{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T01:41:57Z","timestamp":1784770917138,"version":"3.55.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T00:00:00Z","timestamp":1688515200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Retrograde closure of perimembranous ventricular septal defects (pmVSDs) is a well-established procedure. However, interventionists are still looking for the best closure device.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a single-center retrospective review of 5-year-experience (from July 2015 to July 2020) with retrograde closure of pmVSDs using Amplatzer<jats:sup>TM<\/jats:sup> Duct Occluder II (ADOII) and KONAR-MF\u2122 VSD occluder (MFO). Deficient sub-aortic rim (SAR) (\u22642.5\u2005mm for MFO and \u22643\u2005mm for ADOII) was an exclusion criterion in defects with a diameter ratio (right-side exit\/left-side entry)\u2009&amp;gt;\u20090.5.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 77 patients (57.1% males) with a median age of 4.3 years (IQR, 2.2\u20138.3) and a median weight of 16\u2005kg (IQR, 11.2\u201324.5). 44 (57.1%) defects (22.7% with deficient SARs) with a median left-side defect diameter of 8.7\u2005mm (IQR, 5.7\u201310) were closed with ADOIIs. 33 (42.9%) defects (51.5% with deficient SARs) with a median left-side defect diameter of 10.8\u2005mm (IQR, 8.8\u201313.5) were closed with MFOs. One 7\/5 MFO was removed before release and upsized to a 12\/10 MFO. Implantation success rate was 100% with ADOII and 90.9% with MFO devices. Two MFOs were snare-recaptured after embolization, and one 9\/7 MFO was snare-retrieved for a new onset of grade-2 aortic regurgitation that persisted afterward. Median follow-up was 3.3 years (IQR, 2.1\u20134.2) for ADOII and 2.3 years (IQR, 1.7\u20132.5) for MFO. No permanent heart block or death occurred. Freedom from left ventricular dilation was 94.62% at 36 months of follow-up. Freedom from residual shunt was 90.62% for MFO and 89.61% for ADOII at 24 months of follow-up. One 2.6-year-old patient with baseline mild aortic valve prolapse and trivial aortic regurgitation developed a grade-2 aortic regurgitation after 9\/7 MFO implantation. He was treated surgically after two years without device extraction. One new grade-2 asymptomatic tricuspid regurgitation persisted at the last follow-up in the ADOII group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>ADOII and MFO are complementary devices for effective retrograde closure of pmVSDs in children, including defects with absent or deficient SAR. ADOII is limited to smaller defects but offers a lower profile and a flexible left-side disk for better maneuverability over the aortic valve during retrograde implantation.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2023.1215397","type":"journal-article","created":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T20:27:55Z","timestamp":1688588875000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":25,"title":["Comparative outcomes of two competitive devices for retrograde closure of perimembranous ventricular septal defects"],"prefix":"10.3389","volume":"10","author":[{"given":"Raymond N.","family":"Haddad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zakhia 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