Transcatheter Closure of Post-operative Residual Ventricular Septal Defect Using a Patent Ductus Arteriosus Closure Device in an Adult: a Case Report
Abstract: Transcatheter
closure of perimembranous and muscular ventricular septal defect (VSD) has been
performed widely and it has more advantages compare to surgery. However,
transcatheter closure of residual VSD post operation of complex congenital
heart disease is still challenging because of the complexity of anatomy and
concern about device stability, so the operator should meticulously choose the
most appropriate technique and device.
We would like to report a case of transcatheter closure of residual VSD
post Rastelli operation in a patient with double outlet right ventricle (DORV),
sub-aortic VSD, severe infundibulum pulmonary stenosis (PS) and single coronary
artery. The patient had undergone operations for four times, but he still had
intractable heart failure that did not response to medications. On the first
attempt. we closed theVSD using a VSD occluder, unfortunately the device
embolized into the descending aorta, but fortunately we was able to snare it
out. Then we decided to close the VSD using a patent ductus arteriosus (PDA
occluder). On transesophageal echocardiography (TEE) and angiography
evaluation, the device position was stable. Post transcatheter VSD closure, the
patient clinical condition improved significantly and he could finally be discharged
after a long post-surgery hospitalization. Based on this experience we
concluded that the transcatheter closure of residual VSD in complex CHD using
PDA occluder could be an effective alternative treatment.
Key words: residual VSD, PDA
occluder, transcatheter closure, heart failure, Rastelli
Author: Mulyadi M Djer, Nikmah
S Idris, Idrus Alwi, Ika P Wijaya
Journal Code: jpkedokterangg140326
