How Do you Close a Ventricular Septal Defect (VSD)?
A ventricular septal defect (VSD) is a hole between the left and right ventricles.
To close a VSD a patient is placed under General Anaesthesia to protect their airway with a breathing tube. This is done so that they may remain on their back while an ultrasound probe is passed down their gullet (transesophageal echo, TOE) to provide close-up images of the heart to direct the procedure.
Access to the heart is gained by inserting two tubes under local anaesthetic into the femoral vessels, located at the top of the leg at the level of the skin fold of the hip. Access to the left side of the heart is through a tube in the femoral artery and access to the right side of the heart is through a tube in the femoral vein.
The tube is passed up the artery and through the aortic valve into the left ventricle. A wire is carefully directed through the pulmonary valve into the pulmonary artery. A second tube is passed from the femoral vein up to the right atrium, through the tricuspid valve into the right ventricle and then through the pulmonary valve into the pulmonary artery. A loop snare is used through the second tube to capture the end of the first wire and then to pull it back out of the femoral vein. This completes a loop of wire that passes into the body at the femoral artery, up to the heart and through the VSD before returning down the leg and out of the body through the femoral vein.
Once that wire loop is in place, a delivery tube is passed up to the heart and through the VSD form either the artery (left side) or vein (right side). The wire is then removed and the chosen VSD device is delivered to the heart. Once the first disc is deployed on the far side of wall between the ventricles, the tube is withdrawn to the wall and the second disc is deployed on the near side. Once the position has been confirmed on TOE and x-ray imaging, the device is released from the delivery cable and the tubes removed from the leg.
Over the next six months, the patient’s cells heal over the device incorporating it into the wall of the heart.
Dr McGaw has expertise in this procedure.