Muscular ventricular septal defect closure with Gianturco coil at Soetomo hospital (a case report)

Abstract

Ventricular septal defect (VSD) is the most common congenital heart disease (CHD) in children.1'2 It occurs in 1.5 to 3.5 of 1,000 live births and constitutes 20% of congenital cardiac defects.1 The VSD may be small, medium or large and is classified based on its location in the interventricular septum. There are four types of VSD, i.e., perimembranous (80% ofVSDs), muscular type (5% to 20%) inlet or AV canal type (8%), and finally, subpulmonary (5% to 7%).1-4 When multiple muscular defects are seen, it is often referred to as "Swiss-cheese" type of VSD. 1•2 The management strategies, which consist of medical, surgical and intervention techniques, depend to a large degree on the size of the VSD.1-4 Approximately 40% of VSDs spontaneously and completely closed, with closure rates approaching 80-90% by age 2 years.2 Indication ofVSD closure are symptoms of heart failure, left heart chambers overload and history of endocarditis. The surgical approach is considered gold standard but it is associated with morbidity and mortality, high cost, patient discomfort, sternostomy and skin scar.3 Since 1988, percutaneous techniques have been conducted in order to reduce those drawbacks of surgery. More recently, percutaneous techniques and devices have been developed specifically for closure of muscular VSD (m VSD) and perimembranous VSD (pm VSD) using either the Rashkind double umbrella, the Bard Clamshell, the Button device, theAmplatzer septal, duct 118 • Paediatr lrulones, Vol. 50, No. 2, March 2010 or muscular VSD occluder, or the Gianturco coils.3A Gianturco coils have been widely used to close unwanted vascular communications and small- to moderate- sized patent ductus arteriosus, with excellent closure rates. In 1999, Latiff et al successfully used this coil to close multiple muscular VSDs in a 10-month old boy. Thus, percutaneuos closure of VSDs using Gianturco coils is a feasible, reasonable alternative to surgery.5'6 We report a case of fouryear- old girl with muscular VSD who underwent cardiac catheterization and transcatheter closure with Gianturo coil in Dr. Soetomo Hospital, Surabaya.