Transcatheter closure of post myocardial infarction, iatrogenic, and congenital ventricular septal defects

Introduction

Transcatheter closure of ventricular septal defects (VSDs) is a less invasive treatment option for patients with suitable anatomy for device closure and those who are considered to be high-risk candidates for surgical therapy. ^, This chapter provides an overview, procedural techniques, and outcomes of transcatheter VSD closure.

AHA guidelines

Additional indications

Four types of VSD may be amenable to transcatheter closure. This first category includes patients with post–myocardial infarction VSD (PMI-VSD). Medical and surgical therapy is associated with very high mortality in the acute phase of PMI-VSD, and as a result, transcatheter therapy is often used as a temporizing bridge to clinically stabilize patients. The second category includes patients with iatrogenic or postoperative residual VSD. Iatrogenic VSD can occur after procedures such as septal myectomy, and postoperative residual VSD can be due to patch dehiscence, suture disruption, or incomplete closure of the defect. ^, Transcatheter closure of residual postoperative and iatrogenic VSD is increasingly being used in this population because of the high morbidity and mortality associated with reoperation. ^,

Other VSD types that may be amenable to transcatheter closure are congenital muscular VSDs (mVSD) and certain perimembranous VSDs (pmVSD). Surgery remains the standard of care for the treatment of congenital VSD, but transcatheter therapy may be considered in patients with mVSDs that are not easily accessible for surgical closure, especially in the setting of refractory heart failure despite optimal medical therapy. In addition, some patients with pmVSD who have developed a deep aneurysm of the membranous septum but who have a persistent significant shunt may be candidates for device closure.