Innovative Transcatheter Ventricular Septal Defect Closure Utilizing an Atrial Septal Device in Small Infants: A Case Series

Ventricular septal defect (VSD) represents the most prevalent congenital anomaly within the pediatric population. Surgical intervention for closure was the prevailing standard until the late 1980s, when the first transcatheter closure was done. Subsequently, the device industry underwent a transformative evolution, marked by the introduction of a variety of devices aimed at facilitating VSD transcatheter closure. We hereby present two clinical cases involving small infants diagnosed with hemodynamically significant muscular VSD, employing an atrial septal device, accompanied by a detailed procedural description and the resultant outcomes. Presenting two infants were diagnosed with significant congestive heart failure and pulmonary hypertension secondary to large muscular VSD (Case 1, aged 11 months and weighing 5 kg, while Case 2 was 10 months and weighing 5.7 kg). Both patients were subsequently admitted to the catheterization laboratory, where diagnostic cardiac catheterization was performed. Following this, a successful transcatheter closure was achieved via an antegrade approach employing the Amplatzer™ Septal Occluder. In Case 1, six months post procedure, the residual shunt had resolved completely along with the pulmonary hypertension. In Case 2, at a 12-week follow-up, there was a significant decrease in the residual shunt and a reduction in pulmonary hypertension; however, tragically, four months subsequent to the intervention, the patient died due to a COVID-19 infection. The utilization of atrial septal occluders for the transcatheter closure of muscular VSD is achievable during infancy. The selection of an appropriate device size is essential, with the benefits associated with an antegrade approach.