Successful Closure of a Ventricular Septal Defect Using a Novel Non-Prosthesis Touching Technique Following Mechanical Aortic Valve Replacement

Abstract

Percutaneous intervention is preferred over reoperation for the treatment of iatrogenic membranous ventricular septal defects (VSDs). During the standard percutaneous procedure, an arterio-venous loop is used for occluder deployment, entailing the risk of device impingement on the prosthetic aortic valve, which may cause serious complications or even death. In this report, we describe a novel non-prosthesis touching procedure for the closure of a VSD in a patient with prior aortic valve replacement. The unique feature of this technique is the use of an apex-venous loop for occluder deployment, which prevents the device impingement on the prosthetic valve, thus avoiding difficulties, lengthy operation and serious complications associated with the standard procedure. Immediate and 1-year follow-up results showed that the VSD was successfully closed and no serious complications were observed.

Keywords: Aortic valves; Apex-venous loop; Arterio-venous loop; Iatrogenic ventricular septal defect; Transcatheter closure.

Figure 1

Angiography assessment and the establishment of the apex-venous loop. (a) LV angiography confirmed the membranous VSD. (b, c) Through the apex, a guide wire was advanced across the VSD to the right ventricle and then to the left pulmonary artery where it was snared (b) and exteriorized from the RFV (c), thus the apex-venous loop was established.

Figure 2

Occluder deployment through the apex-venous loop. (a) Occluder deployment was performed with the distal tip of the delivery sheath pointing to the apex. (b) The left disk was carefully opened and positioned beneath the edge of mechanical valve followed by the opening of the waist and the right side of the occluder. (c) The occluder was released and the loop wire was withdrawn after final LV angiography confirmation.