain Fraisse8, Ender Odemis10, Clément Karsenty5, Jean Benoit Thambo3, Sébastien Hascoët11. 1. Pediatric Cardiology Department, Lille University Hospital, University Nord de France, 59000 Lille, France; Perinatal Growth and Health, University of Lille, EA4489, 59000 Lille, France; Department of Neonatology, CHU Lille, Jeanne-de-Flandre Hospital, 59000 Lille, France. Electronic address: dalih77@gmail.com. 2. Pediatric Cardiology Department, Lille University Hospital, University Nord de France, 59000 Lille, France; Perinatal Growth and Health, University of Lille, EA4489, 59000 Lille, France. 3. Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), 33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, 33600 Pessac-Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, 33000 Bordeaux, France. 4. Pediatric Cardiology Department, Marseille University Hospital, 13000 Marseille, France. 5. Pediatric Cardiology Department, Toulouse University Hospital, 31000 Toulouse, France. 6. Pediatric Cardiology Department, Reims University Hospital, 51100 Reims, France. 7. Pediatric Cardiology Department, University Hospital of Nantes, 44000 Nantes, France. 8. Congenital Heart Diseases Unit, Brompton Royal Hospital, SW3 6NP London, UK. 9. Pediatric Cardiology Department, Lille University Hospital, University Nord de France, 59000 Lille, France; Perinatal Growth and Health, University of Lille, EA4489, 59000 Lille, France; Department of Neonatology, CHU Lille, Jeanne-de-Flandre Hospital, 59000 Lille, France. 10. Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey. 11. Department of Pediatric and adult congenital heart diseases, M3C Marie-Lannelongue Hospital, Paris-Sud University, 92350 Paris, France.
Abstract
BACKGROUND: Transcatheter perimembranous ventricular septal defect (pmVSD) closure remains challenging and is seldom used in France given the risk of atrioventricular block (AVB). pmVSD closure with the Nit-Occlud Lê VSD coil was recently introduced in France as an alternative to occluder devices. AIMS: To study the safety and feasibility of pmVSD closure with the Nit-Occlud Lê VSD coil. METHODS: All consecutives cases of pmVSD closure with the Nit-Occlud Lê VSD coil in 20 tertiary French centres were included between January 2015 and December 2018. RESULTS: Among 46 procedures in five centres, indications for pmVSD closure were left ventricle overload (76.1%), exertional dyspnoea (17.4%), history of infective endocarditis (4.3%) and mild pulmonary hypertension (2.2%). The median (interquartile [IQR]) age of the patients was 13.9 (5.7-31.8) years. Aneurismal tissue was identified in 91.3% of patients. VSD median (IQR) size was 8 (7-10) mm on the left ventricle side and 5 (4-6) mm on the right ventricle side. Implantation was successful in 40 patients (87.0%; 95% confidence interval [CI] 73.7-95.1%). Severe complications occurred in six patients (13.0%, 95% CI 4.9-26.3%), mainly severe haemolysis (8.7%, 95% CI 2.4-20.8%). One aortic valve lesion required surgical aortic valvuloplasty. Occurrence of severe complications was significantly related to the presence of haemolysis (P=0.001), residual shunt (P=0.007) and multi-exit VSD (P=0.005). Residual shunt was observed in 40% of cases with the implanted device shortly after closure and 15% after a median follow-up of 27 months. No immediate or delayed device embolization or complete AVB was recorded. CONCLUSION: pmVSD closure with the Nit-Occlud Lê VSD Coil is feasible in older children and adults. However, residual shunting (leading to haemolysis) is a dreaded complication that should not be tolerated. pmVSD closure with the Nit-Occlud Lê VSD as a therapeutic strategy remains controversial and is limited to selected patients.
BACKGROUND: Transcatheter perimembranous ventricular septal defect (pmVSD) closure remains challenging and is seldom used in France given the risk of atrioventricular block (AVB). pmVSD closure with the Nit-Occlud Lê VSD coil was recently introduced in France as an alternative to occluder devices. AIMS: To study the safety and feasibility of pmVSD closure with the Nit-Occlud Lê VSD coil. METHODS: All consecutives cases of pmVSD closure with the Nit-Occlud Lê VSD coil in 20 tertiary French centres were included between January 2015 and December 2018. RESULTS: Among 46 procedures in five centres, indications for pmVSD closure were left ventricle overload (76.1%), exertional dyspnoea (17.4%), history of infective endocarditis (4.3%) and mild pulmonary hypertension (2.2%). The median (interquartile [IQR]) age of the patients was 13.9 (5.7-31.8) years. Aneurismal tissue was identified in 91.3% of patients. VSD median (IQR) size was 8 (7-10) mm on the left ventricle side and 5 (4-6) mm on the right ventricle side. Implantation was successful in 40 patients (87.0%; 95% confidence interval [CI] 73.7-95.1%). Severe complications occurred in six patients (13.0%, 95% CI 4.9-26.3%), mainly severe haemolysis (8.7%, 95% CI 2.4-20.8%). One aortic valve lesion required surgical aortic valvuloplasty. Occurrence of severe complications was significantly related to the presence of haemolysis (P=0.001), residual shunt (P=0.007) and multi-exit VSD (P=0.005). Residual shunt was observed in 40% of cases with the implanted device shortly after closure and 15% after a median follow-up of 27 months. No immediate or delayed device embolization or complete AVB was recorded. CONCLUSION: pmVSD closure with the Nit-Occlud Lê VSD Coil is feasible in older children and adults. However, residual shunting (leading to haemolysis) is a dreaded complication that should not be tolerated. pmVSD closure with the Nit-Occlud Lê VSD as a therapeutic strategy remains controversial and is limited to selected patients.
Authors: Stefana Maria Moisa; Alexandru Burlacu; Crischentian Brinza; Elena Țarcă; Lăcrămioara Ionela Butnariu; Laura Mihaela Trandafir Journal: Diagnostics (Basel) Date: 2022-05-10