Djer Mulyadi M, Idris Nikmah S, Alwi Idrus, Wijaya Ika P
Department of Pediatrics, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Acta Med Indones. 2014 Jul;46(3):233-7.
Transcatheter closure of perimembranous and muscular ventricular septal defect (VSD) has been performed widely and it has more advantages compare to surgery. However, transcatheter closure of residual VSD post operation of complex congenital heart disease is still challenging because of the complexity of anatomy and concern about device stability, so the operator should meticulously choose the most appropriate technique and device. We would like to report a case of transcatheter closure of residual VSD post Rastelli operation in a patient with double outlet right ventricle (DORV), sub-aortic VSD, severe infundibulum pulmonary stenosis (PS) and single coronary artery. The patient had undergone operations for four times, but he still had intractable heart failure that did not response to medications. On the first attempt. we closed the VSD using a VSD occluder, unfortunately the device embolized into the descending aorta, but fortunately we was able to snare it out. Then we decided to close the VSD using a patent ductus arteriosus (PDA occluder). On transesophageal echocardiography (TEE) and angiography evaluation, the device position was stable. Post transcatheter VSD closure, the patient clinical condition improved significantly and he could finally be discharged after a long post-surgery hospitalization. Based on this experience we concluded that the transcatheter closure of residual VSD in complex CHD using PDA occluder could be an effective alternative treatment.
经导管封堵膜周部和肌部室间隔缺损（VSD）已被广泛应用，与手术相比具有更多优势。然而，由于解剖结构复杂以及对器械稳定性的担忧，复杂先天性心脏病术后残余VSD的经导管封堵仍然具有挑战性，因此操作者应精心选择最合适的技术和器械。我们报告一例右心室双出口（DORV）、主动脉下VSD、重度漏斗部肺动脉狭窄（PS）和单冠状动脉患者经Rastelli手术后残余VSD的经导管封堵病例。该患者已接受四次手术，但仍有难治性心力衰竭，药物治疗无效。首次尝试时，我们使用VSD封堵器封堵VSD，不幸的是，器械栓塞至降主动脉，但幸运的是我们能够将其圈套取出。然后我们决定使用动脉导管未闭（PDA）封堵器封堵VSD。经食管超声心动图（TEE）和血管造影评估显示，器械位置稳定。经导管VSD封堵术后，患者临床状况显著改善，经过长时间的术后住院治疗后最终出院。基于这一经验，我们得出结论，使用PDA封堵器经导管封堵复杂先天性心脏病残余VSD可能是一种有效的替代治疗方法。
