What is the best test for detecting a ventricular septal defect (VSD) after stent placement?

From the Guidelines

The best test for evaluating a ventricular septal defect (VSD) after stent placement is transthoracic echocardiography (TTE). This non-invasive imaging modality provides excellent visualization of the VSD repair site, allowing assessment of stent position, residual shunting, and overall cardiac function 1. According to the 2020 ACC/AHA/ASE/HRS/ISACHD/SCAI/SCCT/SCMR/SOPE appropriate use criteria, TTE is considered appropriate for routine postprocedural evaluation within 30 days after surgical or catheter-based VSD closure 1.

Key Considerations

• TTE should be performed within 24 hours post-procedure, then at 1 month, 6 months, and annually thereafter.
• If TTE images are suboptimal due to poor acoustic windows, transesophageal echocardiography (TEE) may be necessary for better visualization 1.
• In some cases, cardiac MRI serves as a complementary test to quantify residual shunting more precisely.
• Cardiac CT angiography might be considered when stent integrity needs evaluation, though it involves radiation exposure.
• Doppler assessment during echocardiography is particularly valuable for detecting and quantifying any residual shunting across the VSD repair site, which is crucial for determining the success of the stent placement procedure 1.

Surveillance Recommendations

• Routine surveillance within a year following surgical or device VSD closure in an asymptomatic patient with no or mild sequelae is recommended 1.
• Annual surveillance may be necessary for patients with significant residual shunt, valvular or ventricular dysfunction, arrhythmias, and/or pulmonary hypertension 1.

From the Research

Best Test for VSD after Stent Placement

The best test for detecting ventricular septal defects (VSDs) after stent placement is a topic of interest in the medical field. Based on the available evidence, the following points can be considered:

• Transesophageal echocardiography (TEE) has been shown to be effective in identifying intramural VSDs, with a sensitivity of 56% and specificity of 100% 2.
• TEE can also detect peripatch VSDs, with a sensitivity of 63% and specificity of 92% 2.
• Echo-Doppler studies are essential for assessing the defect's clinical significance and determining the need for intervention 3.
• Color Doppler examination has been shown to be effective in detecting and localizing VSDs, with a detection rate of 86% 4.
• Intraoperative transesophageal echocardiography (IOTEE) can be used to assess for residual defect and the need to return to bypass after repair of VSD, with a frequency of residual VSD of one-third in patients evaluated 5.
• IOTEE can also be used to evaluate the size of residual VSD and predict the need for immediate reoperation, with a residual defect measuring > or = 4 mm predicting the need for immediate reoperation 5.
• TEE findings in patients with VSD before and after closure have been evaluated, with preoperative results showing anatomic findings and aortic regurgitation associated with VSD 6.

Key Findings

• TEE is a useful tool for detecting VSDs after stent placement.
• Echo-Doppler studies are essential for assessing the defect's clinical significance.
• Color Doppler examination is effective in detecting and localizing VSDs.
• IOTEE can be used to assess for residual defect and predict the need for immediate reoperation.
• TEE findings can provide valuable information on anatomic findings and aortic regurgitation associated with VSD.

Diagnostic Options

• Transesophageal echocardiography (TEE)
• Echo-Doppler studies
• Color Doppler examination
• Intraoperative transesophageal echocardiography (IOTEE)
• Transthoracic echocardiography (TTE)