TECHNICAL OVERVIEW OF PERCUTANEOUS TRANS-CATHETER DEVICE OCCLUSION OF VENTRICULAR SEPTAL DEFECTS WITH VARIOUS BRANDS OF SEPTAL OCCLUDERS. EXPERIENCE AT AFIC-NIHD RAWALPINDI

ABSTRACT Objective: To review our current trans-catheter practices and challenges involved during occlusion of ventricular septal defects (VSDs) and ventricular septal ruptures (VSRs) and share our experience using the varied specialized devices accessible in the market employing several approaches and techniques and the attendant pros and cons attached with each device. Study Design: Descriptive cross-sectional study. Place and Duration of Study: At Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD), two years retrospective analysis from data gathered on VSD closures on children and adults from Sep 2017 to Sep 2019, including ventricular septal ruptures in patients with acute myocardial infarctions. Methodology: It is a retrospective descriptive cross-sectional study. The retrospective analysis of all trans-Catheter VSD occlusions that were carried out over last 2 years in AFIC/NIHD deploying various brands of VSD closure. We collected 339 cases of percutaneous trans-catheter device occlusion of VSDs from peads cardiac catheterization data base. Results: Total no of cases with attempted percutaneous Trans-Catheter Ventricular Septal device Closures were 339 and procedure considered successful in 317 (93.5%) and only 22 (6.5%) cases were not successful. Three (0.8%) cases had transient intravascular hemolysis, while in one case the device had to be explanted. Conclusion: Trans-catheter occlusion of VSDs is now possible with a variety of devices available. Often at times, in a given situation, more than one device type can produce a similar preferred outcome. Device cost shall however be a major factor in our choice of device selection during VSD occlusions. The success rate compares to surgical patch plasty with minimum morbidity and mortality.