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Traditionally, ventricular septal defects (VSDs) have been closed with an open approach. Since then, a percutaneous transcatheter closure has been developed, though it is currently reserved for nonsurgical candidates. This activity reviews the use of catheters to close VSDs and the indications and contraindications of this procedure. It also highlights the interprofessional team's role in managing patients with heart defects. Objectives: Identify the indications for catheter management of VSDs. Evaluate the technique of catheter management of VSDs. Assess the complications of catheter management of VSDs. Communicate how the interprofessional team can improve outcomes in patients undergoing catheter management of VSDs. Access free multiple choice questions on this topic.

Ventricular septal defect (VSD) is currently the most common congenital heart disease in the pediatric population (see Image. Ventricular Septal Defect). As the population ages, VSDs have become the second most common congenital heart disease, right behind bicuspid aortic valves. This disease is most likely due to the early spontaneous closure of VSDs.[1] While many VSDs close naturally, some do not close spontaneously. Depending on the size and flow of the VSD, hemodynamic compromise may occur. Treatment options include surveillance for small, asymptomatic VSDs in the absence of pulmonary artery hypertension; surgical repair is recommended for medium to large-sized VSDs in the presence of hemodynamic compromise. Traditionally, VSDs have been closed with an open approach, but now there is a new emerging intervention- the percutaneous transcatheter closure currently reserved for nonsurgical candidates.[2] Whereas the closure of a VSD can pose a significant risk to the rare patient, some congenital disabilities benefit from the percutaneous closure of a VSD. The very first percutaneous transcatheter VSD closure was performed in 2013 by Lin et al.[3]

Complications of catheter use in ventral septal defect include: Arrhythmias: The most common complication of VSD closure. Patients have a 4.6 to 17‰ risk of arrhythmia following device implantation.[6] While most arrhythmias occur within 1 day to 1-week post-operation, transient atrioventricular block and complete heart block have been noted intraoperatively, with a prevalence of about 1.6%. Common post-operative arrhythmias include right bundle branch block 6.4%, left bundle branch block 1.6%, sinus tachycardia 3.2%, and second atrioventricular block (AVB) 1.09%.[7] The risk of pacemaker dependence is approximately 3.8%, according to Carminatti et al.[8] There is evidence to support various arrhythmia risks depending on the VSD type. For example, complete heart block seems to occur more often in perimembranous VSD compared to muscular VSDs.[8] Trivial residual shunt: A trivial residual shunt occurs when venous blood enters the bloodstream without passing through functional lung tissue without hemodynamic compromise. Approximately 5 to 6.7% of patients who undergo VSD closure develop a trivial residual shunt.[8][9] Aortic Regurgitation: According to 1 study, the rate of AR following VSD device closure is approximately 3.4‰.[6] Tricuspid Regurgitation: TR was noted in several case studies. It is thought that post-VSD closure TR is secondary to direct trauma to the tricuspid valve.[10] Iatrogenic embolization of VSD occluder: The rate of device embolization is approximately 0.82%.[11] Data suggest an association between device embolization, small device sizes, and incompetent aortic rims. Despite possible device embolization, most embolic phenomena are retrievable by percutaneous catheter extraction. Endocarditis: While rare, occurrence data varies from 0.3% to 0.9%. More extensive studies may be needed to discern a more accurate prevalence.[12] Pulmonary hypertension: According to Jorveit et al, the approximate rate of development of PH status post VSD closure is about 0.3‰.[6][13]

The development of catheter-based treatment for cardiac structural defects has introduced new complexity to cardiology. The need for interprofessional communication has become increasingly more vital than ever to optimize patient-centered care and improve outcomes. Percutaneous transcatheter interventions require care coordination by physicians in specialties, including cardiac imaging, interventional cardiology, pediatric cardiology, anesthesia, cardiothoracic surgery, and radiology.[4] All institutions with interventional capabilities currently performing percutaneous VSD interventions or planning to complete the percutaneous interventions of the VSD in the future must have protocols in place to maximize team communication and treatment plans for each patient. To provide the best outcomes, an interprofessional team perioperatively should include specialty-trained clinicians, pharmacists, and nurses. Team coordination of patient and family education and monitoring should occur before and after the procedure. The pharmacist should assist with evaluating for potential drug-drug interactions and any drug-induced complications. The clinical team should provide open lines of communication. An interprofessional approach leads to the best outcomes.