VSD device closure with PDA device

摘要

Background: Transcatheter closure of ventricular septal defectusing PDA devices is gaining acceptance in selected cases ascompared to surgical closure which is associated with morbidityand mortality. Potential advantages of the transcatheter closureover conventional surgery include a smaller incision, shorter stay,and fewer complications.Methodology: A total 78 cases underwent echo and cardiac cath.Out of 78 patients, 10 patients sent to surgery because of impropersize or location of the VSD. A total of 68 cases were having defectsize ranging from 3mm to 10 mm. The location of VSD wasperimembranous in 60 cases, muscular in 08 cases, and apicalin 01 case. The procedure was performed in 68 cases with PDAdevice.Procedure: LV angiography showed VSD. LIMA catheter was passedin LV with rotation and pull-back technique, then crossed VSD andwas placed in RV. Double length Terumo 0.03500 260 cm wire wastaken and passed through RV, RA, IVC, SVC, or PA. Snared throughfemoral venous and arterio venous loop was created with the helpof Terumo wire. PDA sheath was passed through RA, RV and theninto aorta with Kissing technique sheath was positioned in LV. PDAdevice was loaded in sheath. Device was positioned on LV side firstand then on RV side. Position was checked on 2D-Echo which wasfound to be accurate. Wire and catheter was removed. Post proceduretreatment with steroids was advised as per standard treatment.Anti-platelet aspirin was recommended for one month.Results: Procedure was done successfully in 66 without any complications.In 15 cases, transient BBB was developed on duringprocedure. In 1 case, complication of CHB occurred during procedurein which temporary pacemaker (TPM) was implanted for 3days. In another case, complication of CHB occurred in ICU after 3 hin which TPM was done for 2 days. In 2 cases, device was embolized,1 device successfully retrieved with help of the basket snareand continued procedure with bigger size device, another 1 casewent to surgery. A total of 1 case of death was observed on 5th day,which was due to stroke. At 1-year follow-up, no shunt was notedin ECHO and ECG remained same with no additional conditionaldefect.Conclusion: Transcatheter closure is safe and efficacious inselected cases of perimembranous and muscular VSD using PDAdevice.