[Transcatheter closure of intracristal ventricular septal defect using eccentric occluders in 39 children]

Objective: To evaluate the efficacy and clinical outcomes of transcatheter closure of intracristal ventricular septal defect (VSD) using an eccentric occluder. Methods: In this case series study, 39 children with intracristal VSD who underwent attempted transcatheter closure using an eccentric occluder at the Second Affiliated Hospital of Wenzhou Medical University from January 2011 to December 2021 were included. All children were regularly followed up at 1, 3, 6, 12, 24 and 36 months after the procedure. Echocardiography, electrocardiography and treadmill exercise testing were used for postoperative follow-up evaluation. The main outcomes included occlude morphology and position, residual shunt, valvular regurgitation, cardiac function, arrhythmia and postoperative exercise capacity. Comparisons among different follow-up time points were performed using the paired t-test or repeated-measures analysis of variance, Friedman test or Wilcoxon signed-rank test. Results: Device implantation was successful in 38 of 39 children (97%). One child underwent surgical repair because the aortic valve prolapse protruded into the VSD shunt orifice, making transcatheter closure unsuitable. No severe complications occurred after the procedure. Follow-up showed that residual shunt was observed in 7 children (18%) after the procedure and disappeared within 24 months of follow-up. Valvular regurgitation occurred in 9 children (24%) and did not worsen during follow-up; in 7children, valvular regurgitation disappeared within 36 months. Arrhythmia occurred in 6 children (16%), including incomplete right bundle branch block in 2 children and premature ventricular contractions in 4 children. Five children resolved within 12 months, and the remaining 1 child resolved by 36 months of follow-up. Compared with baseline, the Z scores of left ventricular end-diastolic diameters and left atrial diameters showed a progressive decrease during the first 1 to 6 months after transcatheter closure (both P<0.05), and remained stable after 24 months. Right ventricular diameter and left ventricular ejection fraction showed no significant changes before and after the procedure (all P>0.05). A total of 20 children underwent treadmill exercise testing 1 year after the procedure, and 19 children (95%) had negative results. Conclusion: Transcatheter closure of intracristal VSD using an eccentric occluder is effective and feasible, with favorable safety and efficacy during short-and mid-term follow-up.