The transcatheter closure of intracristal and subpulmonary ventricular septal defect

Objective: To assess the efficacy and safety of transcatheter closure of intracristal ventricular septal defect (IVSD) and subpulmonary ventricular septal defect (SVSD) with home-made eccentric national occluder. Methods: Transcatheter closure was attempted in 28 patients (15 men and 13 women), with IVSD (n=22) and SVSD (n=6) at an average of 12.44 ± 5.86 years (ranged from 3 to 34 years of age). The homemade device consists of two low profile disks made of National wire mesh with a 2 mm connecting waist. The left disk is 6 mm towards the apex and 0 mm towards the aortic valve. The right disk is 4 mm larger than the diameter of the waist. The devices were deployed via the femoral vein using 7-10 Fr sheaths under the guidance of transthoracic echocardiography and fluoroscopy. Results: The VSD average diameter was 4.54 ± 1.93 mm (ranged 2 to 12 mm) with the distance of VSD to aortic valve averaging 0.35 ± 0.45 mm (range 0 to 1 mm) and the connecting waist diameter of device of 7.65 ± 3.11 mm (ranged 4 to 14 mm). The device was implanted successfully in 26 of 28 procedures. A trivial aortic regurgitation occurred in 1 patient with SVSD after deployment of the occluder. Implantation was unsuccessful in 2 patients with SVSD having large septal defects. No other complications were observed. The mean fluoroscopy time for the procedures was 14.07 ± 5.19 min (range 9 to 40 min) and the whole procedure time was 59.81 ± 17.76 min (range 40 to 150 min). Conclusions: Transcatheter closure of IVSD and SVSD with homemade eccentric national occluder is effective, easy and safe. Longer term follow-up is necessary for assessing the efficacy. (authors)