Transcatheter Closure of Ventricular Septal Defects

Comment In this retrospective review of 70 consecutive transcatheter ventricular septal defect (VSD) closures performed at the Boston Children's Hospital by an experienced team of pediatric interventional cardiologists and pediatric cardiac anesthesiologists, anesthesiology generalists learn the following practical tips from anesthesiology super-specialists. 1) Anesthesiologists can anticipate new clients in all of the interventional medical fields, where new closed procedures may offer our patients more comfort postanesthetically, more cost-effectiveness, and equal success but no less morbidity in terms of hemodynamic instability, blood replacement, or duration of procedure than open surgery. 2) The smallest infants (less than 10 kg) remain the most difficult to manage and lose the most blood. As a corollary, blood loss during pediatric cardiac catheterizations can often be surreptitious and massive. 3) Even superspecialists can start off on the wrong foot by selecting intravenous sedation for prolonged (3–9 hr) and, usually, multiple (1–2 cardiac catheterizations, transesophageal echocardiography, jugular venous cannulation) procedures in children; balanced general endotracheal anesthetics are now recommended. 4) Positioning problems can plague all prolonged cases, regardless of anesthetic or surgical techniques, with brachial plexus hyperextension for cardiac fluoroscopy and sacral decubiti from hard x-ray tables being unique to interventional cardiac catheterizations. 5) ASA physical status, type of septal defect, and patient size are not significantly