Transcatheter ventricular septal defect closure via femoral vein alone
under transthoracic echocardiography guidance without fluoroscopy:
Objective. Transcatheter closure of congenital ventricular
septal defects under echocardiography guidance could avoid potential
radiation damage from fluoroscopy probes. However, mini-surgical
incision, transesophageal echocardiography combined with tracheal
intubation, and limited artery access further complicate the procedure.
Therefore, we aimed to describe our preliminary experiences in
percutaneous VSD closure via the femoral vein only under transthoracic
echocardiography (TTE) guidance. Methods. Between December 2018
and November 2021, 19 patients underwent transcatheter VSD closure via
femoral vein alone under the guidance of TTE in our hospital. The
morphology, location, diameter of VSD, and procedural outcomes were
thoroughly reviewed. Symmetric, asymmetric, or eccentric occlusion
device was chosen for closure based on the VSD characteristics.
Results. There were 16 perimembranous VSD and 3 intracristal
VSD patients in this cohort. The range of diameter of the VSD was from
3.8 to 7.4 mm. Fifteen symmetrical occluders were implanted in 13
perimembranous and 2 intracristal VSD patients. Two eccentric occluders
were implanted in 1 perimembranous and 1 intracristal VSD patient since
the rim to the aortic valve distance was <2 mm. Moreover, 2
asymmetrical occluders were used in 2 perimembranous multi-hole VSDs.
Immediate procedure and 16.1±9.9 months’ follow-up outcomes showed no
device dislodgement and embolism, no new-onset aortic valve
regurgitation, and no atrioventricular heart block.
Conclusions. Transcatheter perimembranous and intracristal VSD
closure via femoral vein alone under the TTE guidance is feasible and
safe in eligible patients. The new type of multipurpose specialized
catheter will facilitate this procedure.