Al Shamaileh Cardiology Clinic
Dr. Qasem Al Shamaileh is a consultant in cardiology and interventional cardiology. His practice includes coronary and valve assessment, selection of appropriat…
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Ventricular septal defect (VSD) closure Doctors in Jordan
إغلاق الفتحة بين البُطينين
Transcatheter closure of a ventricular septal defect seals a hole in the wall between the two lower heart chambers with a small occluder device, delivered folded inside a catheter from a vessel in the upper thigh into the heart and then opened to grip the defect from both sides. The procedure is guided by X-ray and echocardiography. In some very small children it is performed as a hybrid approach together with a cardiac surgeon through a small chest incision, still avoiding the cardiopulmonary bypass machine. A ventricular septal defect drives blood from the high-pressure left ventricle into the right and on to the lungs, increasing the load on heart and lungs when it is large: rapid breathing, sweating during feeds and poor growth in infants, or breathlessness and fatigue on exertion in older patients. One point must be understood, however: **not every ventricular septal defect needs closing.** Many small defects close spontaneously during childhood or remain without any effect on heart size or pulmonary pressure, and the correct management is periodic follow-up and dental infection prevention rather than intervention. The limits of catheter closure are equally explicit: **it suits only specific types** — particularly defects in the muscular part of the septum, and selected cases of the type near the membranous area with adequate rims. Large defects, those lying against the valves, those in certain septal positions, and defects accompanied by other lesions needing repair are better treated by open-heart surgery. The procedure also **does not treat pulmonary hypertension once it has become advanced and fixed**, and is not appropriate at every age or weight. Suitability is determined by clinical assessment and detailed echocardiography, not by reading. An important consideration is that the heart's electrical conduction system runs through the ventricular septum, so conduction can be affected and a permanent pacemaker is needed in a small number of cases. A small residual leak, an effect on a neighbouring valve, or breakdown of red blood cells when blood jets through the device may also occur. **Seek emergency care immediately for fainting, severe dizziness or a noticeably slow pulse, tea-coloured or cola-coloured urine, increasing breathlessness, or fever with chills.**
1 specialists
Procedure steps
- 1
Defining the type and position of the defect
A detailed echocardiogram defines where the defect lies in the septum, its diameter and its relationship to the valves, and measures its effect on chamber size and pulmonary pressure. These details decide between simple follow-up, catheter closure, or open-heart surgery.
- 2
Anaesthesia and access to the heart
The procedure is usually performed under general anaesthesia, and a sheath is placed in a vessel in the upper thigh. Right-sided and pulmonary artery pressures are measured first, and the left ventricle is imaged to see the defect precisely and choose the appropriate device size.
- 3
Crossing the defect and establishing the delivery track
A fine wire is passed across the defect from one side to the other, establishing a track along which the occluder is delivered precisely to its position. This is the most delicate step and may take time; the ECG is watched closely because the work lies near the conduction pathway.
- 4
Deploying the device and echo verification
The device is opened on both sides of the septum, then the team confirms by echocardiography and angiography that it sits stably, does not impinge on a neighbouring valve, and leaves only trivial residual flow. It is released from the delivery system only once these checks are complete.
- 5
Post-procedure conduction monitoring
Continuous ECG monitoring follows, because conduction disturbance can appear hours or days later, and urine colour, the access site and blood results are checked. An echocardiogram is done before discharge, and repeat ECGs are scheduled over the following weeks.
Before the procedure
Tell your doctor about every medicine you take, especially anticoagulants and antiplatelet drugs, since some are adjusted before the procedure on the doctor's instruction alone; never stop a medicine yourself. Report your kidney function if you have a recent result, and any previous reaction to X-ray contrast, iodine or metals. Raise any active infection before the date — gum infection, a dental abscess, or a urinary, chest or skin infection — because implanting a device inside the heart while infection is present is hazardous and is better postponed and treated first. Follow the fasting instructions exactly, especially for children. Bring previous echocardiogram and ECG reports and the child's growth record, say if you are or might be pregnant, and arrange for a stay of one night or more with a companion to remain with the child.
After the procedure
Watch the groin puncture site, keep the dressing clean and dry, and avoid strenuous effort and lifting in the first days as advised. Check urine colour during the first days. **Go to the emergency department immediately for: tea- or cola-coloured urine with pallor or marked fatigue; fainting, severe dizziness or a noticeably slow pulse; new persistent palpitations; increasing breathlessness, or in a child rapid breathing with sweating and refusal to feed; increasing swelling, bleeding or severe pain at the access site; a cold or blue leg; or fever with chills and night sweats — which may indicate infection inside the heart, so do not start an antibiotic yourself before being examined.** **Do not stop or alter the antiplatelet medicine prescribed after the device on your own, not even for a tooth extraction; the doctor who implanted it decides.** Tell every dentist and surgeon about the device, and keep all ECG and echocardiogram appointments, since conduction monitoring continues after discharge.
Expected duration
Usually one to two hours, longer when crossing the defect is difficult or its position is complex, followed by one to three days of in-hospital cardiac rhythm monitoring because conduction disturbance can appear late, with an echocardiogram before discharge.
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