Transcatheter closure of ventricular septal defects.

Abstract

, we attempted percutaneous transcatheter closure of seven ventricular septal defects (VSD) in six patients; none of the patients was a candidate for operative management. Patients' ages ranged from 8 months to 82 years (6.0-70 kg); diagnoses included postinfarction VSD (n = 4), congenital VSD (n = 1), and postoperative congenital VSD (n = 2). Indications for VSD closure were shock or respiratory failure (n = 5) or multiple episodes of endocarditis (n = 1). Closure was attempted with a Rashkind double umbrella: VSDs were crossed via the left ventricle and a guide wire was advanced to the right heart, snared with a venous catheter, and used to direct a long sheath (and ultimately the double umbrella) across the VSD. We crossed the VSD in all seven attempts, and a 17-mm double umbrella was successfully placed in each VSD. In the first (postinfarction) patient with the largest (12 mm) VSD, the umbrella embolized after 20 seconds to the pulmonary artery (without reducing flow). The other six umbrellas remained in position, either diminishing or abolishing the left-to-right shunts. Postinfarction patients had increasing VSD shunting over the next several days and died; at postmortem, the umbrellas remained well positioned in the septum, with other VSDs present. All three congenital VSDs had absent or diminished shunts after umbrella closure. These preliminary data indicate that transcatheter VSD closure is feasible in selected cases.

Cardiogenic Shock

“…One limitation of this approach is that ventricular septal defect sizing may be technically difficult, and healing of the infarcted myocardium may increase the size of the ventricular septal defect, leading to device malapposition or even embolization. 86 The use of devices with diameter larger than the ventricular septal defect has been associated with relatively good outcome. 87 …”

Transcatheter Device Closure of Congenital and Postoperative Residual Ventricular Septal Defects

“…Since first reporting transcatheter closure of muscular VSDs in 1988, 7 we have performed device closure as primary treatment for simple defects, as an adjunct to surgery in patients with more complex disease, and as a means to reduce shunting from postoperative VSDs without further exposure to cardiopulmonary bypass. 8 -10 To date, published reports of this approach are limited to small series with relatively limited follow-up.…”

Oclusão de comunicação interventricular pós-infarto com prótese percutânea CERA

“…which may result in subsequent abrupt expansion of the defect, with subsequent residual shunt. Obviously, the surgical results are better when you expect the healing of myocardial infarction (four to six weeks) 3,5,7 , but these findings only feature a selection bias (more severe cases die earlier), and the official recommendation of all current guidelines on the subject is the correction of the defect as soon as possible after diagnosis The VSD occurring after AMI is an event with high morbidity and mortality, especially in patients who develop cardiogenic shock and those not subject to surgical closure of the deffect 1,3,4 . However, this type of treatment still presents success rates of less than ideal, especially when performed in patients with high operative risk and / or unfavorable anatomy 4 .…”

“…Obviously, the surgical results are better when you expect the healing of myocardial infarction (four to six weeks) 3,5,7 , but these findings only feature a selection bias (more severe cases die earlier), and the official recommendation of all current guidelines on the subject is the correction of the defect as soon as possible after diagnosis …”