Challenging Case: Ventricular Septal Defect Device Removal

Objectives

Treatment of perimembranous ventricular septal defects (VSD) has traditionally been surgical. Surgery most often includes midline sternotomy, cardiopulmonary bypass with cardioplegic arrest, and patch closure of the defect. Devices have become available that allow for percutaneous perimembranous ventricular septal defect closure in the cardiac catheterization lab, thereby eliminating the risks of open heart surgery. Risks of device closure include incomplete closure, heart block, and interference with aortic and tricuspid valve function.

Methods

The authors present a challenging case of device removal for a persistent ventricular septal defect with a significant left-to-right shunt. Intraoperatively, both an aortotomy and right atriotomy were performed for optimal exposure. Through the initial aortotomy, a hole in the noncoronary leaflet of the aortic valve was identified that required closure. The hole was caused by erosion from repeated contact with the device below. Through the subsequent right atriotomy, the device was removed. Despite a meticulous dissection, device removal caused a disruption in the aortic annulus and tricuspid valve regurgitation, both of which required surgical repair as well.

Results

Ultimately, the repair went well and the postoperative echocardiogram showed no residual defect and good aortic and tricuspid valve function.

Conclusion

Complications from VSD device closure can be very challenging to repair surgically.

This educational video was originally presented during the STSA 65th Annual Meeting. This content is published with the permission of the STSA. For more information on the STSA and its next Annual Meeting, please click here.