A nitinol device for closing muscular<unk> s, 4 mm diameter in the centre. It is shown mounted on the catheter into which it will be withdrawn during insertion. Most cases do not need treatment and heal during the first years of life. Treatment is either conservative or surgical. Smaller congenital<unk> s often close on their own, as the heart grows, and in such cases may be treated conservatively. Some cases may necessitate surgical intervention, i.e. with the following indications: # Failure of congestive cardiac failure to respond to medications #<unk>  with pulmonic stenosis # Large<unk>  with pulmonary hypertension #<unk>  with aortic regurgitation For the surgical procedure, a heart-lung machine is required and a median sternotomy is performed. Percutaneous endovascular procedures are less invasive and can be done on a beating heart, but are only suitable for certain patients. Repair of most<unk> s is complicated by the fact that the conducting system of the heart is in the immediate vicinity.<unk>  septum defect in infants is initially treated medically with cardiac glycosides (e.g., digoxin 10-20 μg/kg per day), loop diuretics (e.g., furosemide 1–3 mg/kg per day) and ACE inhibitors (e.g., captopril 0.5–2 mg/kg per day). Transcatheter closure A device, known as the Amplatzer muscular<unk>  occluder, may be used to close certain<unk> s. It was initially approved in 2009. It appears to work well and be safe. The cost is also lower than having open heart surgery. The device is placed through a small incision in the groin. The Amplatzer septal occluder was shown to have full closure of the<unk>  defect within the 24 hours of placement. It has a low risk of embolism after implantation. Some tricuspid valve regurgitation was shown after the procedure that could possibly be due from the right<unk>  disc. There have been some reports that the Amplatzer septal occluder may cause life-threatening erosion of the tissue inside the heart. This occurs in one percent of people implanted with the device and requires immediate open-heart surgery. This erosion occurs due to improper sizing of the device resulting with it being too large for the defect, causing rubbing of the septal tissue and erosion. Surgery Surgical closure of a Perimembranous<unk>  is performed on cardiopulmonary bypass with ischemic arrest. Patients are usually cooled to 28 degrees. Percutaneous Device closure of these defects is rarely performed in the United States because of the reported incidence of both early and late onset complete heart block after device closure, presumably secondary to device trauma to the AV node. Surgical exposure is achieved through the right atrium. The tricuspid valve septal leaflet is retracted or incised to expose the defect margins. Several patch materials are available, including native pericardium, bovine pericardium, PTFE (Gore-Tex or Impra), or Dacron. Suture techniques include horizontal pledgeted mattress sutures, and running polypropylene suture. Critical attention is necessary to avoid injury to the conduction system located on the left<unk>  side of the interventricular septum near the papillary muscle of the conus. Care is taken to avoid injury to the aortic valve with sutures. Once the repair is complete, the heart is extensively deaired by venting blood through the aortic cardioplegia site, and by infusing Carbon Dioxide into the operative field to displace air. Intraoperative transesophageal echocardiography is used to confirm secure closure of the<unk> , normal function of the aortic and tricuspid valves, good<unk>  function, and the elimination of all air from the left side of the heart. The sternum, fascia and skin are closed, with potential placement of a local anesthetic infusion catheter under the fascia, to enhance postoperative pain control. Multiple muscular<unk> s are a challenge to close, achieving a complete closure can be aided by the use of fluorescein dye.
Ventricular septal defect
Heart septal defect
Atrioventricular septal defect
Atrial septal defect
Aortopulmonary septal defect
Tricuspid atresia
Double aortic arch
Double inlet left ventricle