Transcatheter Closure of Congenital VSDs: Tips and Tricks

Abstract

Nowadays transcatheter device closure of ventricular septal defects (VSDs) is an attractive and feasible alternative to surgical closure of congenital VSDs. Isolated congenital VSDs constitute the most common form of congenital heart disease (CHD) in infants and children and account for 20-30% of all types of cardiac malformations. Most of the VSDs are located in the membranous portion of the ventricular septum (perimembranous VSDs). There are also less common types of VSDs located in the muscular portion (muscular VSDs), below the pulmonary valve (subpulmonary or supracristal VSDs), and near the junction of the tricuspid and mitral valves (inlet type VSDs). Indications for closure of VSDs include a hemodynamically significant left to right shunt and prevention of long-term complications, including pulmonary hypertension, progressive ventricular dilatation, aortic insufficiency, double-chambered right ventricle, and endocarditis. In this chapter, we review the technical details for achieving a successful procedure, as well as some tips and tricks on using off-label devices during transcatheter approach in VSD closure.

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

“…13 This could happen because the perimembranous type is the most common type of VSD with a percentage of 70%, followed by 15-20% muscular type and 5% subarterial. 19 However, the prevalence of the subarterial type is higher in Asia, which is 30%. 20 In addition, the difference in the number of types of VSD that were performed the transcatheter VSD closure could be influenced by the prevalence of spontaneous closure of the defect which was different for each type of VSD.…”

Classification of Ventricular Septal Defects (Vsds) on the Basis of Genetics

“…Spontaneous closure is uncommon in type 1 defects. 13 There are further two subtypes of type 1 defects, (Type Ia) without pulmonary infundibular stenosis, (Type Ib) with pulmonary infundibular stenosis. 14 Type 2 defects account up to 70% of all defects.…”

“…14 Type 2 defects account up to 70% of all defects. 13 As name indicated, type 2 VSD located in the membranous portion of the ventricular septum. Perimembranous or paramembranous are further subtypes of type 2 defects.…”

“…15 Type 3 defects account for 5% in all defects, and lie in the right ventricular septum at posterior inlet portion correspond to outlet portion of left ventricular septum. 13 The defect expands superiorly to membranous septum. Type 4 defect is muscular defect and this includes a variety of single or multiple defects in the muscular septum.…”

“…16 Muscular defects comprise about 15-20% of all defects. 13 Frequently, type 4 defects are present in multiple numbers. Muscular defects are more likely to close spontaneously, by the development of septal muscles.…”