Transcatheter closure of postsurgical residual ventricular septal defects: early and mid-term results.
BACKGROUND
The incidence of residual ventricular septal defects (VSDs) after surgery is 5-25%. Redo surgery is associated with higher risks.


METHODS
Between January 2000 to December 2008, 170 patients underwent percutaneous VSD closure in our centre: 22(16M) of these had 23 closures for residual VSDs. Median age was 32.5 yrs (1.4-79). All patients had echocardiographic signs of left ventricle volume overload (Q(p)/Q(s) >or= 1.5). Nine patients had previous VSD closure, 6 tetralogy of Fallot repair, and 7, other procedures. There were 15 muscular, 6 perimembranous and 2 apical VSDs.


RESULTS
Amplatzer VSD devices were used in all. Median VSD size was 8 mm (4.3-16). Median fluoroscopy time was 33 minutes (15-130). There were three adverse events: 1 ventricular fibrillation requiring DC cardioversion; 1 transient complete atrio-ventricular block reverting to sinus rhythm at 24-hours; one patient had transient atrial flutter during the procedure. All procedures were successful; no additional procedures were required. Trivial residual shunts were seen in 3 patients at follow-up. There were no late events. One patient experienced arrhythmic death 5-yrs after procedure. One patient was reoperated due to dehiscence of VSD patch 2-yrs after the second successful percutaneous closure.


CONCLUSIONS
Transcatheter closure of postsurgical residual VSD is safe and efficacious management option and obviates the need for further surgery and by-pass.
Dua
Jaspal S
JS
Department of Paediatric Cardiology and Cardiac Surgery and Adult Congenital Heart Defect, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
Carminati
Mario
M
Lucente
Mariella
M
Piazza
Luciane
L
Chessa
Massimo
M
Negura
Diana
D
Bussadori
Claudio
C
Saliba
Zakhia
Z
Butera
Gianfranco
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D011859:Radiography; D012086:Reoperation; D018570:Risk Assessment; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D055815:Young Adult