Catastrophic Pediatric Stroke Following Attempted Transcatheter Ventricular Septal Defect Closure

Periprocedural stroke is a rare but potentially catastrophic complication of pediatric cardiac catheterization.

An 18-month-old girl with a perimembranous ventricular septal defect and progressive aortic valve prolapse underwent elective transcatheter closure. The procedure was abandoned after 2 unsuccessful device deployment attempts due to worsening aortic regurgitation and device instability. Two hours later, she developed acute neurological deterioration. Brain computed tomography demonstrated a large right hemispheric infarction combining mixed-density subdural collection, and uncal herniation. Emergency decompressive craniectomy with hematoma evacuation was performed. Evaluation for thrombophilia and coagulopathy was negative.

Thromboembolism related to subtherapeutic anticoagulation, contrast-related neurotoxicity, and patient vulnerability in the setting of procedural complexity were considered the most plausible mechanism.

Strict anticoagulation monitoring, appropriate heparin dosing, careful contrast selection, and thoughtful patient selection are essential to improve the safety of pediatric transcatheter interventions.