Contents lists available at ScienceDirect Progress in Pediatric Cardiology journal homepage: www.elsevier.com/locate/ppedcard Immediate and short term outcome post VSD closure using nitocclud PFM coil, a single center experience Dina Adel EzzEldin ⁎ , Alaa Mahmoud Roshdy, Heba Mohamed Atteya, Housam Magdy, Maiy Hamdy Elsayed Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt ABSTRACT Objectives: We sought to study the immediate and short term outcome post VSD closure using nitocclud PFM coil to document the safety and efficacy of the procedure. Patients and Methods: The study included 16 patients with perimembranous subaortic VSD who were scheduled for elective trans catheter VSD closure using nitocclud PFM coil in the period from May 2014 to July 2016. All patients underwent full clinical examination, ECG and full echocardiographic study immediately before trans catheter closure as well as 24 h, 1 month and every 6 months after the procedure. Any intra or post procedural complications and their respective management were recorded. Results: The mean age of the study subjects was 7.4 years. The distance between the defect and the aortic valve was an average of 5.4 ± 1.8 mm, and the left ventricular opening averaged 10.6 ± 3.7 mm. immediate closure of the VSD was achieved in 25% of the cases. This percentage increased to 75% after 1 month. Intravascular hemolysis developed 3 days after the procedure in one patient with a residual shunt and was successfully managed by a PDA Amplatzer occluder device implanted in the residual defect. Three children had transient self-limiting bradycardia and junctional rhythm during the procedure. Conclusion: VSD closure using nitocclud PFM coil is safe and effective in selected patients. However, we report hemolysis in one patient with residual shunt which needs careful follow up and prompt management. 1. Introduction Ventricular septal defect (VSD) is the most common congenital heart disease, accounting for 40% of all congenital heart diseases (CHD). It has an overall prevalence of 3.94 per 1000 patients [1]. A notable marked increase in incidence rates is observed from 1.56 to 53.2 per 1000 live births, this can be attributed to the advancement in imaging and screening programs. This increase in prevalence and in- cidence requires proper management plan and follow up of these pa- tients as this will have a high impact on the wellbeing of the community [2]. The Clinical presentation of VSD is variable, depending on several factors, such as size, location, direction, shunt fraction and other as- sociated cardiac defects. It may be present as isolated form, or in complex combinations which in accordance needs careful assessment and the use of different diagnostic modalities for accurate diagnosis of such patients [1]. A perimembranous Ventricular septal defect (PmVSD) is situated in the membranous portion of the septum. It is located immediately below the aortic valve and the outflow tract of the left ventricle. PmVSD is the most common type of VSD accounting for 75% of all VSDs after infancy. Fibrous continuity between leaflets, tricuspid and aortic valve is a di- agnostic feature [3]. Fig. 1. Although surgical closure is the gold standard in management of VSD, percutaneous closure for VSD is considered an effective manage- ment, with no statistical difference in success rate and fewer compli- cations: as better cosmetic results, shorter hospital stay, no need for exploratory thoracotomy and blood transfusion. Patient selection is crucial for high success rate [4]. In 1987 Lock et al. described the first percutaneous VSD closure for six patients using Rashkind double umbrella device [5]. Since then percutaneous VSD closure has been used as an alternative to surgery [6]. Most commonly used devices for percutaneous closure of VSD are Amplatzer septal occluder, Amplatzer PDA occluder, Amplatzer mus- cular VSD occluder, concentric Amplatzer VSD occluder, and eccentric Amplatzer VSD occluder. The most significant complication observed following percutaneous closure of VSD was permanent and complete heart block. This has led to safety concerns among cardiologists. To alleviate these concerns, a newer device Nit-Occlud® Lê VSD has been manufactured [7,8]. The Nit Occlud® Lê VSD coil (PFM: Produkte für die Medizin AG, Cologne, Germany). Nit Occlud® Lê VSD coil has a specific nature, https://doi.org/10.1016/j.ppedcard.2018.12.002 Received 1 March 2018; Received in revised form 9 November 2018; Accepted 15 December 2018 ⁎ Corresponding author at: Cardiology Department, Ain Shams University Hospital, Abbassya, Cairo, Egypt. E-mail address: dinaezzeldin83@yahoo.com (D.A. EzzEldin). Progress in Pediatric Cardiology xxx (xxxx) xxx–xxx 1058-9813/ © 2018 Elsevier B.V. All rights reserved. Please cite this article as: EzzEldin, D.A., Progress in Pediatric Cardiology, https://doi.org/10.1016/j.ppedcard.2018.12.002