Anesthetic challenge for ventricular septal defect closure in cardiac catheterization laboratories

ABSTRACT

Transcatheter device closure has been used to close ventricular septal defects with satisfactory results. We report our initial experience with ventricular septal defect [VSD] device closure from January 2003 to April 2006 using the new Amplatzer perimembranous and muscular ventricular septal occluders in Cardiac Catheterization Laboratories [CCL]. During this period, we closed 42 VSD's percutaneously, 25 perimembranous and 15 muscular under general anesthesia. Two patients were excluded for technical causes. The mean age was [10.00 +/- 09.10] years [range 2-33 years], mean weight of [28.19 +/- 19.86] kg [range from 10-84 kg], 18 males and 22 females. Duration of procedures ranged from 46-310 minutes with the mean time of [147.80 +/- 72.67 minutes], 18 patients developed significant hypotension, two of them needed blood transfusion, 8 patients developed significant arrhythmia which needed intervention, 7 patients developed hypothermia and active warming was needed, one patient developed brachial plexus injury post procedure, pediatric intensive care [PICU] admission was needed in 13 patients, No deaths occurred, no air embolism, no haemothorax, and no cardiac tamponade or there were no late morbidity due to catheterization-related events. Hemodynamic instability and hypothermia were common during device closure of VSDs, and were likely to be inescapable features of these procedures in many patients because of the technique necessary for device placement