Transcatheter closure of ruptured sinus of Valsalva aneurysm using the Amplatzer duct occluder: Immediate and intermediate-term results

  • Prof Prafulla Kerkar, King Edward VII Memorial Hospital, Parel. Mumbai 400 012, India
  • Prof Prasanna Nyayadhish, King Edward VII Memorial Hospital, Parel, Mumbai 400 012, India
  • Dr Charan Lanjewar, King Edward VII Memorial Hospital, Parel, Mumbai 400 012, India
  • Dr Nidheesh Mishra, King Edward VII Memorial Hospital, Parel, Mumbai 400 012, India
  • Dr Milind Phadke, King Edward VII Memorial Hospital, Parel, Mumbai 400 012, India
  • Dr Gaurav Verma, King Edward VII Memorial Hospital, Parel, Mumbai 400 012, India
  • Dr Amit Sharma, King Edward VII Memorial Hospital, Parel, Mumbai 400 012, India
  • Dr Isaac Mammen, King Edward VII Memorial Hospital, Parel, Mumbai 400 012, India

    • Objective

    To assess the immediate and intermediate-term results of transcatheter closure (TCC) of congenital ruptured sinus of Valsalva aneurysm (RSVA)

    Methods

    Between July 2004 and January 2009, TCC of RSVA was attempted in 17 patients (8F/9M, aged 17-47 years). Most (10/17) were in NYHA Class III or IV. Three had previous surgeries for CAD, VSD and RSVA. None had associated defects requiring surgery. Echocardiography revealed RSVA from right coronary sinus to RA in 3 and RV outflow in 4, while noncoronary sinus ruptured into RA in 9 and RV inflow in 1. The echo/angio estimated diameter of the defect at its aortic end was 4-11 mm. After establishing an arterio-venous wire loop, a 2-4 mm larger Amplatzer duct occluder (ADO) was deployed by venous approach, ensuring closure at aortic end and non-encroachment on aortic valve/coronaries by online TEE/angiography.

    Results

    The ADO deployment failed in 2 {large defect size (11 mm) in one and significant procedure-related AR (PRAR) in other}. Of 15 successful deployments, 10 had complete closure at 24 hours. Five had residual shunts (4 small, 1 moderate with self-abating hemolysis). Trace PRAR occurred in 4. On a median follow-up of 26 months, 12 patients were in Class I and 3 in Class II. Residual shunts disappeared in 2 and were small in 3; PRAR vanished in 3 of 4. There was no AR progression, recurrence or infective endocarditis.

    Conclusions

    Thus, TCC of RSVA using ADO is a safe and effective alternative to surgery. However, a longer follow-up is warranted.