Technical considerations for ventricular septal defect device closure using cocoon occluders at tertiary care center in Pakistan

Amjad Mahmood; Khurram Akhtar; Filza Tariq; Nadeem Sadiq; Andaleeeb Ara; Sana Imtiaz; Mehboob Sultan; Hajira Akbar

Objective: Transcatheter device closure of ventricular septal defect (VSD) is now a day's safe and feasible alternative to surgery in most of cases. Ventricular septal defect device closure with cocoon occluders is technically very suitable due to device geometry and compliance. We are presenting our experience with these occluders in our centre. Study Design: Retrospective cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology, Rawalpindi, from Jan 2020 to Apr 2021. Methodology: We analysed the Cath data and video clips of 13 patients who underwent transcatheter closure of ventricular septal defect with Cocoon occluders at our tertiary care centre. The median patient age was 14 years 6 months, and the median patient weight was 28.2kg. Average ventricular septal defect size was 5.36 mm, Average contrast used was 60ml with fluoro time 15.3 minutes, Male to female ratio was 10:8, Two types of devices (perimembranous and muscular) were used. Minimum device size was 6/4 while maximum 10/7. Three ventricular septal defect devices were used for PDA. Results: All devices were successfully implanted in all patients. The follow-up period was 12 months, and no mortality was noted. In one patients ventricular septal defect cocoon device was used for PDA closure. No complication was observed in all the patients. No immediate residual leak was detected in all patients with perimembranous ventricular septal defect. There was no device embolization and No heart blocks were noted following device closures. Conclusion: Cocoon devices can be used safely and effectively for ventricular septal defect. Selection of cases is of ultimate importance for optimal results. Although this is one year follow up. Later follow up will elaborate more on the long term results and suitability of these devices.