Background. Transcatheter closure of aneurysmal perimembranous ventricular septal defect (pmVSD), pmVSD near the aortic valve, and intracristal VSD (icVSD) with symmetrical or asymmetrical ventricular septal defect occluders still presents significant challenges. We report our experience with transcatheter closure of pmVSD and icVSD using Amplatzer duct occluder II (ADO II) in children. Method. We retrospectively analyzed all children, who presented to our hospital consecutively between March 2014 and June 2020 for attempted transcatheter closure of pmVSD or icVSD with the ADO II device. Standard safety and last-follow-up outcomes were assessed and compared. Results. In total, 41 patients underwent transcatheter closure of VSD with the ADO II (28 in pmVSD and 13 in icVSD groups) with a median age of 3.5 years (total range: 0.9 to 12 years) and median weight of 15.0 kg (total range: 10.0 to 43.0 kg). Implantation was successful in 40/41 patients (97.5%, 27/28 in pmVSD group, 13/13 in icVSD group). One patient with mild aortic valve prolapse in pmVSD group developed new-onset moderate aortic regurgitation after a 4/4 mm ADO II was deployed; however, this resolved after the device was retrieved and successfully replaced with a 5 mm zero eccentric VSD occluder. There was no procedure-related mortality. After a median follow-up of six months (total range: 6 to 72 months), complete closure rates were 85.1% and 76.9% among pmVSD and icVSD groups, respectively. In the pmVSD group, one case of new-onset moderate tricuspid regurgitation was observed at six months, and there was one case of severe tricuspid regurgitation that had progressed from mild tricuspid regurgitation at 12 months. No serious complications were noted in the icVSD group. Conclusion. ADO II provides a safe and reproducible alternative for the closure of perimembranous and intracristal ventricular septal defects with a diameter less than 5 mm in young children.

中文翻译：

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在儿童中使用 Amplatzer 导管封堵器 II 经导管闭合膜周和嵴内室间隔缺损

背景。动脉瘤性膜周室间隔缺损 (pmVSD)、主动脉瓣附近的 pmVSD 和嵴内室间隔缺损 (icVSD) 的经导管闭合与对称或不对称的室间隔缺损封堵器仍然存在重大挑战。我们报告了我们在儿童中使用 Amplatzer 导管封堵器 II (ADO II) 经导管闭合 pmVSD 和 icVSD 的经验。方法。我们回顾性分析了所有在 2014 年 3 月至 2020 年 6 月期间因尝试使用 ADO II 装置经导管关闭 pmVSD 或 icVSD 而到我们医院就诊的儿童。对标准安全性和最后一次随访结果进行了评估和比较。结果. 总共有 41 名患者接受了 ADO II 经导管 VSD 封堵术（pmVSD 组 28 名，icVSD 组 13 名），中位年龄为 3.5 岁（总范围：0.9 至 12 岁），中位体重为 15.0 kg（总范围： 10.0 至 43.0 公斤）。40/41 名患者植入成功（97.5%，pmVSD 组 27/28，icVSD 组 13/13）。pmVSD 组 1 例轻度主动脉瓣脱垂患者在部署 4/4 mm ADO II 后出现新发中度主动脉瓣关闭不全；然而，在设备被取回并成功更换为 5 mm 零偏心 VSD 封堵器后，此问题得以解决。没有与手术相关的死亡率。在中位随访 6 个月（总范围：6 至 72 个月）后，pmVSD 和 icVSD 组的完全闭合率分别为 85.1% 和 76.9%。在 pmVSD 组中，6个月时新发中度三尖瓣反流1例，12个月时轻度三尖瓣反流进展为重度三尖瓣反流1例。icVSD 组未发现严重并发症。结论。ADO II 提供了一种安全且可重复的替代方法，用于闭合幼儿直径小于 5 毫米的膜周和嵴内室间隔缺损。