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.