Author + information
- Chad Kliger,
- Robert Kumar,
- Pablo Diez–Villanueva,
- Teresa Cano,
- Jorge Rodriguez–Capitan,
- Vladimir Jelnin,
- Itzhak Kronzon,
- Gila Perk and
- Carlos Ruiz
Percutaneous closure of perimembranous ventricular septal defects (pmVSDs) using transcatheter techniques has been well described, utilizing retrograde transaortic and/or antegrade venous approaches. However, tortuous or malaligned tracts in relation to access can make the procedure a challenge. In addition, mechanical aortic valve replacement or recent aortic valve surgery may be a contraindication. Percutaneous transapical access provides an alternative, direct approach with favorable angles for crossing and delivery in the complex patient. This is the first described series of patients with percutaneous closure of pmVSDs using a transapical approach.
Between March 2008 and November 2012, we retrospectively reviewed patients who underwent percutaneous transapical pmVSD closure at our center (3 patients: 2 women, ages 51 to 78). Computed tomographic angiography (CTA) with 3D reconstruction and 3D transesophageal echocardiography were obtained with CTA–fluoroscopy fusion imaging (Philips, Netherlands) utilized for procedural guidance. Transapical access was performed such that entry into the left ventricle was aligned with the pmVSD and an AV rail was created to aid in equipment delivery. pmVSDs were closed with the implantation of an Amplatzer Muscular VSD Occluder and transapical access using a 6/4mm Amplazter Ductal Occluder (St Jude Medical, Minneapolis MN).
All patients were deemed as high–risk surgical candidates because of multiple comorbidities. Patients had a prior history of valve surgery, aortic (1 mechanical), mitral (1 bioprosthetic) or combined (1 bioprosthetic), with pmVSD noted as a post–surgical complication. A planned initial transapical approach was performed in all cases with successful closure using 10 or 12mm mVSD Occluders via 7F sheaths. Fluoroscopy and procedural times were 15±20min and 45±18min respectively. No procedural–related complications were noted with follow–up echocardiography that revealed no evidence of residual shunt.
Percutaneous transapical closure of pmVSDs is a feasible alternative in the complex patient, especially when traditional percutaneous approaches are not possible.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Structural Heart Disease Intervention
Abstract Category: 51. TCT@ACC–i2: Non–valvular Structural Heart Disease
Presentation Number: 2114–252
- 2013 American College of Cardiology Foundation