Transcatheter closure of perimembranous ventricular septal defect with right coronary cusp prolapse using the Amplatzer Duct Occluder II device: A noval systematic multicenter experience from Iraq.

BACKGROUND

Perimembranous ventricular septal defect (PM-VSD) with right coronary cusp (RCC) prolapse carries a high risk of progressive aortic regurgitation and often lacks a measurable aortic rim, complicating device closure. While surgery remains the standard treatment, transcatheter therapy using the Amplatzer Duct Occluder II (ADO II) offers a less invasive option, though data in Middle Eastern populations are scarce.

OBJECTIVE

To evaluate the feasibility, safety, and intermediate-term outcomes of ADO II closure in PM-VSD patients with RCC prolapse.

METHODS

We conducted a retrospective multicenter study of 29 consecutive patients (mean age: 8.86 ± 5.77 years; 55.2% male) with PM-VSD and RCC prolapse who underwent ADO II closure at two Iraqi cardiac centers (January 2023-November 2024). Inclusion criteria required an effective flow diameter ≤3 mm (left ventricular side), hemodynamic significance (Qp:Qs > 1.5 or left ventricular volume overload), and absence of severe aortic regurgitation or pulmonary hypertension.

RESULTS

Device implantation succeeded in 28 of 29 patients (96.6%). Immediate complete closure occurred in 23 patients (79.3%); 5 had small residual shunts (<2 mm). One patient required surgical conversion. At 6 months, complete closure persisted in 23 patients (79.3%), and 27 patients (93.1%) had favorable outcomes (complete closure or mild valvular regurgitation only). Critically, no new-onset aortic regurgitation developed, and baseline mild aortic insufficiency did not worsen.

CONCLUSION

Transcatheter PM-VSD closure with ADO II is feasible, safe, and effective in carefully selected patients with RCC prolapse-even without a traditional aortic rim. This first systematic multicenter experience from Iraq supports expanding minimally invasive therapy for this high-risk subgroup in resource-constrained settings.