Early Experiences Using Cocoon Occluders for Closure of a Ventricular Septal Defect

Abstract

BACKGROUNDTranscatheter device closure of ventricular septal defect (VSD) has become an attractive alternative to surgery. We report here on our early experiences of transcatheter closure of VSD using Cocoon devices, which are now available in Korea.METHODSWe reviewed the medical records and angiographic images of 13 patients who underwent transcatheter closure of VSD with a Cocoon occluder at Samsung Medical Center. The median patient age was 5.8 years, and the median patient weight was 20.3 kg.RESULTSThe device was successfully implanted in all patients. The follow-up period was 10 ± 6 months, and no mortality was observed. An immediate residual leak on the next day was detected in 7 patients (including 4 with perimembranous VSD). However, 6 months later, a residual leak was observed only in 2 patients with perimembranous VSD and 1 patient with muscular VSD. Early conduction abnormalities were observed in 3 patients, all of whom had perimembranous VSD, but no significant complete atrioventricular block was observed. One patient experienced newly developed significant aortic regurgitation that decreased spontaneously but still existed at the 6 month follow-up. No hemolysis or embolization was noted on the next day or during the follow-up period.CONCLUSIONSCocoon devices can be used safely and effectively for VSD closure. However, residual leaks and conduction abnormalities may occur early after implantation, especially in patients with perimembranous VSD. Although normal conduction was recovered, long-term evaluation remains essential.

Right ventricular outflow obstruction caused by cocoon duct occluder used for closure of ruptured sinus of valsalva aneurysm

“…A CDO is made from nitinol wires coated with platinum and has the same profile as the Amplatzer duct occluder. [ 6 ] Increasing shunt across a CDO can be due to erosion around the device, usually related to abrasive mechanical force between device and human tissue caused by the material of which it is made. It can be further worsened by the motion of the device against the tissue as is also mentioned by Huang and colleagues.…”

Tratamiento de la Comunicación Interventricular (CIV) congénita con dispositivos de inserción percutánea y perventricular

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