J Cardiovasc Imaging.  2018 Sep;26(3):165-174. 10.4250/jcvi.2018.26.e19.

Early Experiences Using Cocoon Occluders for Closure of a Ventricular Septal Defect

• Park H
• Song J
• Kim ES
• Huh J
• Kang IS

• KMID: 2429858
• DOI: http://doi.org/10.4250/jcvi.2018.26.e19

Abstract

BACKGROUND
Transcatheter device closure of ventricular septal defect (VSD) has become an attractive alternative to surgery. We report here on our early experiences of transcatheter closure of VSD using Cocoon devices, which are now available in Korea.
METHODS
We reviewed the medical records and angiographic images of 13 patients who underwent transcatheter closure of VSD with a Cocoon occluder at Samsung Medical Center. The median patient age was 5.8 years, and the median patient weight was 20.3 kg.
RESULTS
The device was successfully implanted in all patients. The follow-up period was 10 ± 6 months, and no mortality was observed. An immediate residual leak on the next day was detected in 7 patients (including 4 with perimembranous VSD). However, 6 months later, a residual leak was observed only in 2 patients with perimembranous VSD and 1 patient with muscular VSD. Early conduction abnormalities were observed in 3 patients, all of whom had perimembranous VSD, but no significant complete atrioventricular block was observed. One patient experienced newly developed significant aortic regurgitation that decreased spontaneously but still existed at the 6 month follow-up. No hemolysis or embolization was noted on the next day or during the follow-up period.
CONCLUSIONS
Cocoon devices can be used safely and effectively for VSD closure. However, residual leaks and conduction abnormalities may occur early after implantation, especially in patients with perimembranous VSD. Although normal conduction was recovered, long-term evaluation remains essential.

Keyword

Heart septal defects; Ventricular; Cardiac catheterization; Septal device occluder

MeSH Terms

Aortic Valve Insufficiency
Atrioventricular Block
Cardiac Catheterization
Follow-Up Studies
Heart Septal Defects
Heart Septal Defects, Ventricular*
Hemolysis
Humans
Korea
Medical Records
Mortality

Figure

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  Figure 1 Cocoon occluders. Membranous type VSD occluder (A), muscular type VSD occluder (B), aneurysmal type VSD occluder (C), and duct occluder (D).

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  Figure 2 Abnormal electrocardiograms after device closure. Accelerated junctional rhythm in patient No. 7 (A), right bundle branch block in patient No. 2 (B), and PR and QRS prolongation in patient No. 5 (C).

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  Figure 3 Transthoracic echocardiogram after the procedure. 4 chamber view (A), parasternal long axis view (B), parasternal short axis view (C), color Doppler image of parasternal short axis view (D).

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