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Percutaneous closure of ventricular septal defects in children: key parameters affecting patient radiation exposure
Raymond N Haddad1, Chadia Rizk2, Zakhia Saliba3
1Hotel Dieu de France University Medical Center, Department of Pediatrics, Saint Joseph University Beirut, Lebanon.
Insights
Radiation exposure during pediatric ventricular septal defect (VSD) closure varies significantly. Higher patient weight, more operators, complex device placement, and procedural incidents increase radiation dose in children undergoing VSD transcatheter closure.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Transcatheter closure of ventricular septal defects (VSD) is increasingly common.
- Data on factors influencing radiation exposure in pediatric VSD closure are limited.
Purpose of the Study:
- To comprehensively analyze parameters affecting pediatric radiation exposure during VSD interventional closure.
- To identify key factors influencing patient dose in this procedure.
Main Methods:
- Retrospective review of pediatric VSD cases treated between March 2016 and August 2019.
- Analysis of clinical, technical, and procedural parameters using multiple linear regression.
- Assessment of radiation exposure via total air kerma area product (PKA,T).
Main Results:
- 85 pediatric VSD cases were analyzed; 82.4% had perimembranous defects.
- Successful device implantation was achieved in 96.5% of cases.
- Increased PKA,T was significantly associated with higher patient weight, more operators, complex device positioning, and procedural incidents.
Conclusions:
- Radiation exposure during pediatric VSD percutaneous closure exhibits high variability.
- Patient weight, number of operators, device positioning complexity, and procedural incidents are key determinants of radiation dose.
- Age, device design, and delivery approach did not significantly impact radiation exposure.
Background:
Ventricular septal defect (VSD) transcatheter closure is gaining worldwide popularity despite its complexity. Reports on key factors affecting radiation exposure in children are scarce.
Aims:
This clinical study is the first to comprehensively analyze the impact of all relevant parameters on children's radiation exposure during VSD interventional closures.
Methods:
Between March 2016 and August 2019, all pediatric VSD cases percutaneously treated at a reference center for interventional congenital cardiology and equipped with a single-plane Innova 2100 X-ray unit were retrospectively reviewed. Multiple linear regression was performed to investigate the impact of clinical, technical, and procedural parameters on patients' radiation exposure assessed using total air kerma area product (PKA,T).
Results:
A total of 85 patients were included in this study and 82.4% had perimembranous defects. Device implantation was successful in 96.5% of cases. The procedure lasted for a median of 60 min with a median PKA,T of 19.6 Gy.cm2 (range, 1.1 to 244.8 Gy.cm2). Patients' weight (B = 1.679, P = 0.01), number of operators (B = 1.561, P = 0.02), device positioning complexity (B = 2.381, P = 0.002), and procedural incidents (B = 2.096, P = 0.008) significantly increased PKA,T. Patients' age (B = 1.053, P = 0.784), device design (B = -1.216, P = 0.780) and approach of delivery (B = -1.119, P = 0.511) did not significantly affect PKA,T.
Conclusions:
Radiation exposure in children undergoing VSD percutaneous closure was highly variable. A higher patient's weight, numbers of operators, complexity in device positioning, and procedural incidents, were identified as key factors increasing patient dose for this kind of intervention.
