Transcatheter Device Closure of a Large Muscular VSD during Neonatal Period: An Opt-out Strategy in a Complex Case

Background: Transcatheter device closure of ventricular septum defects (VSDs) has become a growing alternative for young patients with congenital heart defects. Nevertheless, most of the current scientific data refers to patients after neonatal period, describing interventions at the age of a few months at the earliest. We present the case of a 3.5 kg weight infant undergoing a transcatheter device closure of a large muscular VSD (5.4 mm) as opt-out strategy after aortic arch patch plastic at the age of 19 days.

Methods: The term male newborn was diagnosed with critical coarctation of the aorta with hypoplasia of the aorta after the origin of the left carotid artery, large muscular VSD and ASD at the 4th day of life. Due to his critical health status, mechanical ventilation and manipulation of PDA with Minprostin was necessary until resection and extend end-to-end-repair of the coarctation from lateral thoracotomy at the fifth day of life. The aortic anastomosis had to be revised due to stenosis and thrombosis of the clamping field, resulting in a suture stenosis. Surgery was switched to median thoracotomy and aortic patch-plastic was successfully performed on cardiopulmonary bypass. The patient in the presence of large left to right shunt could not be weaned stable from mechanical ventilation. Surgical repair of VSD was assessed as a high-risk procedure 2 weeks after complex CPB-surgery and pulmonary artery banding was discussed as surgical opt-out strategy.

Results: During interdisciplinary discussion, we opted for an interventional closure of this large muscular VSD (5.4 mm). A 6 × 4 mm device was placed from the right side using a vessel loop entering from the left ventricle after puncture of the right femoral artery and vein after unsuccessful attempts from the aortic route. Device-placement was supported by TEE-guidance. Postinterventional, we documented a small residual pressure reducing left-to-right shunt at the caudal part of the device. No device-related obstruction of outflow tract was observed. Extubation onto a High-Flow therapy took place the day of catheterization, transfer to a peripheral pediatric hospital was 2 weeks after. Intermittent monomorphic ventricular arrhythmia was successfully treated with Propranolol. Follow-up at 10 weeks documented a residual muscular VSD and a stable patient without respiratory support on the edge of hospital discharge after a complex course of disease.

Conclusion: Transcatheter device closure of a large VSD is feasible in a neonate and proved to be a successful opt-out strategy in this special case.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
13 February 2024