Percutaneous closure of ventricular septal defects in children aged <12: early and mid-term results
Gianfranco Butera1, Mario Carminati, Massimo Chessa
1Department of Pediatric Cardiology and Cardiac Surgery, Istituto Policlinico San Donato, Via Morandi, 30, 20097 San Donato Milanese, Italy. gianfra.but@lycos.com
Insights
Percutaneous closure of muscular ventricular septal defects (mVSD) and perimembranous ventricular septal defects (pmVSD) in children is safe and effective. Complete atrioventricular block is a significant concern in young children with pmVSD.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Ventricular septal defects (VSDs) are common congenital heart abnormalities.
- Muscular (mVSD) and perimembranous (pmVSD) VSDs require effective treatment strategies.
- Percutaneous closure offers a minimally invasive alternative to surgical repair.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous closure for pediatric mVSD and pmVSD.
- To assess the follow-up outcomes, including complications, of these procedures.
- To identify risk factors associated with adverse events, particularly complete atrioventricular block (cAVB).
Main Methods:
- Retrospective analysis of 140 pediatric patients undergoing percutaneous VSD closure (mVSD and pmVSD) between 2000 and 2005.
- Utilized Amplatzer occluders specifically designed for mVSD and pmVSD.
- Assessed procedural success, early complications, and long-term outcomes during a median 24-month follow-up.
Main Results:
- Successful percutaneous closure was achieved in 94% of patients.
- Early complications occurred in 14.7%, including device embolization and vascular issues.
- Complete atrioventricular block (cAVB) requiring pacemaker implantation occurred in 1.1% early and 3.4% during follow-up, with younger age being a risk factor for cAVB.
Conclusions:
- Percutaneous closure of pediatric mVSD and pmVSD is a safe and successful intervention.
- Younger children with pmVSD are at higher risk for developing cAVB post-procedure.
- Careful patient selection and monitoring are crucial for optimizing outcomes in pediatric VSD percutaneous closure.
Aims:
The aim of the article is to study the safety, efficacy, and follow-up of percutaneous closure of muscular ventricular septal defect (mVSD) and perimembranous ventricular septal defect (pmVSD) in children.
Methods And Results:
Between January 2000 and June 2005, among 140 patients who underwent percutaneous closure of an mVSD or a pmVSD, 88 were aged lt;12. Two different Amplatzer devices were used: the mVSD occluder and the pmVSD occluder. Mean age and weight at procedure were 4.5+/-3.3 years and 18.7+/-11.2 kg, respectively. Percutaneous closure was successfully achieved in 83 subjects (94%). No deaths occurred. Thirteen patients (14.7%) had early complications: device embolization (n=4), vascular complications (n=3), and rhythm abnormalities (n=6). These were transient complications in all but one case [1.1% complete atrioventricular block (cAVB) needing pacemaker implantation]. During a median follow-up of 24 months, three subjects treated for a pmVSD needed pacemaker implantation due to the occurrence of cAVB. Multivariable analysis using Cox's proportional hazard regression showed that age was the only risk factor associated with the occurrence of cAVB (P=0.028; relative risk: 0.25).
Conclusion:
Percutaneous closure of mVSD and pmVSD in children can be performed safely and successfully. The occurrence of cAVB is a major concern in young children with pmVSD.
