Transcatheter Device Closure of a Perimembranous Ventricular Septal Defect in Congenitally Corrected Transposition of the Great Arteries

Catherine E Tomasulo,Michael L O’Byrne,Lauren Andrade,Lindsay S Rogers

doi:10.32604/chd.2022.017721

Catherine E Tomasulo, Michael L O’Byrne + Show 2 more

Open Access

https://doi.org/10.32604/chd.2022.017721

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Abstract

The majority of patients with congenitally corrected transposition of the great arteries, also known as transposition of the great arteries {S,L,L} have ventricular septal defects (VSD), most commonly perimembranous VSD (pmVSD). Transcatheter device closure of pmVSD in these patients has not been widely described. We present a case of device closure of pmVSD in L-TGA with an Amplatzer Duct Occluder II (ADOII) device using a deployment starting in the subpulmonary left ventricle. The case demonstrates some of the technical advantages of the ADOII device for VSD closure, specifically its low profile, symmetric shape, and soft material. These characteristics are advantageous in closing conventional pmVSD but are especially useful in patients with challenging anatomic substrates.

Highlights

Corrected transposition of the great arteries, known as transposition of the great arteries {S,L,L} (L-TGA) is frequently associated with additional cardiac defects: ventricular septal defects, perimembranous ventricular septal defects in series outside of Asia (60–80%), pulmonary outflow tract obstruction (30–50%), and abnormalities of the tricuspid valve (90% prevalence on pathology though less frequently significant in vivo) [1]
Transcatheter device closure of perimembranous ventricular septal defects (pmVSD) has become more widely utilized in general; it is complicated in L-TGA due to several factors, including (1) location of the ventricular septal defects (VSD) in L-TGA is closer to the pulmonary valve and more remote from the aortic valve compared to D-looped ventricles with normally related great arteries, (2) crossing the defect retrograde is challenging because of sub-aortic right ventricular trabeculations, and (3) the tricuspid valve is frequently abnormal in L-TGA
We present a case of transcatheter closure of a pmVSD with an Amplatzer Duct Occluder II (ADOII)

Summary

Introduction

Corrected transposition of the great arteries, known as transposition of the great arteries {S,L,L} (L-TGA) is frequently associated with additional cardiac defects: ventricular septal defects, perimembranous ventricular septal defects (pmVSD) in series outside of Asia (60–80%), pulmonary outflow tract obstruction (30–50%), and abnormalities of the tricuspid valve (90% prevalence on pathology though less frequently significant in vivo) [1]. Transcatheter device closure of pmVSD has become more widely utilized in general; it is complicated in L-TGA due to several factors, including (1) location of the VSD in L-TGA is closer to the pulmonary valve and more remote from the aortic valve compared to D-looped ventricles with normally related great arteries, (2) crossing the defect retrograde (i.e., from systemic to pulmonary ventricle) is challenging because of sub-aortic right ventricular trabeculations, and (3) the tricuspid valve is frequently abnormal in L-TGA. These structural and functional abnormalities can potentially complicate seating a device in the sac created by aneurysmal. The case is illustrative of the potential advantages of using the ADOII for transcatheter VSD closure in the specific case of L-TGA and in the more common situation of a pmVSD in a patient with D-looped ventricles

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