Echocardiographic Classification of Perimembranous Ventricular Septal Defect Guides Selection of the Occluder Design for Their Transcatheter Device Closure

Abstract

BACKGROUND Perimembranous ventricular septal defects (VSDs) has proximate relation to the aortic and tricuspid valves as well as the conduction tissues. Transcatheter closure utilizes various off-label device designs. METHODS Perimembranous VSD without aortic margin were classified as group A, with thick aortic margin as group B, with membranous septal aneurysm as group C and defects restricted by tricuspid valve attachments as group D. The proposed ideal design was asymmetric device in group A; duct occluder I (ADOI) and muscular ventricular septal occluder (MVSO) in group B; thin profile duct occluder II (ADOII) in group C and ADOI in group D. Device was 0–2 mm larger than the defect. RESULTS Eighty patients with VSD measuring 6.83 ± 2.87mm underwent successful closure. Device was retrieved before release in one group A and one group C patient due to aortic regurgitation. Asymmetric device was used in 16 group A defects. Among group B defects, ADOI was used in 5, ADOII in 5, MVSO in one and asymmetric device in 3. Group C defects were closed with ADOI in 7, ADOII in 10 and asymmetric device in 3. Three patients with multiple exits had 2 ADOII devices. Group D defects were closed using ADOI in 20 and ADOII in 10 patients. There was no late aortic regurgitation or heart block on a follow-up exceeding 7 years. CONCLUSIONS This echocardiographic classification helps device selection in every single patient. While asymmetric device is uniquely suited for group A defects, different designs are appropriate in the other groups.

Echocardiography in Simple Congenital Heart Diseases: Guiding Adult Patient Management

“…Importantly, the size and intensity of the Doppler jet provide valuable insights into the volume of shunt flow, which is crucial in gauging the severity of the defect. [ 44 ] In addition, CW Doppler assists in calculating pressure gradients across the VSD. This information furnishes a more profound understanding of the hemodynamic relevance of the shunt and the degree of left-to-right flow.…”

“…Echocardiography can provide insights into the feasibility of both percutaneous and surgical treatment options. [ 44 ] Both transcatheter and surgical closure of VSDs have specific indications and contraindications. Transcatheter closure is indicated for cases with various criteria, such as cardiomegaly, elevated Qp/Qs ratio, and specific postoperative or post-infarct VSDs.…”

“…The decision for closure should be tailored to individual patient factors and anatomical considerations. [ 44 ]…”

“…A study conducted by Singhi and Sivakumar[ 44 ] introduces an echocardiographic classification system for perimembranous VSDs to guide the selection of occluder designs for their transcatheter device closure. The classification categorizes defects into four groups based on their anatomical features: Group A, without aortic margin; Group B, with thick aortic margin; Group C, with membranous septal aneurysm; and Group D, defects restricted by tricuspid valve attachments.…”

Echocardiographic Classification and Guidance for Transcatheter Closure of Ventricular Septal Defect

“…Furthermore, detailed information, like location, size, number, and adjacent structures, are provided by echocardiography. For this reason, Singhi and Sivakumar 20) suggested classification of perimembranous VSDs according to transthoracic echocardiography (TTE). Recently, 3-dimensional, real-time, transthoracic or transesophageal, echocardiography-guided procedures have been increasing in the catheterization laboratory and demonstrating excellent results.…”