Impact of percutaneous ventricular septal defect closure on left ventricular remodeling and function

Ventricular septal defect (VSD) is the most common congenital heart disease. In patients with large VSD, left side chambers are subjected to volume overload with subsequent chambers dilatation and eccentric left ventricular hypertrophy. Percutaneous closure of VSD has been shown to be an effective method with equal safety and efficacy when compared to surgery. The effect of VSD closure on LV remodeling has been mainly assessed in patients treated with surgery and to date published data remain scarce. Therefore, we aim to evaluate the effect of percutaneous VSD closure on different LV parameters.

Seventeen patients (median age 6 years (IQR 4.75-8 years), 70.6% females) who underwent percutaneous VSD closure were enrolled in the study. Sixteen patients (94%) had perimembranous VSD, and one patient had muscular VSD. The procedure was successful in all patients with no major complications. Nit Occlud® Lê coil device was implanted in 16 patients (94%), and one patient received Amplatzer PDA duct occlude device. At 6-months follow-up, there was a significant reduction in indexed LV dimensions [LVEDD/BSA (median 46.5 mm/m² vs. 42.9 mm/m², p = 0.03), LVESD/BSA (median 31.7 mm/m² vs. 26.7 mm/m², p = 0.02)], indexed LV volumes [LVEDV/BSA (median 52.6 ml/m² vs. 37.3 ml/m², p = 0.02), LVESV/BSA (median 31.7 ml/m² vs. 23.3 ml/m², p = 0.02)] and indexed LV mass (median 62.4 gm/m² vs. 57.9 ml/m², p = 0.01). There was a significant reduction in LVEDD Z-score (p = 0.01) and LVESD Z-score (p = 0.04). There was no significant change in LV EF.

Percutaneous VSD closure is associated with improvement of various LV parameters with consequential favorable LV remodeling and function.