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Practice Patterns in the Management of Pressure Restrictive Perimembranous Ventricular Septal Defects: A

Abdulrahman Alkanhal1,2, Robin Ducas3, Andrew S Mackie1

  • 1Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, 8440-112th St. NW, Edmonton, AB, T6G 2B7, Canada.

Pediatric Cardiology
|December 20, 2022
PubMed

Insights

Practice patterns for closing perimembranous ventricular septal defects (pmVSD) vary globally. US pediatric cardiologists show a lower threshold for pmVSD closure, particularly concerning left ventricular dilation and flow ratios.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Disease
  • Echocardiography

Background:

  • Indications for closing pressure restrictive perimembranous ventricular septal defects (pmVSD) in children are not standardized.
  • Practice variability exists among international pediatric cardiologists regarding pmVSD closure criteria.

Purpose of the Study:

  • To assess practice patterns and variability among pediatric cardiologists in the US, Canada, Australia, and New Zealand concerning pmVSD closure.
  • To identify common indications and thresholds for intervention in pressure restrictive pmVSDs.

Main Methods:

  • A survey was distributed to pediatric cardiologists in the US, Canada, Australia, and New Zealand.
  • The survey included case vignettes with progressive disease severity to ascertain practice patterns.
  • Respondents' practice patterns were analyzed based on country of practice and demographic factors.

Main Results:

  • Left ventricular (LV) dilation (z-score ≥ 2) and significant pulmonary-systemic flow ratio (QP:QS ≥ 1.5:1) were common indications for pmVSD closure.
  • US pediatric cardiologists demonstrated lower thresholds for LV dilation (z-score) and QP:QS ratio for pmVSD closure compared to other countries.
  • Right coronary cusp prolapse with stable or progressive aortic regurgitation was also a factor influencing closure decisions.

Conclusions:

  • Common indications for pressure restrictive pmVSD closure include LV dilation, volume loading, and aortic valve prolapse with regurgitation.
  • Significant practice variability exists in the thresholds for pmVSD closure among international pediatric cardiologists.
  • US pediatric cardiologists may have a lower threshold for intervening in pressure restrictive pmVSDs.

Keywords:
Congenital heart defectsPercutaneous closurePressure restrictive perimembranous ventricular septal defectsVentricular heart septal defects

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