The experience of transcatheter closure of postoperative ventricular septal defect after total correction

Abstract

Background The purpose of this study was to describe our experience with patients who underwent transcatheter closure of a post-operative ventricular septal defect (VSD). Methods All patients who underwent transcatheter closure of a VSD after total correction of congenital heart disease since 2012 were enrolled. Medical records were retrospectively reviewed to determine the patients’ initial diagnosis, closure device used, and final outcome after device closure. Results Six patients with a median age of 17.7 years (range: 7 months–48 years) underwent transcatheter closure of an unresolved VSD. The median time interval from the initial corrective surgery to the percutaneous closure procedure was 10.4 years (range: 0.3–33.0 years). The initial diagnoses included tetralogy of Fallot (one patient), VSD (two patients), double outlet of the right ventricle (two patients), and aortic valve stenosis (one patient). The reasons for unresolved VSD (other than leakage) after corrective surgery included previous fenestration (in two patients), and iatrogenic Gerbode shunt (in one patient). Various devices were used, including the Amplatzer duct occluder I, Amplatzer duct occluder II, Amplatzer vascular plug II, and Cocoon membranous VSD occluder. Only one device was used in each patient. There were no major complications associated with the closure procedures. The immediate results were satisfactory. The median follow-up duration was 2.75 years. All cases were successful, with the exception of minimal leak in one patient. Conclusions Transcatheter device closure of post-operative VSD can be performed using various device types of devices and is safe and effective. But more experiences are mandatory.

Characteristics of Patients with Ventricular Septal Defect that Had Been Closed with Transcatheter in Dr. Soetomo General Hospital from January 2019 to December 2021

“…Even so, other studies have shown that the patient's weight that can be done with a transcatheter defect closure is at least 7 kg and even 6 kg. 16,17 This is because body weight is one of the factors that contribute to the successful closure of defects with transcatheter occlusions because patients with low body weight have small vascular diameters so that the selection of the right device and vascular access becomes more difficult. 18 The most common type of VSD that was closed with a transcatheter in this study was the perimembranous type, followed by the subaortic type and the SADC type.…”

Transcatheter Closure of Left Ventricle to Coronary Sinus Fistula Post-MVR and Septal Myectomy

“…Compared to reoperation, the endovascular approach decreased recovery time and cost, while avoiding the high surgical risk associated with recent sternotomy. The long-term risks and durability of percutaneous LV-CS fistula closure are unknown, although procedures following a similar technique for ventricular septal defect (VSD) occlusion have demonstrated favorable efficacy, procedural safety, and short-term clinical outcomes ( 9 , 10 ).…”

Efficacy and safety of the Amplatzer Duct Occluder II for ventricular septal defect closure: a meta-analysis

“…Furthermore, the surgery is simpler, with a shorter time as well as less mechanical damage and intraoperative blood loss. 6,19 soft and elastic design of Amplatzer duct occluder II reduces surgical complications According to Santhanam et al, 32 the most common complication during VSD occlusion is RS (pooled rate, 15.9%; 95% CI, 10.9%-21.5%). Other complications included arrhythmia (pooled rate, 10.3%; 95% CI, 8.3%-12.4%) and valve dysfunction (pooled rate, 4.1%; 95% CI, 2.4%-6.1%), and the incidence of cAVB was 1.1% (95% CI, 0.5%-1.9%).…”

“…5 Recently, the off -label use of the ADO II for closing VSD has been described. 6 Due to the finer and more flexible mesh structure of the ADO II, the device can pass through a small 4F or 5F catheter system. 7 In addition, its soft design is expected to reduce the risk of cAVB.…”