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

Abstract

BackgroundSurgery is typically used to correct challenging ventricular septal defects (VSDs), such as VSD with pulmonary hypertension and multiple defects. In this case report, we would like to highlight the feasibility of multiple defects VSD closure with single device percutaneously using zero-fluoroscopy technique.Case presentationA 7-year-old child was referred with the main symptom of shortness of breath. She started experiencing repeated respiratory tract infections, feeding issues, and failure to thrive at the age of six months. Her body weight was only 18 kg. TEE revealed several muscular VSD with 2–3 mm and 12 mm diameters, 3 mm spacing between VSD, L to R shunt, AR (-), and TR mild with septal leaflet tricuspid prolapse. Following right heart catheterization (Qp:Qs 3.5, PVRi 5.23WUmsq, PVR 4.55 WU, PVR/SVR 0.16), we made the decision to correct the defect using an Amplatzer Septal Occluder (AGA) No. 16 mm using transjugular method. Full device deployment was successfully performed with several episodes of PVC storm and severe bradycardia. One and a half years after the procedure, her TVG dropped to only 18 mmHg, her visible indicators of PH subsided, and the PA dilator treatment was discontinued. Her body weight had increased to 28 kg, and she had no complaints.ConclusionsOur experience demonstrated that percutaneous closure of multiple VSD with a single device is possible, even with pulmonary hypertension.

Transoesophageal echocardiography-guided balloon-assisted percutaneous closure of a large secundum atrial septal defect in a pregnant woman: a case report

“…Our institution has demonstrated a high success rate that is comparable with the use of conventional fluoroscopy. 8–10 This method is particularly beneficial to special populations, notably to young children and expectant mothers who are more susceptible to radiation exposure, making it the appropriate treatment for these populations. 7 …”

The Current Strategy in Managing Congenital and Structural Heart Disease: Find and Treat Them Appropriately

“…[1][2][3] Recent studies have demonstrated favorable outcomes with device closure of acyanotic CHDs, including atrial septal defect (ASD), ventricular septal defect (VSD), and patent ductus arteriosus (PDA). [4][5][6][7] Concerns over radiation exposure, especially in children and pregnant women, have led to the adoption of non-fluoroscopy techniques for defect closure, with comparable efficacy and safety to traditional methods. In our effort to mitigate radiation exposure during transcatheter closure procedures for congenital heart defects, we have implemented a policy promoting non-fluoroscopy techniques, even in challenging cases such as multiple ventricular septal defects (VSDs) and in pregnant women with atrial septal defect (ASD) with pulmonary hypertension.…”

“…In our effort to mitigate radiation exposure during transcatheter closure procedures for congenital heart defects, we have implemented a policy promoting non-fluoroscopy techniques, even in challenging cases such as multiple ventricular septal defects (VSDs) and in pregnant women with atrial septal defect (ASD) with pulmonary hypertension. 4,5 This strategic shift aims to minimize the potential risks associated with radiation exposure, particularly for vulnerable populations. In one study demonstrated by Siagian et al 6 , echocardiography-guided closure of patent ductus arteriosus (PDA) is a viable alternative to fluoroscopyguided procedures.…”