Transcatheter Closure of VSDs Advanced Angioplasty 2003

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Transcatheter Closure of VSDsAdvanced
Angioplasty 2003

• J.V. DeGiovanni
• Childrens Hospital
• Birmingham

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VSD Types

• Congenital Perimembranous
• Muscular
• Multiple
• Acquired Post Infarction
• Post Trauma
• Residual Post Surgery

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INDICATIONS FOR CLOSURE

• LOW CARDIAC OUTPUT
• LARGE SHUNT
• ELECTIVE
• PREVENTION OF ENDOCARDITIS
• SYMPTOMS

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TIMING OF CLOSURE

• EARLY IF UNSTABLE
• RIGHT VENTRICULAR DILATATION AND FAILURE
• AFTER 4 6 WEEKS IF STABLE
• LATE CLOSURE IF UNCOMPLICATED

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APPROACH

• Clinical Echo Evaluation
• Optimise Support ( Inotropes/IA Balloon)
• GA
• Image Coros and Revascularise
• Assess VSD by TOE and Angio
• Cross VSD from LV or RV
• Balloon Size
• Choose Device and Deploy

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Catheter Closure of Perimembranous VSD Using the
New Amplatzer Device
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Catheter Closure of Perimembranous VSD Using the
New Amplatzer Device
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Catheter Closure of Perimembranous VSD Using the
New Amplatzer Device
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Catheter Closure of Perimembranous VSD Using the
New Amplatzer Device
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Catheter Closure of Perimembranous VSD Using the
New Amplatzer Device
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Catheter Closure of Perimembranous VSD Using the
New Amplatzer Device
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CONCLUSION

• Transcatheter Closure of all types of VSD is
  feasible
• Use specifically designed devices
• Ensure surgical support and recruit a team
• Risks are inevitable but most can be prevented
• Consider early closure with revascularisation
• May need to be done in stages
• Intervention experience is essential

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