VSD closure device in the setting of adult congenital heart disease

✍ Scribed by Douglas S. Moodie

• Publisher: John Wiley and Sons
• Year: 2005
• Tongue: English
• Weight: 23 KB
• Volume: 64
• Category: Article
• ISSN: 1522-1946
• DOI: 10.1002/ccd.20267

✦ Synopsis

The Rastelli operation has been the procedure of choice for patients with transposition of the great vessels, pulmonary stenosis, and ventricular septal defect. Surgical sequelae of this operation in adulthood are primarily right ventricular outflow tract obstruction and pulmonary regurgitation, secondary to aging conduit dysfunction. Balloon dilatation and stenting of these conduits can be performed in adults with good results and reduction of the outflow tract gradient. However, residual pulmonary regurgitation remains a concern.

Residual ventricular septal defects in the setting of a post-Rastelli-type repair are uncommon, but complicate the standard approach. Giardini et al. report the use of transcatheter VSD closure in the setting of a residual VSD in a young adult post-Rastelli repair. The VSD closure was successful, with a dramatic decrease in the right ventricular outflow tract gradient. The pressure gradient decreased from approximately 80-85 to 18 mm Hg.

The authors correctly point out that echocardiography may lead to a significant overestimation of the right ventricular outflow tract obstruction when there is high