Transcatheter closure of inferior sinus venosus defect using a patent ductus arteriosus occluder following simulation with a 3D-printed model

Abstract

Background Transcatheter closure of inferior sinus venosus defect (ISVD) is still contraindication. To explore whether transcatheter closure with patent ductus arteriosus (PDA) occluders is possible for ISVD. Methods From June 2014 to March 2021, 12 patients were recruited diagnosed as <25 mm ISVD. The three-dimensional printing (3DP) heart model was produced based on multi-slice computed tomography (MSCT) scans. Preoperative closure simulation was planned on the personalized 3D model for each patient. Follow-up including electrocardiography (ECG), transthoracic echocardiography (TTE), and X-ray was traced. Results 3DP models of 12 patients were successfully printed. Twelve patients had been diagnosed with <25 mm ISVD and 4 of them had another secundum atrial septal defect (ASD). All patients were produced interventional therapy successfully. PDA occluder was implanted to closed ISVD, and ASD was closed using ASD occluder simultaneously. The average diameter of ISVD measured by TTE was (12.67±3.80), and the average diameter of sagittal axes and longitudinal axes measured by the 3D-printed model was (17.08±3.20) and (18.42±4.62) mm, respectively. The average size of PDA (diameter of pulmonary artery side) was (28.17±3.35) mm. Compared with the preoperative, the X-ray cardiothoracic ratio (0.51±0.04 vs. 0.47±0.06, P=0.007) and the right ventricle anterior-posterior diameter (31.17±5.65 vs. 24.58±3.75 mm, P<0.001) of postoperative was significantly decreased. During the average (47.75±27.52) months follow-up, it has achieved satisfying results, and there were no severe adverse events such as device transposition, death, and pericardial tamponade occurred. Conclusions Assisting by 3D heart model, transcatheter closure of ISVD with PDA occluder had an excellent outcome. This method provides a new considerable treatment strategy for ISVD.

Congenital heart disease: types, pathophysiology, diagnosis, and treatment options

“…However, this was a retrospective, nonrandomized study that included a small cohort and no comparative group; additional randomized studies with longer follow‐up periods would be required to confirm the superiority of covered stent implantation over the surgical approach in the management of these patients. Another recent study of 12 patients with inferior sinus venosus‐type ASD who underwent successful transcatheter closure using PDA occluders and three‐dimensional‐printed heart models reported that interventional therapy may not be contraindicated in patients with inferior sinus venosus‐type ASD 143 . However, this previous study was a retrospective study with a small sample size, and prospective, randomized controlled trials including a large cohort of patients are necessary.…”

“…Another recent study of 12 patients with inferior sinus venosus-type ASD who underwent successful transcatheter closure using PDA occluders and three-dimensional-printed heart models reported that interventional therapy may not be contraindicated in patients with inferior sinus venosus-type ASD. 143 However, this previous study was a retrospective study with a small sample size, and prospective, randomized controlled trials including a large cohort of patients are necessary. At this time, the surgical repair remains the standard treatments in patients with sinus venosus-type ASD.…”