A group of researchers from Turkey improved the health of an 18-year-old patient using a homemade fenestrated atrial septal occluder. They published their study in BioMed Central with the conclusion that their device was safe to use in conditions such as those presented by the patient.
The patient had a large mid-trabecular ventricular septal defect (a hole in one of the heart walls that allows blood leakage between chambers) and severe pulmonary hypertension. Hemodynamically significant muscular ventricular septal defects such as these are rare and are ideally treated with transcatheter closure. However, since the patient had high blood pressure, the researchers deemed it necessary to fenestrate (perforate) a device to place within the defect.
An examination of the patient with 2D echocardiography revealed a 22 mm diameter hole and enlarged chambers of the heart. Her blood pressure was elevated as a result of insufficient blood pumping.
To fix the issue, the researchers used a 24 mm diameter septal occluder. They created fenestrations using a sheath dilator and made 4.5-5 mm openings to alleviate the blood pressure.
After the procedure, the patient was monitored for hemolysis, but none was observed as a result of the device. She began to show improvements as soon as 4 days after the procedure and showed great improvements at a one-month follow-up. Out of all the major complications that could have occurred as a result of the surgery–including thromboembolism and death–the patient saw a nodal rhythm, or abnormal heart beat, twelve hours after the procedure, but a normal rhythm returned nine days later. The researchers attributed the abnormal rhythm to the somewhat larger size of the device relative to the defect.
The researchers were pioneers in their fenestrated device–no other literature-reported cases of ventricular septal defects with pulmonary hypertension have been treated with a fenestrated atrial septal occluder, and the success of this case study may allow the technique to be used in similar cases.