Question

Discuss interventional closure of ventricular septal defect with regards to:
Patient selection, sizing of the defect and choosing appropriate device.

Hint:

Careful patient selection, precise defect sizing, and the right device are essential for the successful interventional closure of a VSD.

Answer 1

Interventional closure of a ventricular septal defect (VSD) is a minimally invasive procedure performed using a catheter to close the defect with an appropriate device, usually a septal occluder. The process requires careful consideration of patient selection, defect sizing, and choosing the appropriate device.
Step 1: Patient Selection:
1. Age and Size of the Patient: The procedure is typically indicated for patients who are older than 6 months, but the suitability depends on the patient’s overall health and the size of the defect.
2. Hemodynamics: Candidates must have clinically significant symptoms due to the VSD, such as failure to thrive, recurrent respiratory infections, or heart failure signs.
3. Associated Conditions: The patient should be free from other major congenital heart defects like pulmonary hypertension or significant aortic valve issues.
4. VSD Characteristics: The VSD should be of an appropriate size and location for device closure, usually a muscular or perimembranous VSD.
Step 2: Sizing the Defect:
1. Angiography and Echocardiography: Precise measurement of the defect size is performed using echocardiography or cardiac catheterization to assess the VSD diameter and shape.
2. Cardiac MRI or CT: In some cases, additional imaging like MRI or CT can be used to evaluate the anatomy of the VSD more thoroughly.
Step 3: Choosing the Appropriate Device:
1. Device Types: Several types of closure devices are available, including the Amplatzer VSD occluder and the occluder for muscular VSDs. The choice depends on the size and location of the defect.
2. Device Selection: The device must be selected based on the diameter of the VSD and the surrounding tissue structure. The device should be slightly larger than the defect to ensure a secure closure.