Obstruction of the ventricular and atrial septal defect

This is an automatically translated article.

The article was professionally consulted with Master, Doctor Cao Thanh Tam - Cardiologist - Cardiovascular Center - Vinmec Central Park International General Hospital.
Ventricular septal defect and atrial septal defect are common congenital heart diseases. If not treated early, these diseases can lead to many dangerous, life-threatening complications. Currently, the most commonly used treatment method for these two diseases is occlusion of the ventricular septal defect and atrial septal defect.

1. Learn the technique of occlusion of the ventricular and atrial septal defect

Ventricular septal defect is a common congenital heart disease, accounting for about 20% of congenital heart diseases. Long-term complications of the disease include: pulmonary hypertension, infective endocarditis, right heart failure or total heart failure. For treatment, the doctor appoints a technique to close the ventricular septal defect with an instrument to repair this defect, helping the physiology of blood flow in the heart return to normal. This is the technique of sealing the ventricular septal defect.
Atrial septal defect is a common congenital heart disease. Among the types of atrial septal defect, atrial septal defect is the most common. The main treatment is occlusion of the atrial septal defect in cases of secondary septal defect, which allows for thorough treatment without surgery.
Currently, occlusion of the ventricular and atrial septal defect is an effective and safe method of congenital heart disease.

2. The technique of sealing the ventricular septal defect

2.1 Indications Pericardial ventricular septal defect or ventricular septal defect; Patients with a history of infective endocarditis; Ventricular septal defect affects hemodynamics; There is a ventricular septal defect with significant left-right shunt, left ventricular dilatation, increased left ventricular end-diastolic diameter relative to body area and age; Not accompanied by other lesions requiring surgery with extracorporeal circulation such as mitral regurgitation, aortic regurgitation, subaortic stenosis; If it is a ventricular septal defect, the septal defect is not larger than 10mm, the aortic ridge is more than 3mm, without too large aneurysms. 2.2 Contraindications Pregnant women; People with blood clotting disorders, bleeding; Echocardiography or cardiac Doppler detects the presence of warts in the heart chambers, blood vessels or shunt through the ventricular septal defect, which is a right - left shunt; Having a serious illness or other acute illness; The patient is allergic to the contrast medium; Children weighing less than 5kg; People with serious abnormalities of the thoracic or spine anatomy; The patient did not consent to occlusion of the ventricular septal defect with an instrument; In the case of patients with too high pulmonary artery pressure, occlusion is contraindicated if pulmonary resistance exceeds 7 Wood units or Rp/Rs > 0.5. 2.3 Preparation for implementation Personnel: 2 doctors and 2 technicians specializing in interventional cardiology; Equipment: Instrument table, sterile gauze, pump of all sizes, 3-prong device, arterial and venous access kit, catheters, ventricular occlusion device, instrument delivery system , Guidewire (conductor),...; Patient: Explained about the procedure, agreed to do the procedure, signed the written commitment; the patient is a child who needs endotracheal anesthesia, so it is necessary to prepare as carefully as before surgery; patients over 12 years old can perform the procedure under local anesthesia; Young patients need to induce sleep in combination with the use of pain relievers during the procedure; Medical records: Prepare complete records as prescribed.

2.4 Carry out ventricular septal septal occlusion. Disinfect large skin around the site of vascular access; Open access to the femoral artery and the right femoral vein; Take the left ventricular chamber with the correct technique to accurately determine the size and morphology of the ventricular septal defect, the distance to the aortic valve, the associated lesions such as mitral regurgitation, ventricular septal aneurysm,...; Measure the size of the ventricular septal defect by 2 methods on angiography and echocardiography during the procedure so that it can decide the type of instrument, the size of the instrument used; Insert the catheter into the appropriate position and then insert the ventricular septum occlusion device into the catheter. The instrument will be pulled toward the aortic valve and carefully pulled down to the left ventricle; Continue to pull the instrument toward the septum until it is firmly pressed against the left side of the septum. At this time, it is necessary to take the left ventricular chamber with the correct technique, which can be combined with ultrasound to make sure the ventricular septal defect is in the right position; After making sure that the left side of the instrument covers the left side of the ventricular septal defect, open the right wing by continuing to pull the catheter back, pushing the instrument out; Echocardiography examines and scans the left ventricular chamber, making sure there is no shunt; Release the instrument, remove the catheter according to the correct technique; Ultrasound, re-scan and check in positions according to the correct technique to make sure there is no residual shunt. After occlusion of the ventricular septal defect was performed, the patient was re-examined on ultrasound and periodically thereafter. All patients will be prescribed aspirin for 6 months and prevention of infective endocarditis for 1 year.
2.5 Common complications and how to manage Air embolism or thrombosis: The doctor needs to expel gas, pay attention to anticoagulation for the patient; Pericardial effusion due to tear, perforation of the atrioventricular, ventricular, ... related to technical manipulation needs to be detected, drained early and may need early surgery; Hemolysis: A rare complication, usually due to residual shunts. The treatment in this case is to closely monitor and give adequate fluids to the patient; Deviation/falling of the ventricular septal defect blocker from position: Close monitoring is required during and after technical manipulation to take appropriate intervention measures; Causes conduction block: The doctor needs to closely monitor, promptly detect bradycardia and atrioventricular block for treatment; Other complications: The puncture site is bleeding or infected: It is necessary to monitor and manage according to the general intervention procedure.

3. Atrial septal defect sealing technique

3.1 Indication Atrial septal defect type secondary, the size of the hole does not exceed 34 mm; There is a sufficiently wide pericardial margin (atrioventricular valvular margin, right pulmonary venous edge, aortic margin, superior and inferior venous ridge): ≥ 5 mm Large shunt, mainly left shunt, with elevation cardiac output through the foramen; Patients with symptoms of atrial arrhythmia, reverse occlusion; Patients with increased burden on the right heart chamber, with hypoxia; There was no fixed pulmonary arterial hypertension. 3.2 Contraindications The anatomical morphology of the 2nd foramen septal defect is not suitable for percutaneous septal occlusion if the stoma is larger than 34 mm, the ridges are shorter than 5 mm, or the atrial septal defect is accompanied by aneurysms. great wall; Other types of atrial septal defect: coronary sinus septal defect, venovenous septal defect, floor-shaped atrial septal defect, first hole atrial septal defect; Right - left shunt, macrocirculatory oxygen saturation less than 94%; Atrial septal defect is associated with other congenital abnormalities requiring surgical treatment; Patients with coagulation and bleeding disorders; Person with a serious illness or acute illness; Atrial septal defect with fixed pulmonary arterial hypertension; People who are allergic to contrast agents. 3.3 Preparation for implementation Personnel: 2 doctors and 2 technicians specializing in interventional cardiology; Technical facilities: Instrument table, sterile gauze, pumps of all sizes, 3-pronged device, MP catheter, femoral vein access kit, hard wire, AGA balloon, parachute for atrial septal defect, system system for introducing instruments, contrast agents mixed with physiological saline with the ratio 1:5; Patient: The procedure is explained carefully, signed the commitment to do the procedure; check for comorbidities; check kidney function; the patient is a child who needs endotracheal anesthesia, so it is necessary to prepare as carefully as before performing surgery; patients older than 12 years can perform the procedure under local anesthesia; Smaller patients need to induce sleep in combination with analgesics during the technique; Medical records: Prepare appropriate records according to regulations. 3.4 Carrying out atrial septal defect Disinfect the skin extensively around the site of vascular access; Access from the right femoral vein; Right heart catheterization, measurement of hemodynamic parameters, oxygen saturation; Insert the MP catheter from the femoral vein to the pulmonary artery, assess pulmonary artery pressure, make sure the patient does not have pulmonary valve stenosis; Pull the catheter to the right atrium, pass through the atrial septal defect to the left atrium, and put it into the left superior pulmonary vein; Insert the rigid wire into the pulmonary vein, withdraw the catheter and save the wire; Use a balloon to measure the size of the atrial septal defect. Determine the size of the atrial septal defect by 3 methods: on transesophageal ultrasound, on angiogram and through direct external measurement; Select an atrial septal defect occlusion device with a size usually 1mm larger than the measured stoma size; Through the rigid wire, push the instrument delivery system into the left atrium. The atrial septal occlusion device will be pushed into the lumen of the superior system; Slowly push the atrial septal occlusion device into the left atrium to open the left atrial flap. Then, slowly pull the instrument to open the right atrial flap in the right atrium; Check the angiographic film with correct technique, make sure the 2 wings of the atrial septal defect do not touch each other; Do echocardiography, check the posture, make sure that the atrial septal defect is in the right position, not deformed; Remove the atrial septal defect parachute and remove the entire system; If necessary, re-measure the pulmonary artery pressure, repeat the pulmonary artery to make sure there is no residual shunt across the atrial septum. After occlusion of the atrial septal defect, the patient was re-examined on ultrasound. All patients after the procedure were prescribed aspirin for 6 months, preventing infective endocarditis for 1 year.
3.5 Common complications and treatment Pericardial effusion : Due to tearing, perforation of the atrial wall or atrial appendage,... due to technical manipulations. The treatment is early detection, early drainage and early contact with the surgeon; Embolism due to thrombus or air: The doctor should pay attention to anticoagulation and expelling gas; Hemolysis: Due to residual shunt. This is a rare condition that requires close monitoring and adequate perfusion; Complications of displacement or fall of the atrial septal defect from its position: It is necessary to closely monitor the patient in order to promptly appoint a re-surgery; Other complications: Bleeding, infection, ... at the puncture site. Treatment measures are monitoring and intervention in accordance with the standard regimen. The procedure for occluding the ventricular septal defect and Atrial septal defect is a relatively complicated technique. When assigned to perform this technique, patients need to strictly follow all instructions of the doctor to reduce the risk of complications and ensure effective treatment.
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