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

Abstract

Objective. Transcatheter closure of congenital ventricular septal defects under echocardiography guidance could avoid potential radiation damage from fluoroscopy probes. However, mini-surgical incision, transesophageal echocardiography combined with tracheal intubation, and limited artery access further complicate the procedure. Therefore, we aimed to describe our preliminary experiences in percutaneous VSD closure via the femoral vein only under transthoracic echocardiography (TTE) guidance. Methods. Between December 2018 and November 2021, 19 patients underwent transcatheter VSD closure via femoral vein alone under the guidance of TTE in our hospital. The morphology, location, diameter of VSD, and procedural outcomes were thoroughly reviewed. Symmetric, asymmetric, or eccentric occlusion device was chosen for closure based on the VSD characteristics. Results. There were 16 perimembranous VSD and 3 intracristal VSD patients in this cohort. The range of diameter of the VSD was from 3.8 to 7.4 mm. Fifteen symmetrical occluders were implanted in 13 perimembranous and 2 intracristal VSD patients. Two eccentric occluders were implanted in 1 perimembranous and 1 intracristal VSD patient since the rim to the aortic valve distance was <2 mm. Moreover, 2 asymmetrical occluders were used in 2 perimembranous multi-hole VSDs. Immediate procedure and 16.1±9.9 months’ follow-up outcomes showed no device dislodgement and embolism, no new-onset aortic valve regurgitation, and no atrioventricular heart block. Conclusions. Transcatheter perimembranous and intracristal VSD closure via femoral vein alone under the TTE guidance is feasible and safe in eligible patients. The new type of multipurpose specialized catheter will facilitate this procedure.