Transcatheter Closure of Moderate to Large Perimembranous Ventricular Septal Defects in Children Weighing 10 kilograms or less

Abstract

Background: Transcatheter device closure of ventricular septal defect (VSD) is an alternative to conventional surgical closure. Device closure of moderate to large perimembranous VSD (pmVSD) is considered technically challenging in smaller children weighing 10 kg. Very few studies are published on the outcomes of the same. Methods: Descriptive single-center retrospective study. Data of 49 children 10 kg with moderate to large pmVSDs taken up for transcatheter device closure in our institute were analyzed and their follow-up details were reviewed. Results: Of the 87 patients referred for VSD closure, 49 patients qualified for the inclusion criteria. Median age was 18 months (interquartile range: 13-22). Successful device deployment was achieved in 42 (85.7%) patients. Mean VSD size by transthoracic echocardiography was 5.98 mm (range: 4-12 mm). Mean waist size of the device used was 8.26 mm (range: 4-14 mm). There was one device embolization, requiring catheter-directed retrieval from the left ventricle and subsequent surgical referral for VSD closure. Minor complications such as device-related persistent new aortic regurgitation was noted in one patient and mild tricuspid regurgitation and transient heart block occurred in two patients each. There was no mortality or complete heart block requiring permanent pacemaker implantation immediately or during midterm follow-up (mean follow-up: 20 months; range: 6-72.5 months). Conclusion: Device closure of moderate to large pmVSDs in children weighing 10 kg is feasible and safe with a success rate of 85.7%. Careful selection of patients and avoidance of oversizing the defect makes the immediate and midterm results acceptable. Keywords moderate to large perimembranous VSD (pmVSD), transcatheter device closure, success rate, complete heart block (CHB), aortic regurgitation (AR), children 10 kg

Transcatheter closure of ventricular septal defects in children less than 10 kg: experience from a tertiary care referral hospital in Eastern India

“…Due to higher risk of complications, reports of transcatheter closure of ventricular septal defects in less than 10 kg weight category are rare. Only five other case series have been published with a good outcome on short and medium-term follow-up [6][7][8][9][10] with authors concluding that it is feasible to close ventricular septal defects in catheterisation laboratory in early infancy. To the best of our knowledge, ours is the sixth series and only third from India to report the experience of percutaneous ventricular septal defect closure in less than 10 kg weight category.…”

“…This is in contrast to the other case series, where general anaesthesia was routinely used. [6][7][8][9] We intubated only one patient who had accidental right ventricular perforation before shifting to operating room.…”

“…4,5 Although a common procedure for older children and adolescents, the safety of the procedure is not quite adequately evaluated in young children weighing 10 kg or less with only very few operators reporting their experience in this weight category. [6][7][8][9] We report our initial experience with device closure of ventricular septal defects in less than 10 kg weight category with an immediate and short-term follow-up of outcome.…”

Transfemoral Perimembranous Ventricular Septal Defect Device Closure in Infants Weighing ≤ 10 kg

“…Few studies dealing with device closure of PMVSD's have been published on this subgroup of patients with varying approaches including a trans-carotid approach reported to mitigate against the possible hemodynamic impact of an arteriovenous loop [13][14][15]. The aim of this study was to evaluate the efficacy and safety of transfemoral PMVSD device closure in infants ≤ 10 kg body weight in a national tertiary care congenital cardiac institution.…”

Key Regulatory Differentially Expressed Genes in the Blood of Atrial Septal Defect Children Treated With Occlusion Devices

“…Atrial septal defects (ASDs) are the most common types of congenital heart defects (CHDs) and typically present with left to right shunts, which account for up to 10% and 40% of all CHDs, respectively ( Penny and Vick, 2011 ; Rao and Harris, 2017 ). The patients with ASDs may exhibit poor growth and development, decreased activity tolerance, repeated respiratory infections, and hyperhidrosis, and they are accompanied by heart enlargement, increased pulmonary circulation pressure and resistance, heart failure, and atrial arrhythmia ( Huang et al, 2013 ; Leppert et al, 2016 ; Karunanithi et al, 2017 ; Wu et al, 2018 ; Pillai et al, 2019 ). Surgery as the traditional method to treat ASDs has several disadvantages including large trauma, long recovery time and permanent scar left.…”