Transcatheter perimembranous ventricular septal defect closure under transthoracic echocardiographic guidance without fluoroscopy

Abstract

Background: Transcatheter device closure has become an alternative therapy for ventricular septal defect (VSD). This study aimed to investigate the feasibility and safety of transcatheter perimembranous VSD (pm-VSD) closure under transthoracic echocardiography (TTE) guidance alone. Methods: Between October 2012 and July 2016, 118 patients with pm-VSD underwent an attempt of transcatheter device closure for pm-VSD through the femoral artery under TTE guidance alone. Patients were followed-up at 1, 3, 6, and 12 months after the procedure and yearly after discharge. Results: The mean age was 11.7±12.5 years (range, 1.0-53.0 years) and the mean body weight was 32.2±21.6 kg (range, 11.5-102.0 kg). The mean diameter of the VSD was 4.0±1.1 mm (range, 3.0-8.0 mm). Transcatheter device closure under TTE guidance alone was successful in 111 patients. The average procedural time was 44.9±7.3 minutes (range, 29.0-65.0 minutes). All 111 patients were followed-up for 3.4±2.3 years. At the last follow-up, two patients had a residual shunt smaller than 2 mm, seven patients had right bundle branch block (RBBB) including one patient with complete RBBB, six patients had mild or less tricuspid regurgitation, and two patients still had trivial aortic regurgitation including one patient that had it before the procedure. Occluder malposition, complete atrioventricular block, or other complications were not observed. Conclusions: Transcatheter pm-VSD closure can be successfully performed under TTE guidance alone with outcomes similar to those achieved with fluoroscopic guidance in selected patients with weight more than 10 kg and VSD smaller than 8 mm. However, long-term follow-up in a large number of patients would be necessary.

Transcatheter ventricular septal defect closure via femoral vein alone under transthoracic echocardiography guidance without fluoroscopy: preliminary experience

“…So TTE guidance is considered an alternative strategy to atrial septal defect (ASD) or patent ductus arteriosus (PDA) closure, or balloon pulmonary valvuloplasty [20][21][22]. Wang and his colleagues have suggested the feasibility, safety, and effectiveness in percutaneous perimembranous VSD closure under the TTE guidance alone [15]. We had a clear impression of VSD from echocardiography images during preoperative echo assessment.…”

“…Unlike the whole instrument-tracking images from fluoroscopy, echocardiography images are segmental; therefore, an arterio-venous loop is difficult to establish using a snare. A single vessel is routinely employed in such instances [14,15]. Wang et al have demonstrated the feasibility and safety of the retrograde approach through the femoral artery under TTE guidance alone.…”

Transesophageal echocardiography-guided percutaneous closure of multiple muscular ventricular septal defects with pulmonary hypertension using single device: A case report

“…The apical, central, or outflow regions of the interventricular septum are the most common locations for muscular ventricular septal defects (VSDs). Up to 20% of VSDs in babies are muscular VSDs, which can have several occurrences and take on a “Swiss cheese” appearance ( 1 , 2 , 7 ). The VSD in our instance was situated mid-apical.…”

IoT-Based Remote Control Study of a Robotic Trans-Esophageal Ultrasound Probe via LAN and 5G

“…It is generally believed that with the developments of internet and 5G techniques, controlling medical robots remotely over a long distance would have the potential to change the current approaches of diagnosis and surgery. For echocardiography, examples have been found in some recent clinical studies for transcatheter procedures guided solely by trans-thoracic echocardiography conducted in China [12,13]. The clinical team, rather than staying in the centralized hospital in big cities, was routinely deployed to several small clinics in less developed areas to perform the procedure locally.…”