Percutaneous Closure of Perimembranous Ventricular Septal Defects with the Eccentric Amplatzer Device: Multicenter Follow-up Study J. Masura, 1 W. Gao, 2 P. Gavora, 1 K. Sun, 2 A.Q. Zhou, 2 S. Jiang, 3 L. Ting-liang, 4 Y. Wang 4 1 Pediatric Cardiocenter, University of Bratislava, Limboval, 833 51 Bratislava, Slovak Republic 2 Department of Pediatric Cardiology, Shanghai ChildrenÕs Medical Center, 1665 Kong Jiang Road, Shanghai, 200092, China 3 Cardiovascular Institute, Fu Wai Hospital, 167 Bei Li Shi Street, Beijing, 100037, China 4 Department of Pediatric Cardiology, Shandong Provincial Hosptial, 324 Jingwu Road, Jinan, 250021, China Abstract. Using an Amplatzer membranous eccentric occluder, 186 patients with an average weight of 43.5 kg (range 12.5–77) underwent attempted cathe- ter closure of a perimembranous venricular septal defect (PMVSD). Their age ranged from 3 to 51 years, with the an average age being 15.9 years. The patients were divided into three groups according to morphology of PMVSD: 106 patients with single PMVSD, 63 patients with single PMVSD with an- eurysmatic formation, and 17 patients with multiple VSD with aneurysmatic formation. Using angiogra- phy, PMVSDs were measured to be between 2.5 and 12 mm, with an average of 5.1 mm. In the third group of patients, we did not measure the size of PMVSD and a device was selected according to the size of entry to the aneurysm. The device was suc- cessfully implanted in all patients. The immediate closure rate was 90% in the first group, increasing to 100% at 1 month and remained at that level during follow-up. The immediate closure rate in the second group was 98% and remained the same during follow- up. The immediate closure rate in the third group was 89% and during 1 year of follow-up remained the same. There was no clinical evidence of hemolysis and no incidence of device embolization or bacterial endocarditis after implantation.Before the procedure, all patients showed normal electrocardiogram (ECG) or left ventricle enlargement. After the procedure (at least 3 months later) ECG showed left anterior hemiblock (LAH) in nine patients, complete right bundle branch block in eight patients, and incomplete right bundle branch block in seven patients. A com- plete heart block (CHB) developed in 2 patients after the procedure (1.07%). The first patient developed LAH immediately after closure and CHB within 24 hours, The heart rate was 28 beats per minute. After treatment with steroids and atropine, CHB changed to sinus rhythm with LAH within 2 months. One year later, the ECG revealed the same findings. The sec- ond patient developed CHB immediately after the procedure and was on temporary pacing for 1 week. After 1 month, the patient recovered to sinus rhythm and ECG showed LAH. Keywords: Perimembranous ventricular septal de- fects — Amplatzer eccentric occluder — Midterm follow-up — Interventional cardiology Ventricular septal defect (VSD) accounts for approximately 20% of all forms of congenital heart disease. Perimembranous VSD (PMVSD) is the most common congenital cardiac malformation. Approxi- mately 75% of all VSDs are located in the midportion of the upper region of the ventricular septum and are related to the aortic valve. Such VSDs are termed perimembranous trabecular defects or infracristal, subaortic, or type II Kirklin [10]. Treatment has been classically indicated in the presence of significant left- to-right shunt resulting in left ventricular overload. Surgery has been performed safely with very low rates of mortality, although complications such as residual leaks and atrioventricular block have oc- curred [2]. Percutaneous attempts to close PMVSD with Raskhind and button devices have been reported with a high incidence of residual shunt and compli- cations, mainly because these devices were designed for atrial septal defect or patent ductus arteriosus occlusion [9, 11, 13]. A new device, the Amplatzer membranous VSD occluder with eccentric shape, has been designed by AGA Medical Corporation (Golden Valley, MN, Correspondence to: M. Jozef, email: masura@dkch.sk Pediatr Cardiol 26:216–219, 2005 DOI: 10.1007/s00246-005-1003-7 Original Papers