Transcatheter closure of atrial and ventricular septal defects in patients with dextrocardia: a clinical analysis
Jiawang Xiao1, Xianyang Zhu1, Jianming Wang1
1Department of Congenital Heart Disease, General Hospital of Northern Theater Command, Shenyang, China.
Insights
Transcatheter closure is a safe and effective treatment for simple congenital heart defects (CHD) in patients with dextrocardia. Understanding dextrocardia
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Dextrocardia, a congenital condition where the heart is on the right side of the chest, can present unique challenges for cardiac interventions.
- Simple congenital heart defects (CHD) like atrial septal defects (ASD) and ventricular septal defects (VSD) are common in patients with dextrocardia.
Purpose of the Study:
- To evaluate the feasibility and safety of transcatheter closure for isolated ASD or VSD in patients diagnosed with dextrocardia.
- To assess the efficacy of minimally invasive interventional procedures in this specific patient population.
Main Methods:
- A retrospective analysis of 10 patients with dextrocardia and isolated ASD or VSD who underwent successful transcatheter closure between June 2013 and January 2023.
- Data collected included patient demographics, defect characteristics, intraoperative measurements (pulmonary arterial pressure, pulmonary-to-systemic flow ratio), and procedural outcomes.
Main Results:
- The study included 10 patients (3 males, ages 3-38 years) with dextrocardia and either ASD (n=5) or VSD (n=5).
- Successful closure was achieved in all cases, with no severe perioperative or post-operative complications. One patient with interrupted inferior vena cava required an alternative jugular vein approach.
- Intraoperative findings showed mean pulmonary arterial pressure of 20.5 mmHg and a pulmonary-to-systemic flow ratio of 1.80. Post-operative evaluation revealed no significant residual shunts.
Conclusions:
- Transcatheter closure is a viable and effective treatment option for simple CHD in dextrocardia patients requiring intervention.
- While unique anatomical challenges exist, a thorough understanding of dextrocardia's nuances allows for safe and successful application of these interventional techniques.
Objective:
To assess the feasibility of transcatheter closure in patients with dextrocardia and isolated atrial septal defect or ventricular septal defect.
Methods:
A retrospective analysis was performed on the clinical data of 10 patients with dextrocardia and atrial septal defect or ventricular septal defect from June 2013 to January 2023 and successfully underwent transcatheter closure. Patient data were meticulously collected.
Results:
The study cohort comprised 10 patients, with three males, aged between 3 and 38 years. Intraoperative right heart catheterisation revealed the following measurements: the mean pulmonary arterial pressure of 20.5(18,24,3) mmHg, and a pulmonary-to-systemic flow ratio of 1.80(1.58,2.15). There were five atrial septal defects, with defect diameters of 26(20,30) mm, comprising three dextroversion and two mirror-image dextrocardia. Intraoperative echocardiography confirmed the absence of any residual shunt. Among them, a patient with mirror-image dextrocardia, atrial septal defects, and interrupted inferior vena cava required an alternative approach due to femoral vein limitations. The right internal jugular vein was punctured, and a 22 mm atrial septal occluder was successfully deployed via this route. The study identified five ventricular septal defects, with defect diameters of 4(3.5,5.5) mm, including two dextroversion and three mirror-image dextrocardia. Upon post-operative repeat left ventriculography, no residual shunt was detected in all but one case, which exhibited a minimal residual shunt. Throughout the perioperative period and subsequent post-operative follow-up, no severe complications were observed.
Conclusion:
For patients with dextrocardia accompanied by simple CHD, transcatheter closure is a viable option when interventional treatment is indicated. Although transcatheter closure of atrial septal defects or ventricular septal defect in patients with dextrocardia presents unique challenges, it is safe and effective when the anatomical nuances of dextrocardia are thoroughly understood.
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