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Long-Term Outcomes Following Transcatheter Closure of Small Perimembranous Ventricular Septal Defects
Worakan Promphan1,2, Kanjarut Wongwaitaweewong3, Aishath Eleena1,2
1Department of Medical Services, Pediatric Heart Center, Queen Sirikit National Institute of Child Health, Ministry of Public Health, Mueang Nonthaburi, Thailand.
Pediatric Cardiology
|April 11, 2025
Summary
Transcatheter device closure is a safe and effective off-label treatment for perimembranous ventricular septal defects (PMVSD). Long-term follow-up shows a high success rate, with rare complications and expected improvement in residual shunts and regurgitation over time.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Transcatheter device closure is an emerging off-label therapy for perimembranous ventricular septal defects (PMVSD).
- Evaluating the long-term outcomes of this procedure is crucial for establishing its efficacy and safety.
- PMVSDs represent a significant portion of congenital heart defects requiring intervention.
Purpose of the Study:
- To assess the long-term outcomes of transcatheter device closure for perimembranous ventricular septal defects (PMVSD).
- To identify factors influencing procedural success and complication rates.
- To evaluate the incidence and progression of residual shunts and valvular regurgitation post-procedure.
Main Methods:
- Retrospective review of 157 patients with PMVSD who underwent transcatheter closure between 2009 and 2016.
- Analysis of patient demographics, procedural details, defect characteristics (size, Qp/Qs), and device types used.
- Long-term follow-up data including procedural success, residual shunts, and new-onset or worsening valvular regurgitation (tricuspid and aortic).
Main Results:
- A high procedural success rate of 96.8% was achieved.
- The Nit-Occlud® Lê VSD coil was associated with significantly higher residual shunt rates (P < 0.05).
- New-onset tricuspid regurgitation (NTR) and aortic regurgitation (NAR) occurred in 22% and 10.9% of patients, respectively, with most cases being mild and improving over time. Severe NTR persisted in 2.7%.
Conclusions:
- Transcatheter device closure is a valuable option for select patients with small PMVSDs, offering good long-term outcomes.
- While effective, the choice of device may influence residual shunt rates, with Nit-Occlud® Lê VSD coil showing higher rates.
- Close monitoring for NTR and NAR is recommended, as these complications are generally rare and tend to improve, though severe cases may require intervention.
