Transcatheter closure of subpulmonic VSD using amplatzer ductal occluder (ADO) type I and II in IBN Al-bitar center for cardiac surgery: A single center experience

Background: The subpulmonic VSD is associated with the aortic valve, which means it can cause regurgitation and prolapse if left untreated. It is necessary to diagnose and treat aortic valve complications as soon as possible to avoid damage or replacement of the valve, since spontaneous closure is rare and following complications are prevalent and typically worsen over time. Aim of study: To evaluate the safety and efficacy of percutaneous transcatheter closure of subpulmonic VSD by using Amplatzer ductal occluder type I and II. Methods: Clinical trial study was done at Ibn Al-Bitar center for cardiac surgery from January 2015 to December 2019. Thirty-six patients with subpulmonic VSD underwent transcatheter closure using ADO type I and II and enrolled in this study. follow-up by echocardiographic studies done at 1, 3, 6, 12, 24, and 36 months after the closure and in each visit looking for residual shunt, aortic and tricuspid regurgitation, and complete heart block. Results: Of the 664 patients with VSD, 36 (5.4%) were found to have subpulmonic VSD. The systolic pulmonary artery pressure ranged from 20 to 65 mm Hg. Transcatheter closure was achieved successfully in 80.6% and complete closure of the VSD was documented by TTE and angiographically. The procedure was unsuccessful in seven patients, four of them due to creation or augmentation of aortic valve regurgitation and three patients with absent aortic rim, those patients have been referred to cardiac surgery department. Conclusion: The transcatheter closure of subpulmonic VSD can be performed safely without significant major complications including AR and the concern about atrioventricular block can be omitted because the location of subpulmonic VSD is far away from conduction system.