Work

Percutaneous Closure of a Large, Complex Postinfarct Ventricular Septal Defect

Year: 2025

Type: article

Abstract: OBJECTIVE: To describe a ventricular septal defect (VSD) repair via transseptal approach using a venovenous rail. KEY STEPS: Using a venous access, a transseptal puncture was made, and an Agilis sheath and JR4 catheter in mother-daughter configuration was advanced to the left ventricle (LV) over an extra-small Safari wire. Next, a Glidewire was advanced from the LV to the right ventricle (RV), then snared in the pulmonary artery and externalized via contralateral groin, after which it was exchanged for an Amplatz wire. A 9-F sheath was advanced from the RV to the LV over the wire. An 18-mm VSD occluder was then deployed. The 7-mm waist was partially opened in the LV, then retracted to expose the RV disc, after which it was well deployed. POTENTIAL PITFALLS: Creation of a venovenous rail carries the risk of iatrogenic atrial septal defect with bidirectional shunting and worsening tricuspid regurgitation. TAKE-HOME MESSAGE: Transseptal transcatheter repair of a VSD after myocardial infarction is a safe and effective option for select patients, especially when arteriovenous loop creation has significant risks.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.105990

Authors: Muhammad Saad, Nadia El-Hangouche, Raviteja Guddeti, Shabana Shahanavaz, Santiago Garcia

Institutions: Christ Hospital, Cincinnati Children's Hospital Medical Center

Language: English

Topic: Cardiac Structural Anomalies and Repair

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850