The Amplatzer Muscular VSD Occluder is indicated for use in patients with a complex ventricular septal defect (VSD) of significant size to warrant closure—large volume left-to-right shunt, pulmonary hypertension, and/or clinical symptoms of congestive heart failure—in patients who are considered to be at high risk for standard transatrial or transarterialsurgical closure based on anatomical conditions and/or based on overall medical condition.
Both transcatheter and surgical closure are options for patients with moderate to large VSDs. In particular, physicians should perform VSD closure when the patient has:2
- Left ventricular (LV) volume overload
- Worsening aortic regurgitation (AR) caused by perimembranous VSD
- Hemodynamically significant shunts, with pulmonary-to-systemic blood ﬂow ratio (Qp/Qs) of 1.5 or higher*
- A history of infective endocarditis (IE) caused by VSD
In patients whose VSD is not repaired, there is an increased risk of IE, usually involving the tricuspid and pulmonary valves.
*Assuming that PA systolic pressure is less than 50% systemic and pulmonary vascular resistance is less than one-third systemic.
A post-myocardial infarction muscular VSD is a life-threatening complication that often leads to cardiogenic shock.3 Notably, medical management alone is associated with a grim prognosis of a 94% mortality rate at 30 days.4
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- Minette MS, et al. Ventricular septal defects. Circulation. 2006;114:2190-2197.
- Stout KK, et al. 2018 AHA/ACC Guideline for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018;000:e000-e000. doi: 10.1161/CIR.0000000000000603.
- Schlotter F, et al. Interventional post-myocardial infarction ventricular septal defect closure: a systematic review of current evidence. EuroIntervention. 2016;12:94-102.
- Crenshaw BS, et al. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. Circulation. 2000;101(1):27-32.