VSD Device Closure

VSD is the most common congenital heart defect in pediatric population. It is an opening in the septum dividing the two lower chambers of the heart in the unborn baby. Most VSDs close naturally before birth, the ones that persist may cause mixing of oxygenated and deoxygenated blood, compromising the heart and lung function.

What is Device Closure for VSD?

Percutaneous transcatheter closure is a nonsurgical procedure used to close the VSD. The procedure involves inserting a catheter into the heart through a blood vessel on the groin, and then threading a special closure device either folded or attached to a catheter and advanced through the defect. The device is opened and apposed onto the defect to close it.

Who is eligible for device closure?

Not all VSDs can be closed using the closure device. Small to moderate size defects can be closed percutaneously.

Who is not eligible for device closure?

Percutaneous device closure should not be performed in adults with:

  • Severe pulmonary atrial hypertension
  • Current thromboembolism
  • Active endocarditis
  • Cardiac structure precluding safe delivery of catheter

What preparations should I do before the procedure?

A detailed assessment of the defect is performed through transthoracic and transoesophageal echocardiogram to assess the size and location of the defect to determine the eligibility of the procedure.

Pre -procedural medications

  • Anti-platelet therapy with aspirin and plavix
  • Intravenous dose of antibiotic is given one hour before the percutaneous access.
  • General anesthesia is considered for patients below ten years of age, and conscious sedation is used for patients older than ten years of age.
  • Arrangements for intravenous administration of medications or fluids during the procedure will be made.

What happens during the procedure?

  • The patient is asked to wear a hospital gown and lie on an X-ray table where an X-ray camera will move over the chest during the procedure.
  • Arrangements for intravenous administration of medications or fluids during the procedure will be made.
  • The site where the catheter will be inserted is cleaned and sterile drapes are used to cover the site to prevent infection.
  • Electrodes will be placed on the chest and attached to an electrocardiograph monitor (ECG).
  • A sedative might be given to relax the patient and a local anesthetic is given to numb the site of catheter introduction.
  • A plastic sheath will be inserted in the groin, through which a catheter is inserted and threaded to the heart.
  • A contrast dye may be administered to help visualize the heart structures; the dye can make you feel hot or flushed for several seconds.
  • Inform the doctor if you feel an allergic reaction like itching or tightness in throat, nausea, chest discomfort etc.
  • The X-ray cameras are used to measure pressures and oxygen content in the chambers.
  • The appropriate size and the location of the closure might be visualized using a small catheter connected with an ultrasound transducer.
  • A special catheter is used to advance the device into the heart and through the defect.
  • The device is slowly pushed out of the catheter allowing each side of the device to open and close each side of the hole in the septum.
  • The proper position of the device is ensured and is released from the catheter.
  • It may take 1-2 hours for the procedure, but preparations must be made to spend about 5-9 hours in the hospital.
  • The patient should be accompanied by a family member or a friend who can drive him home, as the patient is not allowed to drive on the same day.

What care should be taken after the procedure?

  • The catheter and the imaging probe are removed after the completion of the procedure.
  • A firm pressure may be applied to prevent bleeding, occasionally a small suture may be needed.
  • Bed rest is advised for several hours to prevent bleeding; however, call the doctor immediately if you notice bleeding.
  • You might be advised to drink plenty of water to wash out the contrast material from the body.
  • Your heart rate and rhythm may be monitored.
  • Medications, such as aspirin, may be prescribed to prevent blood clots.
  • Strenuous activity and heavy lifting should be avoided for at least six months.
  • Antibiotic prophylaxis is required for at least six months or lifelong to prevent endocarditis, as per doctor’s advice.

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Contact Dr. Raghu and his team at:
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040 4456 9955
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Mail: raghu@drraghu.com