Ventricular Septal Defect Closure in Right Coronary Cusp Prolapse and Aortic Regurgitation Complicating VSD in the Outlet Septum: Which Treatment is Most Appropriate?

Abstract Background: Transcatheter ventricular septal defect closure remains a complex procedure with potential complications like complete heart block and aortic regurgitation. The ideal device design for such intervention is still evolving. Aim: To assess the safety, efficacy, and short-term outcome of ventricular septal defect closure using LifeTechTM multifunctional (KONAR-MFTM) VSD Occluder. Patients and methods: In a multicenre study, 44 patients with haemodynamically significant, restrictive ventricular septal defects underwent closure with the KONAR-MFTM device from April, 2019 to March, 2020. Clinical, echocardiographic, and angiographic data were collected and reviewed. Patients were followed up at 1, 3, 6, and 12 months. Results: The median age and weight were 8 (1.7–36) years and 20 (11–79) kg. Of 44 patients, 8 (18%) had a high muscular and 36 (82%) had a perimembranous defect, of which 6 had mild prolapse of the right coronary cusp. The median ventricular septal defect size was 8.8 (3.9–13.4) mm. A retrograde approach was adopted in 39 (88.6%) patients. Nine patients (20.5%) had a small residual leak and there was a slight increase in aortic regurgitation in one patient. One device, which embolised to pulmonary artery was retrieved, and the defect was closed with a larger device. At a median follow-up of 13 (5–18) months, the residual leak persisted in 1 (2.3%) patient. Mild aortic regurgitation in one patient remained unchanged. There were no major complications. Conclusion: Percutaneous closure of ventricular septal defect using KONAR-MFTM device is safe and effective in short and midterm follow-up including selected patients with perimembranous defect and mild prolapse of the right coronary cusp.

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Doubly committed subarterial ventricular septal defect with prolapsed right coronary cusp with moderate aortic regurgitation

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v10i4.34561 ◽

2017 ◽

Vol 10 (4) ◽

pp. 240

Author(s):

Redoy Ranjan ◽

Asit Baran Adhikary ◽

Mohammad Rashal Chowdhury ◽

Md. Kabiruzzaman ◽

Md. Mushfiqur Rahman

Keyword(s):

Ventricular Septal Defect ◽

Aortic Regurgitation ◽

Septal Defect ◽

Systolic Pressure ◽

Failure To Thrive ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Pulmonary Artery Systolic Pressure ◽

Coronary Cusp ◽

Right Coronary Cusp

<p>A 4 year old girl was presented with the respiratory tract infection, breathlessness after taking meal, failure to thrive, abnormal movement of the chest on left side overlying the area of heart and systolic murmur. She developed these symptoms gradually for the last 3.5 years. Echocardiography revealed doubly committed subarterial ventricular septal defect with moderate aortic regurgitation. The size of the ventricular septal defect was 7 x 9 mm at the left ventricular outflow tract. The right coronary cusp of the aortic valve was prolapsed. Left atrium and left ventricle were dilated. The pulmonary artery systolic pressure was 35 mm Hg. The ventricular septal defect was closed with the standard surgical procedure using cardiopulmonary bypass followed by aortotomy and right atriotomy. Immediate post-operative period of this case was uneventful and the patient was discharged on 9<sup>th</sup> post-operative day. Follow-up echocardiography showed no residual ventricular septal defect or aortic regurgitation and the ventricular function was good.</p>

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Percutaneous ventricular septal defect closure causing acute aortic regurgitation

The Egyptian Journal of Cardiothoracic Anesthesia ◽

10.4103/ejca.ejca_20_17 ◽

2018 ◽

Vol 12 (1) ◽

pp. 12

Author(s):

Alok Kumar ◽

Sunder Negi ◽

Subrata Podder ◽

AnandK Mishra

Keyword(s):

Ventricular Septal Defect ◽

Aortic Regurgitation ◽

Septal Defect ◽

Defect Closure ◽

Ventricular Septal Defect Closure

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Outcomes of closure of doubly committed subarterial ventricular septal defects in adults

Cardiology in the Young ◽

10.1017/s1047951120000530 ◽

2020 ◽

Vol 30 (5) ◽

pp. 599-606

Author(s):

Zhaoyang Chen ◽

Wanhua Chen ◽

Hang Chen ◽

Zhenmei Liao ◽

Qiang Chen ◽

...

Keyword(s):

Aortic Valve ◽

Ventricular Septal Defect ◽

Aortic Regurgitation ◽

Septal Defect ◽

Intervention Group ◽

Adult Patients ◽

Defect Closure ◽

Ventricular Septal Defect Closure ◽

Sinus Valsalva Aneurysm

AbstractBackground:Outcome data of doubly committed subarterial ventricular septal defect closure in adults are limited.Methods:A review was made of the inpatients >18 years of age who underwent doubly committed subarterial ventricular septal defect closure between June 2010 and June 2017.Results:The patients were categorised into two groups: The valve intervention group consisted of 31 patients who underwent aortic valvuloplasty, aortic valve replacement, or repair of sinus Valsalva aneurysm in addition to doubly committed subarterial ventricular septal defect closure; non-valvular intervention group comprised 58 patients who underwent only doubly committed subarterial ventricular septal defect closure. The groups did not differ by sex and age. Patients in the valve intervention group, with a larger ventricular septal defect size, were shorter and tended to be lighter. The valve intervention group had more patients with pneumonia perioperatively. No infective endocarditis and reoperation were noted during the study period. At last follow-up, 91 and 96.6% of the studied patients were free from left ventricle dilation and pulmonary hypertension. In patients without pre-operative aortic regurgitation, 12 developed new mild aortic regurgitation during the follow-up.Conclusions:About 34.8% of adult patients with doubly committed subarterial ventricular septal defect required concurrent intervention on aortic valve or sinus Valsalva aneurysm. The midterm results of doubly committed subarterial ventricular septal defect closure in adult patients were favourable. However, the incidence of new mild aortic regurgitation after ventricular septal defect closure was high (27.3%). Long-term follow-up of aortic regurgitation progression is needed.

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