Muscular Ventricular Septal Defect Research Articles

Outcome of ventricular septal defect closure with the Nit-Occlud® Le VSD-Coil: single centre experience.

The objective of this study was to review the outcome of patients who underwent transcatheter closure of ventricular septal defect (VSD) using Nit-Occlud® Leˆ VSD-Coil.A retrospective study was carried out at King Abdulaziz Cardiac Center on all paediatric patients who underwent interventional VSD closure, during the period from 2011 and 2016. Data were collected, including demographic information, cardiac diagnosis, pre-operative diagnosis, intra-operative findings and postoperative events. Out of 46 patients, who were evaluated for VSD device closure, 17 of them were excluded; 24 patients out of 29 had successful closure of VSD using Nit-Occlud Leˆ VSD-Coil (success rate of 83%), and five cases were referred to surgery. The age group was from 2 years up to 18 years. Almost 90% of VSD was the perimembranous (PM) type (26 patients) and 3 patients (10%) with muscular VSD. Ten of the 26 PM VSDs had TV accessory tissue partially covering the VSD defects. The hemodynamic assessment showed pulmonary blood flow to systemic blood flow ratio (Qp:Qs) > 1.5 in almost all the patients who underwent defect closure. Immediate closure of the defect was achieved in 11/24 patients (45%). In five additional patients, there was a tiny residual and eight with a small residual. With 6 months of follow-up, only six patients remained with tiny residual VSD defects.The Nit-Occlud® Leˆ VSD-Coil device has minimal effects on the aortic and tricuspid valves, and there was no permanent atrioventricular block, especially in patients with PM VSDs. Patients with a residual shunt should be followed, especially for haemolysis.

Combination of a vascular plug and coiling to treat an ascending aortic pseudoaneurysm following aortic surgery

Combination of a vascular plug and coiling to treat an ascending aortic pseudoaneurysm following aortic surgery

Congenital heart defects in molecularly confirmed KBG syndrome patients.

Congenital heart defects (CHDs) are known to occur in 9%-25% of patients with KBG syndrome. In this study we analyzed the prevalence and anatomic types of CHDs in 46 personal patients with KBG syndrome, carrying pathogenetic variants in ANKRD11 or 16q24.3 deletion, and reviewed CHDs in patients with molecular diagnosis of KBG syndrome from the literature. CHD was diagnosed in 15/40 (38%) patients with ANKRD11 variant, and in one patient with 16q24.3 deletion. Left ventricular outflow tract obstructions have been diagnosed in 9/15 (60%), subaortic or muscular ventricular septal defect in 5/15 (33%), dextrocardia in 1/15 (8%). The single patient with 16q24.3 deletion and CHD had complete atrioventricular septal defect (AVSD) with aortic coarctation. Review of KBG patients from the literature and present series showed that septal defects have been diagnosed in 44% (27/61) of the cases, left ventricular tract obstructions in 31% (19/61), AVSD in 18% (11/61). Septal defects have been diagnosed in 78% of total patients with 16q24.3 deletion. Valvar anomalies are frequently diagnosed, prevalently involving the left side of the heart. A distinctive association with AVSD is identifiable and could represent a marker to suggest the diagnosis in younger patients. In conclusion, after precise molecular diagnosis and systematic cardiological screening the prevalence of CHD in KBG syndrome seems to be higher than previously reported in clinical articles. In addition to septal defects, left-sided anomalies and AVSD should be considered. Clinical management of KBG syndrome should include accurate and detailed echocardiogram at time of diagnosis.

Trikafta in Pregnancy: A Clinical Case Series

To investigate Trikafta (elexacaftor/tezacaftor/ivacaftor and ivacaftor) effects on perinatal outcomes. Five pregnant patients with cystic fibrosis were managed with the combination CFTR modulator, Trikafta, and were enrolled in this clinical case series. Pre-pregnancy cystic fibrosis status, pregnancy and postpartum course, and neonatal outcomes were evaluated in detail. All five pregnancies were conceived spontaneously. One of the five patients had previously required assisted reproductive techniques. Patients were started on Trikafta 1-12 months prior to their pregnancy. Four patients chose to continue Trikafta throughout the majority of the pregnancy, while one chose to discontinue Trikafta in the first trimester but resumed with worsening symptoms. All patients experienced improvement in their pulmonary symptoms and had decreased exacerbations on Trikafta. Only one patient experienced active exacerbation in pregnancy. One patient had hemoptysis before starting Trikafta, and experienced resolution in pregnancy. Two patients developed a hypertensive disorder of pregnancy. Four pregnancies delivered at term, with an iatrogenic late preterm delivery for the fifth patient. Four of the five patients required cesarean section delivery, and three of these were performed due to category II fetal heart rate tracing remote from delivery. Both patients with pre-gestational diabetes had neonates with birth weights < 50%ile and the other three had birth weights < 25%ile. One neonate had a postnatal diagnosis of muscular VSD; no other anomalies were identified. Three neonates required NICU admission, of which two were for transient tachypnea of the newborn. A large multi-center prospective study is needed to assess the full impact of Trikafta use in pregnancy. At this time, providers should continue to weigh the risks and benefits of its use when considering both the maternal and fetal health.

High take off left main coronary artery accompanied by multicryptic left ventricle myocardium detected by cardiac computerized tomography in a young male: case report

BackgroundMyocardial crypts are discrete, narrow, blood filled invaginations within the left ventricular myocardium and high-take-off coronary artery are rare manifestations where coronary arteries originate above the sinotubuler junction.Case presentationA 41-year-old man with multiple coronary artery disease risk factors admitted to our outpatient department with progressive dyspnea and atypical chest pain. Physical examination revealed no pathological findings. His blood examination revealed only mild to moderately high IgE and LDL levels. Transthoracic echocardiography (TTE) was normal. His treadmill test was normal, yet in the 3rd stage of the test he had an atypically located chest pain which was relieved in the resting period. As he had multiple cardiovascular risk factors, we performed a coronary CT angiography to exclude coronary artery disease. Coronary CT angiography(CCTA) demonstrated multiple myocardial crypts, a muscular VSD like defect which were not detectable with TTE and a high take off left main coronary artery (LMCA). After CCTA, we repeated the TTE to investigate the crypts and VSD-like defect which were clear on CCTA, yet a precise TTE hardly showed crypts and didn’t confirm a shunt between the left and right ventricle. We defined the defect as ‘spontaneously closed muscular VSD’. None of these pathologies were clinically relevant with the patient’s symptoms, thus pneumonology started a montelukast therapy for 1 year and we decided to follow up the patient, as multiple crypts may indicate an early phase hypertrophic cardiomyopathy.ConclusionsConsidering that a high take-off LMCA is a congenital anomaly, encountering multiple crypts which are also congenital pathologies, is plausible, as congenital anomalies may accompany eachother. Echocardiography is a very useful, practical imaging tool but regrettably may be suboptimal due to various patient and method related reasons. Target combination of different cardiovascular imaging tools like echocardiography, cardiac CT(CCT), may be utilized in order to ensure a comprehensive diagnosis particularly.

An Alternative Technique of Intraoperative Identification of Multiple Muscular Ventricular Septal Defects

We propose the passage of a thick black braided silk SUTUPAK silk suture (Ethicon, Somerville, NJ) through the additional muscular ventricular septal defects to facilitate patch closure of the multiple muscular ventricular septal defects.

Transcatheter Closure of a Large Muscular Ventricular Septal Defect (VSD) in a Child Weighing Five Kilogram with Severe Pulmonary Arterial Hypertension

Ventricular septal defect (VSD) is the commonest congenial heart lesion which may close spontaneously in significant number of cases. Muscular VSD has better chance of spontaneous closure. Some of the large muscular VSDs may cause severe complications like pulmonary hypertension and intractable heart failure. Closing VSD in young infant is challenging specially with devices as delivery systems are too large comparing to size of femoral vessels. Some centre prefers hybrid procedure of per ventricular device closure as surgical closure is high risk in young infants with complications. Here a case of large muscular VSD with severe pulmonary hypertension is reported in a ten month old girl which was closed successfully with a Konar- MFTM device and patient was discharged after 24 hours. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 84-86

Congenital heart defects in the recurrent 2q13 deletion syndrome

The recurrent 2q13 deletion syndrome is a rare genetic disorder associated with developmental delay, cardiac and urogenital malformations, and minor facial anomalies. Congenital heart defects (CHDs) are the most frequent malformations associated with del2q13. Experimental studies in zebrafish suggest that two genes mapping within the 2q13 critical region (FBLN7 and TMEM87B) could confer susceptibility to congenital heart defects in affected individuals. We reviewed the cardiac characteristics in four patients with 2q13 deletion admitted to our hospitals, and in published patients. Two of our patients had congenital heart defects, consisting in partial anomalous pulmonary venous connection, ostium secundum atrial septal defect ostium secundum, and small muscular ventricular septal defect in one of them, and aortic valve insufficiency with partial fusion of two commissures (incomplete bicuspid aortic valve) and mitral valve insufficiency due to trivial mitral valve prolapse in the other. The anatomic types of CHD in del2q13 syndrome are highly variable and distributed widely, including laterality defects, complex atrioventricular septal defect, septal anomalies, and cardiomyopathies. Cardiac evaluation should be part of the clinical workup at diagnosis of 2q13 deletion.

Usefulness of Postnatal Echocardiograms in Patients with Omphaloceles Who Previously Had a Normal Fetal Echocardiogram.

IntroductionNeonates with omphaloceles routinely have a transthoracic echocardiogram (TTE) performed due to a high association with congenital heart defects (CHD). The utility of a TTE in these patients with a normal fetal echocardiogram is unknown. The primary objective of this study was to determine whether a critical CHD diagnosis was missed in patients with an omphalocele who had a normal fetal echocardiogram. The secondary objective of the study was to determine whether any CHD diagnosis was missed postnatally when a fetal echocardiogram was read as normal.MethodsA retrospective chart review was performed of patients with omphaloceles born between January 1, 2008, and June 30, 2020. Patients were included if they had a fetal echocardiogram that was read as normal and had a postnatal echocardiogram performed. Baseline demographics, postnatal data echocardiographic findings, and hospital course were collected. Critical CHD was defined as CHD requiring neonatal cardiac intervention.ResultsFifty-six fetal echocardiograms on patients with omphaloceles were performed, of which 24 patients met the inclusion criteria. No patient was diagnosed with a critical CHD postnatally (negative predictive value [NPV] = 100%). Two patients were diagnosed with ventricular septal defects (VSD) postnatally (NPV = 91.7%). One of the VSDs required closure with a patch at 4 months of life, while the other, a small muscular VSD, closed spontaneously within the first year of life. Both patients had a murmur on exam during their initial hospital stay. The patient that required surgery also had an abnormal electrocardiogram and chest X-ray. There were no mortalities due to cardiac causes in these patients.ConclusionCritical CHD was not missed on any patient with an omphalocele who had a normal fetal echocardiogram. All other patients with omphaloceles who had CHD diagnosed postnatally had an abnormal clinical finding on postnatal evaluation. The routine performance of a postnatal TTE in patients with an omphalocele who had a normal fetal echocardiogram may not be needed in those with a normal clinical workup. Further studies evaluating echocardiographic imaging recommendations are needed to maximize care and optimize resource allocation in this complex patient population.

Long-term surgical outcomes after repair of multiple ventricular septal defects in pediatrics

BackgroundSurgical closure of multiple ventricular septal defects (VSDs) is challenging and associated with a high complication rate. Several factors may affect the outcomes after surgical repair of multiple VSDs. We aimed to report the outcomes after surgical repair of multiple VSDs before and after 1 year and identify the factors affecting the outcomes. We have studied forty-eight patients between 2016 and 2017 who had surgical repair of multiple VSDs. We grouped them according to the age at the time of repair. Study outcomes were hospital complications, prolonged hospital stay, and reoperation.ResultsThere were 18 females (60%) in group 1 and 13 (72.22%) in group 2 (P = 0.39). There were no differences in the operative outcomes between the groups. Prolonged postoperative stay was associated with group 1 (OR 0.23 (0.055–0.96); P = 0.04) and lower body weight (OR 0.76 (0.59–0.97); P = 0.03). Hospital mortality occurred in 2 patients (6.67%) in group 1 and 1 patient (5.56%) in group 2 (P > 0.99). Five patients had reoperations: two for residual VSDs, two for subaortic membrane resection, and one for epicardial pacemaker implantation. All reoperations occurred in group 1 (log-rank P = 0.08). Two patients had transcatheter closure of the residual muscular VSDs; both were in group 2.ConclusionsSurgical repair of multiple VSDs was associated with good hospital outcomes. The outcomes were comparable in patients younger or older than 1 year of age. Young age at repair could lead to prolonged postoperative stay and a higher reoperation rate.

Impact of percutaneous ventricular septal defect closure on left ventricular remodeling and function

BackgroundVentricular septal defect (VSD) is the most common congenital heart disease. In patients with large VSD, left side chambers are subjected to volume overload with subsequent chambers dilatation and eccentric left ventricular hypertrophy. Percutaneous closure of VSD has been shown to be an effective method with equal safety and efficacy when compared to surgery. The effect of VSD closure on LV remodeling has been mainly assessed in patients treated with surgery and to date published data remain scarce. Therefore, we aim to evaluate the effect of percutaneous VSD closure on different LV parameters.ResultsSeventeen patients (median age 6 years (IQR 4.75–8 years), 70.6% females) who underwent percutaneous VSD closure were enrolled in the study. Sixteen patients (94%) had perimembranous VSD, and one patient had muscular VSD. The procedure was successful in all patients with no major complications. Nit Occlud® Lê coil device was implanted in 16 patients (94%), and one patient received Amplatzer PDA duct occlude device. At 6-months follow-up, there was a significant reduction in indexed LV dimensions [LVEDD/BSA (median 46.5 mm/m2 vs. 42.9 mm/m2, p = 0.03), LVESD/BSA (median 31.7 mm/m2 vs. 26.7 mm/m2, p = 0.02)], indexed LV volumes [LVEDV/BSA (median 52.6 ml/m2 vs. 37.3 ml/m2, p = 0.02), LVESV/BSA (median 31.7 ml/m2 vs. 23.3 ml/m2, p = 0.02)] and indexed LV mass (median 62.4 gm/m2 vs. 57.9 ml/m2, p = 0.01). There was a significant reduction in LVEDD Z-score (p = 0.01) and LVESD Z-score (p = 0.04). There was no significant change in LV EF.ConclusionsPercutaneous VSD closure is associated with improvement of various LV parameters with consequential favorable LV remodeling and function.

Transcatheter Closure of Residual and Iatrogenic Ventricular Septal Defects: Tertiary Center Experience and Outcome

Abstract Aim This study aimed to review our center experience in transcatheter closure of post-surgical and post-intervention residual and iatrogenic VSDs and to report on their 12-month long-term outcome. Methods All patients who underwent transcatheter closure of residual ventricular septal defects (R-VSDs) and iatrogenic ventricular septal defects (I-VSDs) after either surgical corrections or transcatheter interventions for any congenital heart disease (CHD) between January 2015 and January 2020 were included in the study. Patients' medical records were reviewed and analyzed. Results Twenty-three patients with a mean age of 14.3 ± 8.8 years, a mean weight of 36.2 ± 20.4 Kg, and a mean body surface area of 1.18 ± 0.36 m2 were included. Thirteen (56.5%) patients were males. The VSD was residual in 18 (78.3%) patients and iatrogenic in 5 (21.7%) patients, post-operative in 19 (82.6%) patients and post-transcatheter in 4 (17.4%) patients. The remaining VSD site was peri-membranous in 9 (39.1%) patients, high-muscular in 6 (26.1%) patients, mid-muscular in 4 (17.4%) patients, and Gerbode shunt in 4 (17.4%) patients. The QP/QS ratio was 2.5 ± 0.7, and the VSD diameter was 6.1±2.1 mm with a VSD-aorta rim of 5.4 ± 2.0 mm. Most, 16 (71.43%) patients underwent antegrade device deployment, and 7 (28.57%) patients underwent retrograde transaortic device deployment, with only 3 (13.0%) patients required two devices/patient. Amplatzer™ Muscular VSD devices were used in 16 (69.6%) patients, Amplatzer™ Duct occlude-I devices were used in 4 (17.4%) patients, and Amplatzer™ Duct Occluder-II devices were used in 3 (13.0%) patients with a mean device size of 8.8 ± 2.8 mm. The mean procedural time was 55.1 ± 16.2 minutes, fluoroscopy time was 16.3 ± 4.0 minutes, and the contrast used was 33.8 ± 10.9 ml. Concomitant balloon pulmonary valvuloplasty was done at the same catheterization set in 2 (8.7%) patients. Acute procedural success, satisfactory immediate were achieved in all patients. During follow-up (23.3 ± 15.9 months), no patient required re-intervention or exhibited mortality. Conclusions Transcatheter closure of post-operative, and post-intervention residual and iatrogenic VSDs represents an attractive therapeutic approach. This approach is safe, feasible, effective, and less invasive alternative treatment option for such remaining VSDs.

Transcatheter Closure of Residual and Iatrogenic Ventricular Septal Defects: Tertiary Center Experience and Outcome.

Residual or iatrogenic ventricular septal defects (VSDs) may result in significant hemodynamic effect. This study aimed to review our center experience in transcatheter closure of post-surgical and post-intervention residual and iatrogenic VSDs and to report on their 12-month long-term outcome. All patients who underwent transcatheter closure of residual/iatrogenic VSDs after surgical or transcatheter CHD interventions between January-2015 and January-2020 were included. Patients' medical records were reviewed and analyzed. Twenty-three patients with a mean age of 14.3 ± 8.8years were included. The VSD was residual in 18 (78.3%) patients and iatrogenic in 5 (21.7%) patients, post-operative in 19 (82.6%) patients and post-transcatheter in 4 (17.4%) patients. The VSD site was peri-membranous in 9 (39.1%) patients, high-muscular in 6 (26.1%) patients, mid-muscular in 4 (17.4%) patients, and Gerbode shunt in 4 (17.4%) patients. The QP/QS ratio was 2.5 ± 0.7, and the VSD diameter was 6.1 ± 2.1mm. Most, 16 (71.43%) patients underwent antegrade device deployment, and 7 (28.57%) patients underwent retrograde transaortic device deployment with 3 (13.0%) patients required two devices. Amplatzer™ Muscular VSD devices were used in 16 (69.6%) patients, Amplatzer™ Duct occlude-I devices were used in 4 (17.4%) patients, and Amplatzer™ Duct Occluder-II devices were used in 3 (13.0%) patients with a mean device size of 8.8 ± 2.8mm. Procedural and fluoroscopy times were 55.1 ± 16.2 and 16.3 ± 4.0min respectively. During follow-up (23.3 ± 15.9months), no patient required re-intervention or exhibited mortality. Transcatheter closure of post-operative and post-intervention residual/iatrogenic VSDs represents a safe, feasible, and effective therapeutic approach.

Clinical utility of fetal echocardiography: an Egyptian center experience

BackgroundThe impact of early diagnosis of fetal cardiac abnormalities on the postnatal outcome has been controversial in literature. We aimed to evaluate the role of fetal echocardiography (FE) as a diagnostic tool for early detection and proper management of fetal cardiac abnormalities, study the indications of referral and detect the perinatal outcome in our institution.ResultsThis is a cross-sectional observational and descriptive study that included one hundred and one singleton pregnant women (101 fetuses) who were referred for FE over a period of one year. Indications for referral and perinatal risk factors were documented. FE and postnatal transthoracic echocardiography were done. Fetal cardiac abnormalities were detected in 46.5% of cases. Congenital heart defects (CHDs) in 34.6%, fetal arrythmias in 9.9%, cardiomyopathy in 2.9% and cardiac mass (Rhabdomyoma) in 1% (combined structural and rhythm abnormalities were observed in two fetuses). Of the CHDs, complex heart lesions were diagnosed in 57.1%, common atrioventricular canal in 28.6% and conotrunchal anomalies in 14.3%. Of the ten cases with fetal arrythmias, five fetuses had tachyarrhythmias, four had ectopics and one fetus had congenital heart block in association with maternal lupus. The indications for referral were abnormal obstetric ultrasound (52.5%), maternal medical illnesses (23.8%), multiple neonatal deaths (13.9%) and positive family history of CHD (10.9%). The number of fetuses with cardiac abnormalities was significantly higher than those without cardiac abnormalities in mothers not exposed to perinatal risk factors (p = 0.009) and was statistically lower in mothers exposed to perinatal risk factors (p = 0.005). FE showed 100% accuracy in diagnosing complex lesions, common atrio-ventricular canals, cono-truncal anomalies, cardiac masses and fetal arrhythmias. It missed two cases of tiny muscular ventricular septal defects and one case of aortic coarctation. Cases of fetal supraventricular tachycardia were successfully treated in-utero.ConclusionsCHDs exist in fetuses with no underlying perinatal risk factors. FE can accurately diagnose most of the cardiac anomalies though few errors remain challenging (aortic coarctation). It also offers a good chance for successful early life-saving management of some types of fetal arrhythmia.

Hybrid Procedures. Opening Doors for Surgeon and Cardiologist Close Collaboration.

Background: Collaboration between cardiac surgeons and cardiologists can offer interventions that each specialist may not be able to offer on their own. This type of collaboration has been demonstrated with the hybrid Stage I in patients with hypoplastic heart syndrome. Since that time, a hybrid approach to cardiac interventions has been expanded to an incredible variety of potential indications.Methods: Seventy-one patients were scheduled for a hybrid procedure along 8 years. This was defined as close collaboration between surgeon and cardiologist working together in the same room, either cath-lab (27 patients) or theater (44 patients).Results: Six groups were arbitrarily defined. A: vascular cut-down in the cath-lab (27 neonates); B: bilateral banding (plus ductal stent) in hypoplastic left heart syndrome or alike (15 children); C: perventricular closure of muscular ventricular septal defect (10 cases); D: balloon/stenting of pulmonary branches along with major surgical procedure (12 kids); E: surgical implantation of Melody valve (six patients) and others (F, one case). Two complications were recorded: left ventricular free wall puncture and previous conduit tearing. Both drawbacks were successfully sort out under cardiopulmonary by-pass.Conclusion: Surgeon and cardiologist partnership can succeed where their isolated endeavors are not enough. Hybrid procedures keep on spreading, overcoming initial expectations. As a bridge to biventricular repair or transplant, bilateral banding plus ductal stent sounds interesting. Novel indications can be classified into different groups. Hybrid procedures are not complication-free.

Case Report on Management of Pregnancy in a Patient with Small Muscular Ventricular Septal Defect

Introduction: Maternal morbidity and mortality during pregnancy is significantly associated with hypertensive disorders.&#x0D; Patient history: A 33 years old female was admitted in AVBRH with chief complaint of breathing difficulty with G2P1A1L1 having 30 weeks of gestational age with previous LSCS and conception with small muscular ventricular septal defect, normal function and rhythm for the period of gestation.&#x0D; Obstetric history: Patient had bad obstetric history of 1 induced abortion.&#x0D; Clinical findings: The patient had undergone various investigations like blood tests, USG, Physical examination and antenatal per abdominal examination.&#x0D; Medical Management: Patient was treated with calcium supplement and iron supplement. Nursing management: Administered fluid replacement i.e. DNS and RL, Foetal monitoring, hourly vital sign monitoring.&#x0D; Conclusion: Timely treatment of Ventricular Small Muscular Septal Defect and Management in pregnancy improved the outcome of pregnancy.

Antenatal detection of aberrant subclavian artery (ARSA) by 4D-volume contrast ?maging in mid-trimester ultrasound exam

Background and Purpose: To report a small series of ARSA (Aberrant Right Subclavian Artery) cases which were diagnosed by 4-D (Dimensional) ultrasound (Volume Contrast Imaging-A Plane) with high definition flow technique. Methods: Clinical data of total 1859 singleton, low risk pregnancies from the hospital database. Total 13 cases with isolated ARSA cases were identified. Results: Total 13 cases with isolated ARSA cases were identified. Median maternal age was 32 years old. Median gestational age at ultrasound exam was 21 weeks. Eleven of thirteen cases were isolated. Case 3 had a muscular ventricular septal defect (VSD) and case 6 had an aberrant left subclavian artery. All cases were detected by 4D VCI-A with high definition flow technique successfully. One fetus with ARSA who was misdiagnosed as normal by conventional 2-D ultrasound, 4D VCI-A with high definition flow revealed abnormal courses of the right subclavian artery. Course of azygos vein was discriminated from the ARSA in all cases. Conclusion: 4D VCI-A mode activated with HD-flow (High Definition) is a valuable tool for the investigation of outflow tracts of fetal heart and proximal branches of aorta in midtrimester scans and carries some advantages over conventional 2D sonography combined with High Definition Flow mode.

The Incidence of Isolated Ventricular Septal Defect in Libyan Newborns

This study aimed to evaluate the incidence and spontaneous closure of ventricular septal defects in a randomly selected newborn population, using color Doppler echocardiographic screening. Color flow Doppler echocardiographic screening was performed in 635 neonates within the first week of life. Patients with a ventricular septal defect were also followed up for 6 months to detect spontaneous closure rate and its timing. The incidences of a ventricular septal defect in all neonates, preterm neonates, and term neonates were found as 48.8/1,000, 64/1,000, and 48.1/1,000 live births, respectively. Only three patients were symptomatic. 21 cases had a muscular ventricular septal defect and 10 cases had a perimembranous ventricular septal defect. Most of them had a small ventricular septal defect (≤3 mm). Spontaneous closure was observed in 64.5% of ventricular septal defects within 6 months Closure rate was found as 80% for preterm infants and 66.8% for term infants (p&gt;0.05). The incidence of a ventricular septal defect was considerably high in neonates when routine color flow Doppler echocardiographic examination was performed. Despite the increased incidence of ventricular septal defect, spontaneous closure rate was remarkably high within the first 6 months of life. These defects may result from delayed physiologic development and have a good prognosis.

Closure of a large upper muscular ventricular septal defect in a 2.3 kg baby using a duct occluder

Surgical closure of the ventricular septal defect is a time tested and well-accepted procedure to dateespecially in smaller babies with failure to thrive and severe pulmonary hypertension. Surgicalclosure is regarded as the gold standard treatment. However over the past 10 years percutaneoustrans-catheter device closure has emerged as a safer alternative especially in the case of muscularVSD. Transcatheter closure of ventricular septal defects (VSD) has not yet received generalacceptance. It is not well-established in the younger age group with a weight category of less than5kg. Occasionally, a hybrid procedure has been proposed. We believe that certain types of VSD canbe closed safely by the transcatheter approach even if weight is less than 5kg, especially if the trendof miniaturizing devices continues. This approach should be considered as a valid alternative to asurgical option. We are reporting such a VSD baby with a weight of 2.3 Kg at the age of 6 months,which was closed with a duct occluder

Percutaneous Muscular Ventricular Septal Defect Closure with 2D Transthoracic Echocardiography: Can We Sufficiently Visualize It?

Ventricular septal defect (VSD) is one of the most common congenital heart diseases worldwide today. Although the majority close spontaneously, transcatheter VSD closure is a common option for symptomatic patients with suitable anatomy in adult age. Although transesophageal echocardiography (TEE) and intracardiac echocardiography are the most common imaging modalities for the procedure, in patients with poor TEE images, Transthoracic echocardiography (TTE) can be used as a reliable alternative. Here we present an adult patient with pulmonary hypertension associated with a muscular VSD which was closed percutaneously using 2-dimensional TTE because of poor TEE images.