The feasibility of hybrid procedure of percutaneous puncture for residual shunt after ventricular septal defect repair

Abstract

Objective To explore the feasibility of hybrid procedure of percutaneous puncture for residual shunt after ventricular septal defect(VSD) repair. Methods From March 2015, we did percutaneous punctured transcatheter device closure of residual shunt after VSD repair for four patients. The patients included 2 males and 2 females with age from 4 years 9 months to 11 years 7 months and weight from 18 kg to 44 kg. Four patients are diagnosed for 4 years after VSD repair, 3 years after tetralogy of Fallot(TOF), 3 years after coarctation of aorta(CoA) combined with VSD, and 1 year after VSD repair, respectively. The withsize of residual shunt from 4.8 mm to 6.8 mm. Residual shunt are perimembranous, conoventricular and intracristal.Punctured directly through the right ventricular surface into the right ventricle in the 4th or 5th intercostal space of the left sternal border. Next, extracted the guide wire after inserting a conveyor tube. Subsequently, 7-10 mm VSD closure device were delivered via the conveyor tube. Results All the four operations were succeeded. A total of four closure devices were placed. Two of them are equilateral devices, and two are decentered devices, with size from 7mm to 9mm. Echocardiographyexamination revealed no significant pericardial effusion. Post-operative ultrasonic cardiogram showed the VSD closure device on site, with no pericardial effusion and no obvious morphological abnormalities of the valve. For one-year follow-up, the cardiac functionsof all patients were well. Conclusion Percutaneous punctured transcatheter device closure is a new, efficient and reliable method of treatment for children withresidual shunt after VSD repair. This method also can extend and offer a new avenue for valvular prosthesis and Perimembranous VSD. Key words: Percutaneous punctured; Residual shunt; VSD; Transcatheter device closure