Kuswiyanto RB, Gunawijaya E, Djer MM, Noormanto, Rahman MA, Murni IK, Sukardi R, Utamayasa A, Ardiansyah R, Nova R, Liliyanti S, Rahayuningsih SE, Anggriawan SL, Rahayuningsih TY, Koentartiwi D, Soewarniaty R, Yantie VK, Nugroho S, Hidayat T, Ontoseno T, Tobing TC, Ali M, Bashari MH, Yosy DS, Arafuri N, Hilmanto D, Yanuarso PB, Advani N, Sastroasmoro S, Putra ST.Glob Heart. 2022 Feb 24;17(1):15. doi: 10.5334/gh.1106. eCollection 2022.PMID: 35342698
Take Home Points:
- Transcatheter closure of perimembranous ventricular septal defects is routinely performed in resource limited countries.
- The Lifetech Konar Multi-Functional Occluder (Konar MF VSD Occluder) is safe and effective for the closure of pmVSDs.
- The device has characteristics that make it suitable for closing various types of pmVSDs.
Commentary from Dr. Konstantin Averin (New York), catheterization section editor of Pediatric Cardiology Journal Watch:
In this study Kuswiyanto et al describe a prospective multi-center study to assess the feasibility and efficacy of perimembranous ventricular septal defect (pmVSD) closure using the Lifetech Multifunctional Occluder (MFO, now rebranded as Lifetech MF VSD Occluder) (Figure below). While the initial experience with a purpose made pmVSD device in the early 2000s was disappointing due to an unacceptably high incidence of complete heart block, pmVSD closure has become relatively routine in resource limited countries using a variety of new devices, including the Lifetech MFO.
From January 2016 to December 2017 195 patients underwent pmVSD closure with the Lifetech MFO at 11 centers in Indonesia; 55 patients did not have complete data so were excluded as were 8 adult patients. Thus, the study cohort was comprised of 132 patients – median age 4.5 years (range 0.3-17.4) and median weight 14.8 kg (range 3.5-57.0). The inclusion criteria were reasonable. There was a high successful implantation rate during the first or second attempt (~98%) with 31% of implants performed retrograde while the rest were antegrade. Acute occlusion occurred in 68.2% of patients. There were 3 device embolization within 24 hours of device implant and no other significant pre-discharge complications (no 2/3rd degree heart block). Of 126 patients who were discharged with a device, 12-month follow up was available in all. There was complete occlusion in 99.2% with no evidence of 2nd or 3rd degree heart block. No patients had greater than mild aortic regurgitation and 4 patients had moderate tricuspid regurgitation (3 infants with large devices).
The authors should be congratulated on this contribution to the literature, again demonstrating that the Lifetech Konar MFO is effective in closing pmVSDs in a heterogenous group of patients (ranging in size from 3.5 to 57 kg). The Lifetech Konar MF has several characteristics which make it well suited for closing pmVSDs – it can be deployed both antegrade and prograde, has a relatively low profile, is soft and can articulate giving it the ability to conform to a given anatomy and minimize pressure on the myocardium/conduction tissue. As the experience in Asia (and other countries) increasingly demonstrates the effectiveness of this device, it may eventually become possible to offer this procedure to patients in North America.