Skip to main content

Advertisement

SpringerLink
Log in

Transcatheter Closure of Perimembranous Ventricular Septal Defect Using KONAR-MF™: A Multicenter Experience

  • Research
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Transcatheter closure of perimembranous ventricular septal defect (PmVSD) is an established procedure. However, the occurrence of complete heart block limits its scope. The newer KONAR-MF™ occluder has specific design characteristics that may improve the safety of PmVSD closure. The objective of the study was to describe the efficacy and mid-term follow-up of transcatheter closure of PmVSD using KONAR-MF™. The study was conducted prospectively in 3 Indian centers (January 2018–December 2022). PmVSD closure was done by both antegrade and retrograde methods, and patients were followed up at 1, 3, 6, 12 months, and annually after that. 121 out of 123 patients were included with the following characteristics: median age 4.4 (0.18–40) years; weight 15 (2.1–88) kg; mean Qp/Qs ratio 1.87 ± 0.52 and pulmonary artery mean pressure: 22 ± 6.9 mmHg. The procedure was successful in all but 3; the device was removed due to significant residual shunt (n = 2) and new development of aortic regurgitation (AR) (≥ mild) in 1. The median defect size was 5.2 (2.5–12) mm. Device sizes from 6/4 to 14/12 were deployed (median fluoroscopy time 13.3 min; range 3.6–47.8). Shunt occlusion rates were 90%-Immediate, 95%-pre-discharge, and 97%-1 month, with no instances of complete heart block after the procedure and during follow-up. Six had new onset AR (mild: 2, trivial 4), and one had increased tricuspid regurgitation. All patients were well during follow-up (median: 20 months; range: 6–46). The new KONAR-MF™ occluder appears to be a promising and safe alternative for the closure of the PmVSD; further long-term follow is merited.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data Availability

No datasets were generated or analysed during the current study.

References

  1. Cohen MS, Lopez L (2016) Ventricular septal defect. In: Allen HD, Shaddy RE, Penny DJ, Feltes TF, Cetta F (eds) Moss and adams’ heart disease in infants, children, and adolescents, 9th edn. Williams and Wilkins, Baltimore, pp 783–801

    Google Scholar 

  2. Anderson R, Lenox C, Zuberbuhler J (1983) Mechanisms of closure of perimembranous ventricular septal defect. Am J Cardiol 52(3):341–345

    Article  CAS  PubMed  Google Scholar 

  3. Krovetz L (1998) Spontaneous closure of ventricular septal defect. Am J Cardiol 81(1):100–101

    Article  CAS  PubMed  Google Scholar 

  4. Keith JD, Rose V, Collins G, Kidd BS (1971) Ventricular septal defect. Incidence, morbidity, and mortality in various age groups. Br Heart J 33:81–7

    Article  PubMed Central  Google Scholar 

  5. Kirklin J, Kouchoukos N (2013) Kirklin/Barratt-Boyes cardiac surgery. Elsevier/Saunders, Philadelphia, p 16

    Google Scholar 

  6. Corone P, Doyon F, Gaudeau S, Guérin F, Vernant P, Ducam H et al (1977) Natural history of the ventricular septal defect. A study involving 790 cases. Circulation 55(6):908–15

    Article  CAS  PubMed  Google Scholar 

  7. Van Hare GF, Soffer LJ, Sivakoff MC, Liebman J (1987) Twenty-five-year experience with ventricular septal defect in infants and children. Am Heart J 114(3):606–614

    Article  PubMed  Google Scholar 

  8. Yeager SB, Freed MD, Keane JF, Norwood WI, Castaneda AR (1984) Primary surgical closure of ventricular septal defect in the first year of life: results in 128 infants. J Am Coll Cardiol 3:1269–1276

    Article  CAS  PubMed  Google Scholar 

  9. Fu YC, Bass J, Amin Z, Radtke W, Cheatham JP, Hellenbrand WE, Balzer D, Cao QL, Hijazi ZM (2006) Transcatheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: results of the US phase I trial. J Am Coll Cardiol 47(2):319–25. https://doi.org/10.1016/j.jacc.2005.09.028

    Article  PubMed  Google Scholar 

  10. Predescu D, Chaturvedi RR, Friedberg MK, Benson LN, Ozawa A, Lee KJ (2008) Complete heart block associated with device closure of perimembranous ventricular septal defects. J Thorac Cardiovasc Surg 136(5):1223–1228. https://doi.org/10.1016/j.jtcvs.2008.02.037

    Article  PubMed  Google Scholar 

  11. Schubert S, Kelm M, Koneti NR, Berger F (2019) First European experience of percutaneous closure of ventricular septal defects using a new CE-marked VSD occluder. EuroIntervention 15(3):e242–e243. https://doi.org/10.4244/EIJ-D-18-00867

    Article  PubMed  Google Scholar 

  12. Haddad RN, Daou LS, Saliba ZS (2020) Percutaneous closure of restrictive-type perimembranous ventricular septal defect using the new KONAR multifunctional occluder: midterm outcomes of the first middle-eastern experience. Catheter Cardiovasc Interv 96(3):E295–E302. https://doi.org/10.1002/ccd.28678

    Article  PubMed  Google Scholar 

  13. Tanidir IC, Baspinar O, Saygi M, Kervancioglu M, Guzeltas A, Odemis E (2020) Use of Lifetech™ Konar-MF, a device for both perimembranous and muscular ventricular septal defects: a multicentre study. Int J Cardiol 1(310):43–50. https://doi.org/10.1016/j.ijcard.2020.02.056

    Article  Google Scholar 

  14. Sadiq M, Qureshi AU, Younas M, Arshad S, Hyder SN (2022) Percutaneous closure of ventricular septal defect using LifeTech™ Konar-MF VSD Occluder: initial and short-term multi-institutional results. Cardiol Young 32(5):755–761. https://doi.org/10.1017/S1047951121002985

    Article  PubMed  Google Scholar 

  15. Odemis E, Kizilkaya MH (2023) Early and mid-term outcomes of transcatheter closure of perimembranous ventricular septal defects using the Lifetech™ Konar-MF occluder device (MFO). Cardiol Young 33(10):2021–2026. https://doi.org/10.1017/S1047951122003547

    Article  PubMed  Google Scholar 

  16. Koneti NR, Sreeram N, Penumatsa RR, Arramraj SK, Karunakar V, Trieschmann U (2012) Transcatheter retrograde closure of perimembranous ventricular septal defects in children with the Amplatzer duct occluder II device. J Am Coll Cardiol 60(23):2421–2422. https://doi.org/10.1016/j.jacc.2012.08.1004

    Article  PubMed  Google Scholar 

  17. Koneti NR, Penumatsa RR, Kanchi V, Arramraj SK, Bhupathiraju S (2011) Retrograde transcatheter closure of ventricular septal defects in children using the Amplatzer Duct Occluder II. Catheter Cardiovasc Interv 77(2):252–259. https://doi.org/10.1002/ccd.22675

    Article  PubMed  Google Scholar 

  18. Fischer G, Apostolopoulou SC, Rammos S, Schneider MB, Bjørnstad PG, Kramer HH (2007) The Amplatzer Membranous VSD Occluder and the vulnerability of the atrioventricular conduction system. Cardiol Young 17(5):499–504. https://doi.org/10.1017/S1047951107000984

    Article  PubMed  Google Scholar 

  19. Carminati M, Butera G, Chessa M, De Giovanni J, Fisher G, Gewillig M, Peuster M, Piechaud JF, Santoro G, Sievert H, Spadoni I, Walsh K (2007) Investigators of the European VSD registry. Transcatheter closure of congenital ventricular septal defects: results of the European registry. Eur Heart J 28(19):2361–2368. https://doi.org/10.1093/eurheartj/ehm314

    Article  PubMed  Google Scholar 

  20. Butera G, Carminati M, Chessa M, Piazza L, Micheletti A, Negura DG, Abella R, Giamberti A, Frigiola A (2007) Transcatheter closure of perimembranous ventricular septal defects: early and long-term results. J Am Coll Cardiol 50(12):1189–1195. https://doi.org/10.1016/j.jacc.2007.03.068

    Article  PubMed  Google Scholar 

  21. Latham RA, Anderson RH (1972) Anatomical variations in atrioventricular conduction system with reference to ventricular septal defects. Br Heart J 34(2):185–190

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Bass JL, Kalra GS, Arora R, Masura J, Gavora P, Thanopoulos BD, Torres W, Sievert H, Carminati M, Fischer G, Ewert P (2003) Initial human experience with the Amplatzer perimembranous ventricular septal occluder device. Catheter Cardiovasc Interv 58(2):238–245. https://doi.org/10.1002/ccd.10406

    Article  PubMed  Google Scholar 

  23. Swartbol P, Truedsson L, Pärsson H, Norgren L (1997) Tumor necrosis factor-alpha and interleukin-6 release from white blood cells induced by different graft materials in vitro are affected by pentoxifylline and iloprost. J Biomed Mater Res 36(3):400–406

    Article  CAS  PubMed  Google Scholar 

  24. Voûte MT, Bastos Gonçalves FM, van de Luijtgaarden KM, Klein Nulent CG, Hoeks SE, Stolker RJ, Verhagen HJ (2012) Stent graft composition plays a material role in the postimplantation syndrome. J Vasc Surg 56(6):1503–1509. https://doi.org/10.1016/j.jvs.2012.06.072

    Article  PubMed  Google Scholar 

  25. Nageswara Rao Koneti (2023) Multi-functional occluder, Indian patent no: 420711; Intellectual property of India

  26. Kaur D, Rajan S, Shah M, Koneti NR, Calambur N (2022) Mapping the conduction system in patients undergoing transcatheter device closure of perimembranous ventricular septal defect: a proof-of-concept study. Pediatr Cardiol 43(3):674–684. https://doi.org/10.1007/s00246-021-02773-0

    Article  PubMed  Google Scholar 

  27. Ece İ, Bağrul D, Kavurt AV, Terin H, Torun G, Koca S, Gül AEK (2024) Transcatheter ventricular septal defect closure with Lifetech™ Konar-MF Occluder in infants under 10 kg with only using venous access. Pediatr Cardiol 45(1):175–183. https://doi.org/10.1007/s00246-023-03350-3

    Article  PubMed  Google Scholar 

  28. Kuswiyanto RB, Gunawijaya E, Djer MM, Noormanto RMA, 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 (2022) Transcatheter closure of perimembranous ventricular septal defect using the Lifetech Konar-multi functional occluder: early to midterm results of the indonesian multicenter study. Glob Heart 17(1):15. https://doi.org/10.5334/gh.1106

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Cardiology, Rainbow Children’s Heart Institute, Plot no: 22, Road no: 10, Banjara Hills, Hyderabad, 5000034, India

    Nageswara Rao Koneti, Shweta Bakhru & Bhargavi Dhulipudi

  2. Consultant Pediatric Cardiology, Amrita Hospital Sector 88, Faridabad, India

    Sushil Azad & Radhakrishnan Sitaraman

  3. Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, India

    Raman Krishna Kumar

Authors
  1. Nageswara Rao Koneti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sushil Azad
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shweta Bakhru
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bhargavi Dhulipudi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Radhakrishnan Sitaraman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Raman Krishna Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

K.N, S.Z, K.K wrote manuscript R.S: study design and revision S.B, B.D: statistics and prepared figures.

Corresponding author

Correspondence to Nageswara Rao Koneti.

Ethics declarations

Conflict of interest

Nageswara Rao Koneti is the inventor of the KONAR—MF device and receives a royalty from Lifetech Scientific, Schengen. The multi-functional occluder has patents from India 420711, Euro-Asia 036309, and Korea 10-389237.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koneti, N.R., Azad, S., Bakhru, S. et al. Transcatheter Closure of Perimembranous Ventricular Septal Defect Using KONAR-MF™: A Multicenter Experience. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-024-03505-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00246-024-03505-w

Keywords

Search

Navigation