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. 2019 Mar 6;7(5):562-571.
doi: 10.12998/wjcc.v7.i5.562.

Safety of an improved patent ductus arteriosus occluder for transcatheter closure of perimembranous ventricular septal defects with abnormally attached tricuspid chordae tendineae

Lu He  1 , Ya-Juan Du  1 , Ge-Sheng Cheng  1 , Yu-Shun Zhang  2
Affiliations

Safety of an improved patent ductus arteriosus occluder for transcatheter closure of perimembranous ventricular septal defects with abnormally attached tricuspid chordae tendineae

Lu He et al. World J Clin Cases. .

Abstract

Background: The off-label use of various devices has been reported for the transcatheter closure of perimembranous ventricular septal defects (PmVSD) because of serious complications, such as heart block and tricuspid regurgitation (TR), associated with conventional ventricular septal defect devices. However, whether certain defects such as PmVSD with abnormally attached tricuspid are fit for interventional treatment is still disputable.

Aim: To explore the feasibility and safety of transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae using an improved patent ductus arteriosus (PDA) occluder.

Methods: We retrospectively analyzed 20 patients diagnosed with PmVSD with abnormally attached tricuspid chordae tendineae who underwent interventional treatment using an improved PDA occluder at our center from January 2012 to January 2016. Baseline characteristics and procedural and follow-up data were analyzed.

Results: All 20 patients achieved procedure success. No heart block occurred during the operation. One patient had a transient complete right bundle branch block within 48 h post-procedure and reverted to normal rhythm after intravenous injections of dexamethasone for 3 d. For all 20 patients, no residual shunt was observed by transthoracic echocardiography post-procedure. During the average follow-up period of 2.4 years, no severe TR was observed.

Conclusion: Using of the improved PDA occluder for the transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae is a safe and promising treatment option. However, long-term follow-up in a large group of patients is still warranted.

Keywords: Chordae tendineae; Patent ductus arteriosus occlude; Transcatheter; Tricuspid regurgitation; Ventricular septal defect.

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Conflict of interest statement

Conflict-of-interest statement: None.

Figures

Figure 1
Figure 1
Non-standard aortic short-axis view. The red arrow shows the distance (1.3 mm) from the attachment point of the tricuspid anterior leaflet chordae tendineae to the inferior edge of the right ventricular side. TAL-CT: Tricuspid anterior leaflet chordae tendineae; VSD: Ventricular septal defects.
Figure 2
Figure 2
Non-standard aortic short-axis view. The red arrow shows the distance (1.9 mm) from the attachment point of the tricuspid septal leaflet chordae tendineae to the superior edge of the right ventricular side. TSL-CT: Tricuspid septal leaflet chordae tendineae; VSD: Ventricular septal defects.
Figure 3
Figure 3
The improved patent ductus arteriosus occluder (6 mm) and its advantages for the closure of perimembranous ventricular septal defects with abnormally attached tricuspid chordae tendineae. RV: Right ventricular; TR: Tricuspid regurgitation; AR: Aortic regurgitation.
Figure 4
Figure 4
Left ventricle angiography performed before and after the procedure. A: Left ventricle angiography before the procedure showed perimembranous ventricular septal defects, the diameter of left ventricular side was about 8 mm, and right ventricular side was multiple-outlet with a diameter of about 1.5-2.5 mm; B: Left ventricle angiography after the procedure; C: Angiography of the ascending aorta after the procedure showed that there was no aortic insufficiency.
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