Echocardiography-guided percutaneous closure of perimembranous ventricular septal defects without arterial access and fluoroscopy

Abstract

Background: Traditional percutaneous device closure of perimembranous ventricular septal defects (PmVSDs) is a minimally invasive technique, but can result in high radiation exposure and can result in potential arterial complications. Here, we aimed to assess the safety and feasibility of device closure of PmVSDs via the femoral vein approach under transesophageal echocardiography (TEE) guidance in children. Methods: From January 2014 to December 2017, a total of 46 PmVSD patients (mean age, 6.5 ± 2.3 years [range, 4.2-12.0 years]; mean body weight 22.1 ± 6.6 kg [range, 16.0-38.5 kg]; VSD diameter, 4.1 ± 0.6 mm [range, 3.2-5.0 mm]) underwent attempted transcatheter closure via the femoral vein approach under the guidance of TEE without fluoroscopy. Results: The transcatheter occlusion procedure under TEE guidance was successful in 44 (95.7%) patients. Surgery was necessary in 2 (4.3%) patients. The procedure duration was 28.2 ± 8.7 min (range, 12.0-42.0 min). One patient had immediate post-operative trivial residual shunt and three patients had immediate incomplete right bundle branch block (IRBBB) after operation; the new IRBBB in 1 case was noted in the first postoperative month. No residual shunt was noted at 3 months after the procedure, and no intervention related complications were detected at 1-24 months follow-up. Conclusions: Percutaneous device closure of PmVSDs under TEE guidance solely by femoral vein approach is effective and safe, avoids radiation exposure, potential arterial complications and a surgical incision.

Transcatheter ventricular septal defect closure via femoral vein alone under transthoracic echocardiography guidance without fluoroscopy: preliminary experience

“…Unlike the whole instrument-tracking images from fluoroscopy, echocardiography images are segmental; therefore, an arterio-venous loop is difficult to establish using a snare. A single vessel is routinely employed in such instances [14,15]. Wang et al have demonstrated the feasibility and safety of the retrograde approach through the femoral artery under TTE guidance alone.…”

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

“…Adicionalmente, se seleccionaron 16 series de casos [86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101] para hacer un análisis descriptivo de la seguridad del uso de dispositivos o de la cirugía estándar y que ha aportado una población de estudio adicional de 2940 pacientes.…”

“…Todas las series de casos incorporan pacientes con CIV perimembranosa y en 7 de ellas, incluyen también población con CIV muscular [87][88][89][90][91]94,95 . Una de las series de casos aporta 400 pacientes intervenidos mediante cirugía estándar 87 y una segunda serie de casos, 235 pacientes intervenidos mediante cierre perventricular 98 .…”

Image diagnosis: Eisenmenger’s syndrome in patients with simple congenital heart disease

“…Congenital heart disease (CHD) is currently the common type of congenital malformation in infants [4,5], and PAH presents with unique features in this disease. In these patients, the arteriopathy is triggered by increased pulmonary blood flow resulting from a left-to-right shunt due to intracardiac or extracardiac defect.…”