Transcatheter closure of muscular ventricular septal defect in infant with dilated cardiomyopathy

We describe an infant with prenatally diagnosed muscular ventricular septal defect (VSD) and dilated cardiomyopathy with clinical deterioration despite escalating medical therapy in whom successful transcatheter muscular VSD closure was achieved eliminating need to pursue cardiac transplantation. Correspondence to: Shelby C. White, Division of Pediatric Cardiology, University of Virginia Health System, PO Box 800386, Charlottesville, VA 22908, USA, Tel: (434) 924-9119, Fax: 424-924-5656, E-mail: [email protected] Received: May 20, 2017; Accepted: June 13, 2017; Published: June 16, 2017 Introduction Dilated Cardiomyopathy is the most common form of pediatric cardiomyopathy, with the majority of patients presenting in the first year of life [1]. Alexander et al. reported a 26% rate of death or transplant within the first year of diagnosis and worse survival among those diagnosed at less than 4 weeks of age [2]. Ventricular septal defects are the most common form of congenital heart disease, reports have described an incidence of 2% to 5% including small muscular defects [3]. Based on the size of the defect and the pulmonary vascular resistance, infants can manifest symptoms of heart failure from pulmonary overcirculation as early as 2 weeks of age. Muscular VSDs are difficult to close surgically due to the right ventricular trabeculations and the difficulty visualizing the defect from the right atrium [4,5]. We present a case of an infant born with dilated cardiomyopathy and a mid-muscular VSD with significant heart failure symptoms poorly responsive to medical therapy. This patient underwent transcatheter VSD device closure at 2 months of age with subsequent clinical improvement and normalization of ejection fraction.