Name of the Procedure:

Percutaneous transcatheter closure of a congenital ventricular septal defect with implant
(Commonly known as: VSD closure, Device-based VSD closure)

Summary

Percutaneous transcatheter closure of a ventricular septal defect (VSD) is a minimally invasive procedure used to close an abnormal opening in the wall (septum) between the heart's two lower chambers (ventricles). This procedure uses a small device (implant) delivered through a catheter to seal the defect.

Purpose

This procedure addresses the condition known as a congenital ventricular septal defect, a hole in the heart present from birth. The primary goal is to prevent abnormal blood flow between the ventricles, which can lead to heart complications and inefficient blood circulation. Expected outcomes include improved heart function and the prevention of complications such as heart failure or bacterial endocarditis.

Indications

• Symptoms such as shortness of breath, fatigue, or delayed growth in infants and children.
• Diagnosis of a significant VSD via echocardiogram or other imaging techniques.
• Patients for whom surgical repair is deemed too risky or less desirable.

Preparation

• Fasting for at least 6-8 hours before the procedure.
• Adjustment or temporary discontinuation of certain medications as directed by the physician.
• Pre-procedure diagnostic tests including blood tests, chest X-ray, ECG, and echocardiogram to evaluate heart structure and function.

Procedure Description

1. The patient is under local anesthesia with sedation or general anesthesia.
2. A catheter is inserted into a blood vessel in the groin and guided to the heart under X-ray and echocardiographic guidance.
3. A specialized device (implant) is delivered through the catheter to the site of the VSD.
4. The device is deployed to seal the hole, and the catheter is removed.
5. The procedure site is closed and bandaged.

Duration

The procedure typically takes 1-3 hours, depending on the complexity of the VSD.

Setting

The procedure is performed in a hospital, specifically in a cardiac catheterization lab.

Personnel

• Interventional cardiologist
• Cardiac surgeon (optional)
• Anesthesiologist
• Nursing staff
• Radiologic technologist

Risks and Complications

Common risks:

• Bleeding or bruising at the catheter insertion site
• Infection

Rare risks:

• Device dislodgement or malfunction
• Blood clots
• Arrhythmias
• Heart damage
• Stroke

Management of complications involves immediate medical attention and may include medication or additional procedures.

Benefits

• Effective closure of the VSD without open-heart surgery.
• Shorter recovery time and reduced hospital stay compared to surgical repair.
• Improved heart function and reduced symptoms.

Recovery

• Monitoring in a recovery room for several hours or overnight.
• Instructions to avoid strenuous activities for a few days.
• Follow-up appointments for assessment through echocardiogram and physical exams.
• Pain at the catheter insertion site, managed with over-the-counter pain relievers.

Alternatives

• Surgical repair of the VSD with open-heart surgery, which is more invasive but may be necessary for complex defects.
• Medical management, though this does not close the defect but may control symptoms.

Pros and cons:

• Surgical repair is more invasive with a longer recovery, but it is definitive.
• Medical management may not address the underlying issue permanently.

Patient Experience

• During the procedure, the patient will be sedated or under general anesthesia, so they should not feel pain.
• Post-procedure, mild discomfort at the groin insertion site may occur.
• Patients should expect to rest and limit activities for a few days for optimal recovery. Pain management will be provided as needed.