MemoSorb® Fully Biodegradable Occluder: Case Report of Residual Shunt Following Surgical Repair of Atrial Septal Defect
MemoSorb® Fully Biodegradable Occluder: Case Report of Residual Shunt Following Surgical Repair of Atrial Septal Defect
Patient Introduction
Gender：Female
Age：33
Medical History：The patient presented with dizziness and palpitations after activity three months ago. Transthoracic echocardiography revealed "ventricular septal defect." She has a history of frequent colds but no cyanosis of lips or extremities. There is no nocturnal dyspnea, orthopnea, syncope, or episodes of blurred vision. Compared to peers, her growth, development, and exercise tolerance are below average. On April 3, 2024, echocardiography diagnosed a muscular ventricular septal defect with a defect distance of about 0.3 cm. Subsequent VSD repair surgery was performed in the cardiac surgery department. The patient occasionally experienced chest pain lasting 10-15 seconds, which resolved on its own.
Follow-up after surgical repair of ventricular septal defect:
One month after ventricular septal defect repair surgery, echocardiography showed increased echogenicity at the repair site without evidence of residual shunt.
Three months after ventricular septal defect repair surgery, echocardiography revealed increased echogenicity at the repair site. There was continuous interruption seen in the interventricular septum, with left-to-right shunting visible. Due to the defect's proximity to the valve and considering the patient's condition, it was decided to use a fully biodegradable occluder for interventional treatment
Clinical Strategy
Umbrella Selection Consideration：(Classification) Muscular-type ventricular septal defect, observed via ultrasound around the 11 o'clock position. Considering that muscular-type ventricular septal defects are located at the junction of the atrial and ventricular septa, close to the aortic valve, using conventional metal occluders can lead to wear on the aortic valve and valve regurgitation. Therefore, a fully biodegradable occluder was chosen for closur.
Surgical Strategy：Interventional closure via femoral approach. Initially planned to use the ABFDQ-II 8 occluder with a 10F sheath, but during the procedure, it was found that the ABFDQ-II 8 tended to prolapse into the right ventricle. Therefore, a switch was made to the ABFDQ-II 10 occluder with a 10F sheath.
Conclusion of Specifications Selection：ABFDQ-II 10 occluder with a 10F sheath was selected for the procedure
Insertion of guidewire and catheter from the femoral artery into the pulmonary artery
Guidewire and catheter insertion from the femoral vein into the pulmonary artery
Using a snare device to retrieve the guidewire and establish a complete arteriovenous pathway
Release the left disk
Retrieve left disk along the guidewire
Release the left disk
Release the left disk
The left disk abuts against the interventricular septum
Release the right disk
The left and right disks straddle across the interventricular septum
Both discs of the occluder are fully deployed
Confirm under DSA
Confirm under ultrasound-guided echocardiography
Case Summary
Following surgical repair of a ventricular septal defect (VSD), residual leakage can impact the patient in various physiological, symptomatic, complication risk, treatment considerations, and prognosis aspects. Significant residual leaks may necessitate further surgery or interventional treatment.
The muscular-type VSD observed under ultrasound was located between the 11:30 to 1:30 positions, with shunting mostly perpendicular to the interventricular septum. Its proximity to the aortic and pulmonary valves posed challenges during interventional procedures, necessitating the use of guidewire retention technique to establish a complete delivery pathway, facilitating umbrella replacement during surgery.
During conventional interventional procedures, using traditional metal occluders to seal muscular-type VSDs can adversely affect aortic valve function, leading to regurgitation. Regurgitation not only impacts cardiac function but also increases the risk of postoperative complications. Fully biodegradable occluders offer excellent material flexibility and biocompatibility, conforming better to the septum, reducing wear and tear, and minimizing valve impact, thereby lowering regurgitation risks
Due to the potential underestimation of the diameter of muscular VSDs and inadequate support at the upper margin of the defect, predicting the occluder size preoperatively can be challenging, often requiring larger sizes to ensure effective closure. The availability of 40 sizes of fully biodegradable occluders accommodates various defect sizes, ensuring better wall apposition
Special thanks to Dr. Yongwen Qin and Dr. Yuan Bai from the Cardiovascular Department of Shanghai Changhai Hospital for sharing this case.
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