Transfemoral Perimembranous Ventricular Septal Defect Device Closure in Infants Weighing ≤ 10 kg

Alshahrani, Dhafer; Linnane, Niall; McCrossan, Brian; Oslizlok, Paul; McMahon, Colin J.; Walsh, Kevin; Kenny, Damien

doi:10.1007/s00246-023-03100-5

Cited by 3 publications

(2 citation statements)

References 36 publications

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“…[5][6][7][8][9] These encouraging results led to adoption of device closure even in infants. [10] Intraconal VSDs situated below the RCC of the aortic valve, common in oriental population were also recently considered amenable for TCC using such soft devices. [11,12] The choice among the various off-label device designs were dependent on the anatomical variations between the different types of these defects.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter closure of ventricular septal defects by exclusive transvenous antegrade cannulation from the right ventricle

Sagar,

Thejaswi,

Garg

et al. 2024

Preprint

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Background: Transcatheter closure(TCC) of perimembranous ventricular septal defects(PM-VSD) and intraconal defects routinely involves either arteriovenous loop formation or direct retrograde device deployment from its left ventricular(LV) end. An arterial access is always taken for a left ventriculogram. Direct antegrade cannulation of the defect from the right ventricle for TCC avoids complications associated with femoral arterial access and arteriovenous loop formation. Methods: Feasibility of elective antegrade cannulation for TCC of PM-VSD, intraconal VSD and postoperative residual VSD was retrospectively studied over five years from 2019-2023. Echocardiographic VSD measurements guided the device selection rather than left ventriculographic measurements. Predictors for successful antegrade cannulation and transvenous device deployment were analyzed. Results: Antegrade cannulation was electively attempted in 116/163(71%) TCC VSD closure procedures. The proportion of cases where this antegrade cannulation was electively employed progressively increased from 26% of interventions performed in 2019 to 93% in 2023. The median age of the study cohort that included 24 infants was 55 months (range 1-636 months) and the indexed VSD size was 9.2 mm/m2 (range 1.7-43.3 mm/m2). Two-thirds of patients had varying degrees of pulmonary arterial hypertension. Antegrade cannulation was successful in 97(83.6%) patients. In the remaining 19 patients, retrograde cannulation from LV aided TCC. There were no deaths or need for pacemaker implantation. Overall procedural success of TCC in this cohort was 99.1%.Device embolization with tricuspid chordal tear led to procedural failure in one patient. Four other device embolizations were managed successfully by transcatheter retrieval and closure with an upsized device. Young age, small body size, large VSD size were significantly associated with successful antegrade cannulation. Conclusions: Antegrade cannulation and TCC was feasible in majority of the procedures, especially in small patients and large defects. This strategy simplified the procedure without arterial access and might replace the routine retrograde device delivery and AV loop formation.

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Section: Introductionmentioning

confidence: 99%

Transcatheter closure of ventricular septal defects by exclusive transvenous antegrade cannulation from the right ventricle

Sagar,

Thejaswi,

Garg

et al. 2024

Preprint

View full text Add to dashboard Cite

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“…A part of VSDs spontaneously closes [ 3 ]. The primary treatment for VSD is surgery [ 4 ], but catheter-based treatment has recently begun to emerge [ 5 ]. Two-dimensional echocardiography and three-dimensional imaging by echocardiography, magnetic resonance imaging, and computed tomography are used to evaluate the characteristics, such as the type, size, and number of defects, besides cardiac catheterization [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Demonstrating an Adult Ventricular Septal Defect Using Non-obstructive General Angioscopy

Komatsu¹,

Takahashi²,

Takewa³

et al. 2023

Cureus

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A ventricular septal defect (VSD) is a common congenital heart disease, and the transcatheter technique for VSD requires practical guidance because it requires a complicated procedure. A non-obstructive angioscopy catheter system via the right ventricle successfully revealed an approximately 3-mm VSD with the shape of a rugby ball at the center of the white membranous septum of Kirklin type II in an older female with suspected coronary artery disease. A white membranous terraced septum was observed to be surrounded by a reddish ventricle. Conservative therapy was performed for her VSD because she did not meet the criteria for surgical treatment.

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Word of caution: silent late device embolisation after perimembranous ventricular septal defect closure in a 6-Kg infant

Haddad,

Saliba

2024

Cardiol Young

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We report on a 6-month-old infant (6 Kg/ 64 cm) with perimembranous ventricular septal defect (absent sub-aortic rim, 10 mm left ventricular entry, and 4 and 6 mm right ventricular exists) and successful retrograde closure using an 8x6 mm KONAR-MF™ VSD occluder (Lifetech, China). Immediate and 48 hours post-procedure ultrasounds showed an accurately positioned device and two jets of mild-to-moderate residual shunts. At the 2-week follow-up, the device did not change position and the shunt was stable and intra-prosthetic. The scheduled 3-month follow-up was skipped for familial reasons. The patient came back without alarming symptoms for the regular 6-month follow-up, and the device was found embolised to the left pulmonary artery. The device was retrieved surgically, and the defect was patch-closed with excellent outcomes. There was a pseudoaneurysm involving the tricuspid valve chordae and the device was endothelialized partially on one edge suggesting that embolization occurred somewhere between 3 months and 6 months post-operative. Defects with compromised anatomies should be closed surgically to avoid suboptimal results, especially in small infants.

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Transfemoral Perimembranous Ventricular Septal Defect Device Closure in Infants Weighing ≤ 10 kg

Cited by 3 publications

References 36 publications

Transcatheter closure of ventricular septal defects by exclusive transvenous antegrade cannulation from the right ventricle

Transcatheter closure of ventricular septal defects by exclusive transvenous antegrade cannulation from the right ventricle

Demonstrating an Adult Ventricular Septal Defect Using Non-obstructive General Angioscopy

Word of caution: silent late device embolisation after perimembranous ventricular septal defect closure in a 6-Kg infant

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