Transcatheter closure of ventricular septal defect from retrograde transarterial approach: immediate and long-term outcome

Abstract

Background: Ventricular septal defect (VSD) is a commonly encountered congenital heart defect. The aim of this study was to analyze five years’ experience with patients who had undergone transcatheter closure of VSD using retrograde transarterial approach.Methods: It was a retrospective study conducted from December 2014 to December 2019. Cases planned for VSD closure in retrograde approach were included. A total of 147 cases fulfilled the criteria after left ventricular angiography and procedure was performed without forming arteriovenous loop. Follow up was planned at 1, 3, 6, 12 months and yearly thereafter.Results: The mean age of the patients was 5.94±4.67 years and mean weight was 17.93±8.26 kg. Perimembranous VSD was present in 70.06% cases and the size of the VSD was 5.5±1.8 mm. Amplatzer duct occluder II was the commonest device used (55.24%). Mean device size was 6.2±1.8 (5-8 mm). Complete occlusion was achieved immediately in 94.56% cases, and after one month in 99.36% cases. Four (2.78%) cases were postponed for malpositioning and encroachment of aortic valve. One patient (2.22%) had tiny residual VSD up to 3 years follow up. Bacterial endocarditis was noticed in one patient (0.80%) at one year follow up. No evidence of complete heart block was encountered in follow up period of six to 60 months.Conclusions: This study recommends that retrograde transarterial approach for closure of moderate to small VSD is safe, effective, and minimally invasive, can be performed in short time with less radiation hazard and less trauma to conducting tissues.

Double Intervention in a Patient with Large Patent Ductus Arteriosus (PDA) and Moderate Upper Muscular Ventricular Septal Defect (VSD) with Bidirectional Shunt with Severe Pulmonary Hypertension

“…The presence of hemodynamically significant PDA and VSD imposes a double threat of heart failure, and pulmonary hypertension to the patient. Recent studies showed excellent outcome in young infants after device closure [16,17].…”

Transcatheter Closure of a Large Muscular Ventricular Septal Defect (VSD) in a Child Weighing Five Kilogram with Severe Pulmonary Arterial Hypertension

“…Closing VSD's with the Amplatzer muscular VSD device (MVSD) from AGA medical corporation was in practice since 90's. Multiple studies proved efficacy and excellent outcome of this method of closure [13][14][15][16][17][18] . Surgical closure of muscular VSD still poses some challenges because of course trabeculation on right ventricular side and difficult to localize from standard surgical approaches.…”

“…Closure of muscular VSD specially in the apical septum needs cannulation of internal jugular vein, femoral arteries on both sides, general anesthesia and transoesophageal echocardiography guidance 13 .These are technically not feasible in young infants with weight equal or less than 5kg. Retrograde approach of closing perimembranous and muscular VSD's using Judkins guide catheter as delivery system is an established technique in our center, where multifunctional Konar-MFTM and ADO 11 from Abbot vascular device were used as closure device 14 . Konar-MF was found feasible, safe and effective in many studies [20][21][22] .…”