ABC Imagem Cardiovasc. 2025; 38(3): e20250065
Role of Transthoracic Echocardiography in Percutaneous Closure of Ventricular Septal Defect
DOI: 10.36660/abcimg.20250065i
Abstract
Ventricular septal defect (VSD) is the most common congenital heart defect, and its management has evolved with percutaneous closure, a minimally invasive alternative to surgery. In this context, echocardiography has established itself as the primary imaging tool, crucial in all phases of the procedure. Transthoracic echocardiography (TTE) is essential for diagnosis, anatomical classification (perimembranous, muscular, inlet and outlet), initial hemodynamic assessment, and long-term follow-up. Indication for closure is based on such criteria as the left ventricular (LV) volume overload, with Qp:Qs ≥ 1.5:1. For detailed planning and intraprocedural guidance, transesophageal echocardiography (TEE), especially with three-dimensional (3D) reconstruction, is the gold standard. 3D TEE offers an accurate measurement of defect diameters, a border analysis for safe device anchorage, and an assessment of the relationship with adjacent structures, such as the aortic and tricuspid valves. The success of the intervention, both in congenital VSDs and in the rare and complex post-infarction VSDs, depends directly on the quality of the echocardiographic evaluation. The multimodal approach, which integrates TTE and TEE, ensures appropriate patient selection and safe procedure management, optimizing outcomes and expanding the realms of percutaneous VSD treatment.
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