A large perimembranous ventricular septal defect: challenging transcatheter device closure

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Perimembranous ventricular septal defects (pmVSDs) are common congenital heart abnormalities.
• Large pmVSDs with significant left-to-right shunts pose challenges for transcatheter closure.
• Standard antegrade transvenous and arteriovenous loop techniques can be unsuccessful in complex pmVSD cases.

Purpose of the Study:

• To describe a novel indigenous technique for transcatheter device closure of a large pmVSD.
• To report the successful outcome of this technique when conventional methods failed.

Main Methods:

• Attempted transcatheter closure of a large pmVSD using standard antegrade transvenous approach.
• Attempted transcatheter closure using a conventional arteriovenous loop.
• Developed and employed an indigenous technique involving advancing the delivery sheath towards the left ventricular apex from the venous side with a cut pigtail, while maintaining the arteriovenous loop.

Main Results:

• Both standard transcatheter closure techniques (antegrade transvenous and conventional arteriovenous loop) were unsuccessful.
• The indigenous technique successfully achieved device closure of the large pmVSD.
• The modified approach facilitated sheath delivery in a complex anatomical scenario.

Conclusions:

• A novel indigenous technique for transcatheter device closure of large pmVSDs is feasible and effective.
• This modified approach offers a viable alternative for complex cases where standard techniques fail.
• Further research may validate this technique for broader application in interventional cardiology.