Trans-catheter Device Closure of Ruptured Sinus of Valsalva Aneurysms using PDA Occluder Devices

Abstract

Introduction: Ruptured Sinus of Valsalva (RSOV) is a rare congenital heart disease. Indian data regarding trans-catheter device closure of RSOV is limited. In the current study we aim to look at the feasibility of using a Patent Ductus Arteriosus (PDA) occluder device for this purpose as it is a much economical alternative to the conventional devices. Aim: To study the immediate and intermediate term follow-up after RSOV device closure using PDA device. Materials and Methods: This retrospective analysis, from a large tertiary care hospital in South India, included 24 patients who underwent trans-catheter device closure of RSOV between December 2004 and December 2017, mostly using PDA occluders devices. Patient demographics, clinical characteristics, procedural and device related variables; immediate outcomes during hospital stay were collected from medical records. Follow-up data for residual shunt and complications were also collected. For the descriptive analysis, all continuous variables are expressed as mean values and standard deviation or median with range as appropriate, and discrete variables are presented as percentages. Results: Of the 24 patients 75% were males; the mean age was 35 years (range: 12-61 years). Twenty three PDA occluders (Lifetech, Cardi-O-Fix) and 1-vascular plug were used in total. Successful device closure was achieved in 21 patients (87.5%) and the result was sustained at 6 months follow-up (median follow-up was 8 months). There was one procedure related mortality (immediate) due to aneurysm rupture, one patient was referred for surgical closure (one week after percutaneous procedure) due to persistent shunt across the defect and another referred for surgery due to device embolization (after 24 hours of the procedure). No other procedure related complications such as significant aortic regurgitation or coronary artery occlusion occurred. Conclusion: Trans-catheter device closure of RSOV using PDA device occluder is a safe, feasible, effective and economical modality of treatment with good short-term and intermediate outcomes. In carefully selected patients this provides an attractive alternative to surgical closure, thereby avoiding the inherent morbidity of sternotomy and cardiopulmonary bypass.

Keywords

• aortic regurgitation
• duct occluders
• ruptured aneurysm
• trans-catheter intervention