Question

Discuss interventional closure of ventricular septal defect with regards to:
Intra and post-procedural complications and their management.

Hint:

While interventional closure of VSD is generally safe, awareness and prompt management of complications are critical for successful outcomes.

Answer 1

Interventional closure of a ventricular septal defect (VSD) is a relatively safe procedure; however, it carries the risk of certain complications both during and after the procedure. These complications require prompt identification and management to ensure a successful outcome.
Step 1: Intra-Procedural Complications:
1. Device Malposition: The device may be incorrectly placed or fail to fully occlude the VSD. This can be managed by repositioning or replacing the device.
2. Perforation of the Septum: There is a risk of septal perforation during device placement. This can be managed by withdrawing the device and using a new approach.
3. Arrhythmias: Arrhythmias may occur due to manipulation of the heart. These are usually transient and can be managed with antiarrhythmic drugs or temporary pacing.
Step 2: Post-Procedural Complications:
1. Device Embolization: The device may migrate from its initial position. This is a rare but serious complication that may require retrieval of the device via surgery or catheterization.
2. Infection: Endocarditis or other infections can occur. Prophylactic antibiotics are typically administered to reduce this risk.
3. Thrombosis and Stroke: There is a risk of thrombosis at the device site, potentially leading to embolism or stroke. Anticoagulation therapy may be used in some cases to prevent this.
4. Heart Block: A rare complication, especially in patients with perimembranous VSDs, where the conduction system may be affected, leading to heart block. This may require a pacemaker.
Step 3: Management of Complications:
1. Close Monitoring: After the procedure, patients should be closely monitored for complications such as arrhythmias, infection, or device-related issues.
2. Interventional or Surgical Correction: In the event of device malposition or embolization, additional interventions or surgical procedures may be required to correct the problem.