title: Unconventional uses of septal occluder devices: Our experience reviewed.
abstract: Device closure is now an accepted modality of treatment for cardiac septal defects such as fossa ovalis Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD) and Patent Ductus Arteriosus (PDA) and have well-accepted indication and long term results. Devices used for these defects have been specifically designed for use in closing these defects. In this manuscript, we are reporting the efficacy of closure of nonseptal defects with devices conventionally used for septal cardiac defects although they have not been prototyped for use in such conditions.
  
  
  OBJECTIVE
  To study use of occluder devices in nonseptal defects/malformation.
  
  
  METHODS
  39 patients, in the age group 2-67 yrs, were treated percutaneously with occluder devices for various conditions. These included: coronary arteriovenous (CAV) fistula (n = 6), pulmonary AV fistula (n = 4), systemic AV fistula (vascular plug; n = 1), closure of AP window (duct occluder; n = 3), closure of ascending aorta perforation (septal occluder; n = 2), ruptured sinus of Valsalva (RSOV) (duct occluder; n = 13), Fontan fenestration closure (ASD septal occluder, patent foramen ovale device, vascular plug n = 3,1 each), splenic artery (duct occluder; n = 1), Balock Taussig shunt (duct occlude; n = 1)and closure of mitral paravalvular leak (n = 3; duct occlude devices = 2, VSD device: n = 1) and aortic paravalvular leak n = 2 (duct occluder; n = 2 additional vascular plug = 2).
  
  
  RESULTS
  Procedural success: Successful closure as signified by no residual shunt was achieved in all coronary AV fistula (immediately n = 2, at 3 months in all), ruptured sinus of Valsalva (immediate in all), fenestrated Fontan (immediately in all), and ascending aorta perforations (immediate), mitral paravalvular leak (immediate in none, and late in 2/3). The aortic paravalvular leak closed at 3 months follow-up in one and small residual persisted after 1 month in another.
  
  
  RESULTS
  Local site Hematoma was observed in 4 patients. 2 of them required post procedure transfusion for the same. Hematuria was observed in 2 of the 4 patients of mitral paravalvular leak and 2 patients of RSOV device closure. Hematuria subsided with conservative management before discharge from hospital in all the 4 cases. One patient with residual mitral regurgitation required surgical management for continuing hematuria, anemia and hyperbilirubenemia. There was one mortality observed on table during the attempted closure of a very large RSOV who presented to us in severe congestive heart failure and shock. On follow up ranging from 2 months to 6 years, all the patients are asymptomatic. There was no late complication related to device in any patient.
  
  
  CONCLUSIONS
  It is feasible in selected nonseptal defects, which traditionally have been subjected to surgical interventions, to treat successfully, non surgically with the use of non prototype occluder devices without significant complications. Conventionally these devices have not been recommended for closure of nonseptal defects but show good early outcome. Adequate sample size with good follow up data is necessary before concluding that it can be safe alternative to surgery on long term.
authors.affiliation: Consultant, Department of Pediatric Cardiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi 110025, India. Electronic address: n_awasthy@yahoo.com.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Awasthy
authors.affiliation: Consultant, Pediatric Cardiology, Medanta Medicity, Gurgaon, Haryana, India.
authors.forename: Munesh
authors.initials: M
authors.lastname: Tomar
authors.affiliation: Director and HOD, Department of Pediatric Cardiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi 110025, India.
authors.forename: S
authors.initials: S
authors.lastname: Radhakrishnan
authors.affiliation: Director, Department of Pediatric Cardiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi 110025, India.
authors.forename: Savitri
authors.initials: S
authors.lastname: Shrivastava
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000175:diagnosis / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055989:Septal Occluder Device / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Atrial septal occluder; Coronary AV fistulae closure; Duct occluder; Paravalvular leak closure; RSOV closure; Septal occluder devices