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Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
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Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure

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Risk Factors of Long-Term Sequelae After Transcatheter Closure of Perimembranous Ventricular Septal Defect in Young

Chia-Yi Chin1,2, Chun-An Chen3, Chun-Min Fu3

  • 1Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine.

Circulation Journal : Official Journal of the Japanese Circulation Society
|February 7, 2024
PubMed

Insights

Transcatheter closure of perimembranous ventricular septal defects (pmVSD) is effective, but larger defects (≥4.5 mm) risk residual shunts. Younger children (<4 years) and specific VSD types face higher aortic regurgitation risks post-procedure.

Area of Science:

  • Pediatric Cardiology
  • Interventional Cardiology
  • Congenital Heart Disease

Background:

  • Transcatheter closure is a common treatment for perimembranous ventricular septal defects (pmVSD) in children.
  • Complications like residual shunts and aortic regurgitation (AR) can occur, but risk factors are not fully understood.
  • Identifying these factors is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To identify risk factors associated with residual shunts and AR after transcatheter closure of pmVSD in children aged 2-12 years.
  • To improve the safety and efficacy of pmVSD closure procedures.
  • To guide clinical decision-making for pediatric pmVSD management.

Main Methods:

  • Retrospective analysis of 63 children with pmVSD who underwent transcatheter closure (2011-2018).
  • Inclusion criteria: age 2-12 years, pulmonary-to-systemic blood flow ratio <2.0.
  • Minimum 3-year follow-up to assess outcomes: residual shunts and AR progression.

Main Results:

  • High success rate (98.4%) with no emergency surgery, permanent high-degree AV block, or mortality.
  • pmVSDs ≥4.5 mm were significantly associated with persistent residual shunts (OR 6.85, P=0.03).
  • Age <4 years (OR 27.38) and perimembranous outlet-type VSD (OR 11.94) were independent risk factors for AR progression.

Conclusions:

  • pmVSDs ≥4.5 mm require careful attention during transcatheter closure to prevent residual shunts.
  • Assessing AR risk is essential, particularly in children <4 years old.
  • Transcatheter closure offers benefits but necessitates vigilant monitoring for potential complications.
Abstract

Keywords:
Aortic regurgitationResidual shuntTranscatheter closureVentricular septal defectYoung children

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