Midterm Follow-up Using Lifetech Konar-MF Device for Perimembranous and Muscular Ventricular Septal Defects in Pediatric Patient's

Background: Treatment of muscular ventricular septal defects (mVSDs) is still challenging for pediatric cardiac surgeons and interventionalists, especially in infants. Transcatheter closure was first successfully performed in 1988, but complication rates were high, particularly early- and late-onset complete heart blocks. Until now, interventionalists are still searching for the ideal closure device, as especially mVSDs or “Swiss cheese VSDs” may complicate the procedure. The use of new VSD closure devices has developed over time and complication rates have decreased. We evaluated the efficacy, safety, and outcome of transcatheter perimembranous (p) and mVSD closure using the novel KONAR-MF VSD occluder.

Method: Between July 2020 and August 2021, six patients with hemodynamically significant pVSDs and mVSDs underwent a transcatheter closure using the KONAR-MF VSD occluder. Three of these patients had a complex cardiac anatomy with Swiss cheese VSDs or complex mVSDs. All implantations were performed retrogradely under sedation, transoesophageal echocardiography, and fluoroscopic guidance. Prospective follow-up using transthoracic echocardiography and electrocardiogram were performed until September 2021.

Results: Median age and weight of all five pediatric patients was 179 days (6 months) and 7.3 kg, respectively. One adult patient (66 years) with congenital heart disease also underwent the procedure. Median follow-up time was 134 days. All devices were successfully and rapidly implanted. Median procedure duration was 123 minutes in all patients, 67 minutes in three uncomplicated cases and 238 minutes in the three cases with complex cardiac anatomy. Sheath size was 4 or 6 French. In all patients, VSD closure was achieved. There was no residual shunting in the two pediatric patients with pVSD directly after intervention. Interestingly, we saw minor residual shunting in one of these patients at the latest follow-up. Mild residual shunting was detected in two out of the three patients with mVSDs directly after the intervention and at the latest follow-up. Four patients showed significant improvements regarding signs of heart failure. There was no complete heart block, major complications, or death.

Conclusion: Closure of pVSDs and even complex mVSDs in infants was feasible with only minor residual shunting with the KONAR-MF. Thus, transcatheter VSD closure by KONAR-MF is a promising tool in adult and pediatric patients even with complex cardiac anatomy. Advantages are a softer design, the use of both an antegrade and retrograde approach, a small sheath size, and the lower risk of heart block.

Publication History

Article published online:
12 February 2022