Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 8, Number 6, December 2017, pages 286-292

Transcatheter Closure Versus Repeat Surgery for the Treatment of Postoperative Left-to-Right Shunts: A Single Center 15-Year Experience

Figure 1. Transcatheter closure of a residual VSD. (a) Angiography of left ventricle via a 4F pigtail catheter inserted through the right femoral artery showed the residual VSD (indicated by the arrow). (b) Via the right femoral vein, a femoral vein-inferior vena cava-right ventricle-residual VSD-left ventricle-aorta-right femoral artery loop was established using a 260 cm loach guide wire. Afterwards, a 6-F delivery catheter was advanced along the loop to the left ventricle. (c) The loop wire was withdrawn. Subsequently, a VSD occluder was delivered to left ventricle and then opened in following sequence: left disc, waist and right disc. (d) After repeated angiography showed that the shunt disappeared, and then the occluder was released.

Figure 2. Transcatheter closure of a residual PDA. (a) Angiography of the aortic arch via a 5-F pigtail catheter that was inserted through the right femoral artery showed the residual PDA shunt (indicated by the arrow). (b) By the access of right femoral vein, a MPA2 catheter was advanced via right ventricle, pulmonary artery, PDA to the descending aorta followed by the insert of a 260 mm wire. After the MPA2 catheter was withdrawn, an 8-F delivery sheath was advanced along the wire and the duct occluder was delivered, positioned and opened in such a sequence that the aortic end of the occluder was first opened and then the pulmonary artery end. (c) Repeated angiography showed the occluder was properly placed and the shunt disappeared, and then the duct occluder was released.

Figure 3. Transcatheter closure of a RSVA. (a) Angiography of right coronary sinus via a MPA1 catheter that was inserted into the right femoral artery showed the shunt from right coronary sinus to the right ventricular outflow tract (as indicated by the arrow). (b) Angiography after the MPA1 catheter was further advanced to the pulmonary artery confirmed the shunt (arrow). (c) Via the right femoral vein, a femoral vein-inferior vena cava-right ventricle-RSVA-aorta-right femoral artery loop was established using a 260 cm loach guide wire. (d) A 7-F delivery sheath was advanced along the loop to ascending aorta, and then a 7 mm VSD occluder was delivered passing the RSVA and opened in following sequence: left disc, waist and right disc. (e) The loop wire was withdrawn and angiography showed the shunt disappeared. (f) The occluder was released, delivery catheter withdrawn and repeated angiography showed the occluder was properly placed.

**Table 1.** Demographics and Clinical Characteristics of Patients Undergoing Transcatheter Closure
Patient	Age (years)	Sex	Primary diagnosis	Shunt size (mm)	Qp/Qs	PAP (mm Hg)	Device type size (mm)	Procedure time (min)	Hospital stay (days)
VSD: ventricular septal defect; TOF: tetralogy of Fallot; PDA: patent ductus arteriosus; PAP: pulmonary arterial pressure.
1	7	F	VSD	4	1.5	32/14 (22)	pmVSD, 6	56	6
2	26	M	VSD	8	1.9	27/11 (16)	pmVSD, 10	62	7
3	14	M	VSD	5	1.6	30/13 (19)	pmVSD, 8	45	7
4	29	F	VSD	6	1.5	21/9 (12)	pmVSD, 8	91	6
5	30	F	VSD	3	1.5	19/8 (11)	pmVSD, 5	67	6
6	3	F	VSD	4	2.1	22/11 (15)	pmVSD, 6	46	7
7	28	M	VSD	5	2.2	16/7 (10)	pmVSD, 8	112	7
8	12	F	VSD	8	2.9	15/5 (9)	pmVSD, 10	57	6
9	8	F	VSD	3	1.5	32/15 (23)	pmVSD, 5	36	6
10	13	M	VSD	4	1.7	38/17 (26)	pmVSD, 7	52	6
11	59	F	VSD	7	2.2	24/10 (21)	pmVSD, 10	71	7
12	4	F	VSD	3	1.7	22/9 (14)	pmVSD, 5	45	7
13	9	F	VSD	6	1.9	18/7 (12)	pmVSD, 8	39	6
14	18	M	VSD	12	2.8	17/8 (12)	pmVSD, 14	152	6
15	7	F	VSD	4	1.8	14/6 (8)	pmVSD, 6	41	6
16	38	M	TOF	10	3.1	29/15 (21)	pmVSD, 12	97	6
17	14	M	TOF	4	1.6	35/18 (26)	pmVSD, 6	53	7
18	45	M	VSD	4	1.5	41/22 (30)	pmVSD, 7	108	6
19	5	M	VSD	5	1.9	27/14 (19)	PDA, 10/8	41	6
20	18	F	PDA	3	1.5	26/12 (17)	PDA, 6/4	29	5
21	21	F	PDA	5	1.7	39/18 (28)	PDA, 10/8	39	5
22	19	F	PDA	4	1.8	31/15 (22)	PDA, 8/6	31	5
23	7	M	VSD	4	1.7	26/13 (19)	pmVSD, 7	41	5
24	46	M	PDA	5	1.9	41/23 (31)	PDA, 12/10	39	6
25	14	F	TOF	4	1.6	30/13 (19)	pmVSD, 8	48	5
26	65	M	VSD	5	1.7	43/24 (32)	mVSD, 12	67	8
27	6	F	TOF	3	1.6	21/9 (13)	pmVSD, 5	41	5
28	21	F	TOF	7	1.9	26/14 (17)	pmVSD, 10	52	6
29	9	M	VSD	3	1.7	32/13 (22)	pmVSD, 6	37	5
30	57	M	VSD	6	1.8	49/27 (36)	mVSD, 14	78	6
31	8	M	VSD	5	1.8	17/8 (12)	pmVSD, 7	52	6

Table 1. Demographics and Clinical Characteristics of Patients Undergoing Transcatheter Closure

Patient

Age (years)

Sex

Primary diagnosis

Shunt size (mm)

Qp/Qs

PAP (mm Hg)

Device type size (mm)

Procedure time (min)

Hospital stay (days)

VSD: ventricular septal defect; TOF: tetralogy of Fallot; PDA: patent ductus arteriosus; PAP: pulmonary arterial pressure.

VSD

1.5

32/14 (22)

pmVSD, 6

VSD

1.9

27/11 (16)

pmVSD, 10

VSD

1.6

30/13 (19)

pmVSD, 8

VSD

1.5

21/9 (12)

pmVSD, 8

VSD

1.5

19/8 (11)

pmVSD, 5

VSD

2.1

22/11 (15)

pmVSD, 6

VSD

2.2

16/7 (10)

pmVSD, 8

112

VSD

2.9

15/5 (9)

pmVSD, 10

VSD

1.5

32/15 (23)

pmVSD, 5

VSD

1.7

38/17 (26)

pmVSD, 7

VSD

2.2

24/10 (21)

pmVSD, 10

VSD

1.7

22/9 (14)

pmVSD, 5

VSD

1.9

18/7 (12)

pmVSD, 8

VSD

2.8

17/8 (12)

pmVSD, 14

152

VSD

1.8

14/6 (8)

pmVSD, 6

TOF

3.1

29/15 (21)

pmVSD, 12

TOF

1.6

35/18 (26)

pmVSD, 6

VSD

1.5

41/22 (30)

pmVSD, 7

108

VSD

1.9

27/14 (19)

PDA, 10/8

PDA

1.5

26/12 (17)

PDA, 6/4

PDA

1.7

39/18 (28)

PDA, 10/8

PDA

1.8

31/15 (22)

PDA, 8/6

VSD

1.7

26/13 (19)

pmVSD, 7

PDA

1.9

41/23 (31)

PDA, 12/10

TOF

1.6

30/13 (19)

pmVSD, 8

VSD

1.7

43/24 (32)

mVSD, 12

TOF

1.6

21/9 (13)

pmVSD, 5

TOF

1.9

26/14 (17)

pmVSD, 10

VSD

1.7

32/13 (22)

pmVSD, 6

VSD

1.8

49/27 (36)

mVSD, 14

VSD

1.8

17/8 (12)

pmVSD, 7

**Table 2.** Demographics and Clinical Characteristics of Patients Treated With Reoperation
Patient	Age (years)	Sex	Primary diagnosis	Shunt size (mm)	PAP (mm Hg)	Complications	Procedure time (min)	Hospital stay (days)
VSD: ventricular septal defect; TOF: tetralogy of Fallot; DORV: double outlet right ventricle; B: bleeding; WD: wound dehiscence; P: pneumonia; KI: kidney insufficiency.
1	12	F	VSD	5	21	B	213	15
2	31	M	VSD	4	27	B	287	17
3	37	F	VSD	6	21	B, WD, P	314	21
4	4	M	VSD	4	31		187	14
5	26	F	VSD	7	19	B	261	16
6	15	M	VSD	9	21	B, P	342	19
7	10	F	VSD	3	29		198	13
8	9	F	VSD	4	31		236	15
9	45	M	VSD	6	41	B, P	327	12
10	7	F	VSD	4	16		178	17
11	13	F	VSD	6	17	B	226	11
12	21	M	VSD	8	21	B, KI	291	15
13	6	F	VSD	3	26		170	10
14	36	F	VSD	10	46	B	235	13
15	9	F	TOF	5	16	B	217	14
16	11	M	TOF	5	13		241	16
17	6	F	TOF	6	31		339	17
18	5	M	DORV	4	26	B, WD	358	28
19	14	F	TOF	7	18		261	18

Table 2. Demographics and Clinical Characteristics of Patients Treated With Reoperation

Patient

Age (years)

Sex

Primary diagnosis

Shunt size (mm)

PAP (mm Hg)

Complications

Procedure time (min)

Hospital stay (days)

VSD: ventricular septal defect; TOF: tetralogy of Fallot; DORV: double outlet right ventricle; B: bleeding; WD: wound dehiscence; P: pneumonia; KI: kidney insufficiency.

VSD

213

VSD

287

VSD

B, WD, P

314

VSD

187

VSD

261

VSD

B, P

342

VSD

198

VSD

236

VSD

B, P

327

VSD

178

VSD

226

VSD

B, KI

291

VSD

170

VSD

235

TOF

217

TOF

241

TOF

339

DORV

B, WD

358

TOF

261

**Table 3.** Summarized Data for Patients Undergoing TCC and Reoperation
	Patients with TCC	Patients with reoperation
*P < 0.001 compared with TCC group. N/A: not available. TTC: transcatheter closure.
Total number (before 2010)	1	14
Total number (after 2010)	30	5
Sex	Female: 16; male: 15	Female: 12; male: 7
Age (years)	21.3 ± 17.3	16.7 ± 12.4
Average shunt size (mm)	5.1 ± 2.1	5.6 ± 2.0
Qp/Qs	1.9 ± 0.4	N/A
Procedure time (min)	58.9 ± 27.7	256.7 ± 60.5*
Hospital stay (days)	6.1 ± 0.8	17.0 ± 4.0*

Table 3. Summarized Data for Patients Undergoing TCC and Reoperation

Patients with TCC

Patients with reoperation

*P < 0.001 compared with TCC group. N/A: not available. TTC: transcatheter closure.

Total number (before 2010)

Total number (after 2010)

Sex

Female: 16; male: 15

Female: 12; male: 7

Age (years)

21.3 ± 17.3

16.7 ± 12.4

Average shunt size (mm)

5.1 ± 2.1

5.6 ± 2.0

Qp/Qs

1.9 ± 0.4

N/A

Procedure time (min)

58.9 ± 27.7

256.7 ± 60.5*

Hospital stay (days)

6.1 ± 0.8

17.0 ± 4.0*