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Updated: Oct 12, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Clinical study of transcatheter occlusion in treating ventricular septal defect combined with right coronary cusp
Wei Ji1, Zhifang Zhang1, Wenchuo Zhao1
1Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
Insights
Transcatheter closure is a safe and effective treatment for perimembranous ventricular septal defects with right coronary cusp bulge in children. This minimally invasive approach avoids surgical thoracotomy and shows favorable outcomes during follow-up.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Perimembranous ventricular septal defects (VSD) with right coronary cusp (RCC) bulge typically require surgical repair due to risks of aortic regurgitation.
- Transcatheter closure offers a minimally invasive alternative, attracting significant interest from clinicians and patients.
Observation:
- This study evaluated the efficacy of transcatheter occlusion for VSD with RCC bulge in 40 pediatric patients.
- Procedures involved transthoracic echocardiography, cardiovascular angiography, and electrocardiogram monitoring.
- Follow-up assessments monitored occluder position, residual shunts, aortic regurgitation, and conduction system effects.
Findings:
- All 40 patients underwent successful transcatheter occlusion with no major perioperative complications.
- Three patients had minor residual shunts initially, which resolved during follow-up.
- No new or worsened aortic regurgitation was observed, and conduction system disturbances were minimal (one incomplete right bundle branch block).
Implications:
- Transcatheter occlusion is a viable and effective treatment option for pediatric VSD with RCC bulge.
- Careful patient selection and procedural technique are crucial for favorable outcomes.
- This approach may reduce the need for open-heart surgery in select pediatric cases.
Abstract:
Background: Perimembranous ventricular septal defect combined with right coronary cusp bulge generally should be treated with surgical thoracotomy, owing to the potential aortic regurgitation. However, the minimally invasive method of transcatheter closure has always attracted the attention of cardiologists and patients. The present study aimed to apply transcatheter occlusion in treating ventricular septal defect with right coronary cusp bulge and further evaluate the clinical effect through follow-up. Materials and methods: A total of 40 children diagnosed as having a ventricular septal defect with right coronary cusp bulge, examined using transthoracic echocardiography and cardiovascular angiography, were enrolled in this study. The ventricular septal defects were closed by placing occluders through transcatheter occlusion treatment. During the operation process, the children underwent angiography and transthoracic echocardiography examinations to check the position of the occlude and the extent of aortic regurgitation. The influence of occlusion on the conduction system was evaluated using a surface electrocardiogram. The children were followed up after their procedures. Results: All 40 patients were immediately and successfully occluded. Three patients with filament residual shunts were observed during the operations. No major surgical complications occurred during the perioperative period. During the follow-up period, the positions of all the occluders were good, the residual shunts in the three patients disappeared, and no new or aggravated aortic regurgitation occurred. Electrocardiogram did not reveal any atrioventricular blocks. Only one patient suffered from an incomplete right bundle branch block. Conclusions: Children diagnosed with ventricular septal defect combined with right coronary cusp bulge could be considered for transcatheter occlusion. With appropriate indications and methods, the effect may be favorable.
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