Transcatheter device closure of ventricular septal defects in children: a retrospective study at a single cardiac center

Abstract

BACKGROUND: Ventricular septal defect (VSD) is the most common congenital heart disease in the pediatric population. Nowadays, trans-catheter closure is considered a feasible method of therapy for most muscular and some perimembranous types of VSDs. OBJECTIVE: Assess the safety, efficacy and outcome of percutaneous transcatheter closure of VSDs in children. DESIGN: Retrospective, single center study. SETTING: Madinah Cardiac Center, Madinah, Saudi Arabia. PATIENTS AND METHODS: The study included all consecutive children who underwent transcatheter closure of isolated VSD during the period from December 2014 to January 2019. The data were collected from hospital database medical records. Transthoracic echocardiography (TTE) and an electrocardiogram (ECG) were done before and after the procedure in all the patients. The device was implanted by the retrograde or antegrade approach. All patients were subjected to follow-up evaluation at 1, 3, 6, 12 months, and annually thereafter with TTE and ECG. MAIN OUTCOME MEASURES: Procedure success rate, clinical follow-up, TTE. SAMPLE SIZE: 70 children. RESULTS: The mean (standard deviation) age of patients was 10.2 (4.1) years (range: 2-18 years), and their mean body weight was 30.9 (13.9) kg (range: 7.0-57.7 kg). Forty-eight (68.6%) children had muscular VSD (mVSD), and 22 (31.4%) children had perimembranous VSD (pmVSD). The majority of defects were closed via the retrograde approach using the Amplatzer muscular occluder device. At 24 hours after the procedure, the success rate was 90%. Only four (5.7%) cases had major adverse events including complete atrioventricular block, hemolysis, and thrombus formation. CONCLUSION: Transcatheter closure is a safe and feasible procedure in VSDs of various morphologies, with a low adverse event rate. LIMITATIONS: Retrospective design, single-center study, absence of control group. CONFLICT OF INTEREST: None.

Transcatheter Device Closure of Ventricular Septal Defect in Children: A Retrospective Study at Pediatric Cardiac Center, Children’s Hospital, Ain Shams University

“…This is in agreement with Adhikari et al (8) who reported that there was perimembranous VSD in 49 cases (89%) and muscular VSD in 6 (11%) patients. While, in the study of Khoshhal et al (1) they reported that 68.6% of the studied children had muscular VSD and 31.4% were diagnosed by perimembranous VSD.…”

“…Table (1) revealed the demographic data of the studied groups. The median age was 5 years ranging from 1 y to 14 years.…”

“…Transcatheter VSD closure was indicated for patients with congestive heart failure, failure to thrive, notably enlarged left atrium and left ventricle, high pulmonary artery pressure or both, and a pulmonary-tosystemic flow ratio greater than 2:1. In perimembranous VSD, a good aneurysmal tissue was required for best occluding device deployment away from the aortic valve, as well as a sub-aortic rim of at least 4 mm to prevent pressure on the aortic valve and other nearby structures (1,7) .…”

“…Although VSDs can develop in any area of the interventricular septum, the perimembranous VSD and muscular VSD, which can occur anteriorly, posteriorly, inlet, or outlet, are the most frequent morphological forms. The supracristal variety is less prevalent (1) .…”

“…Large VSDs with RV and pulmonary artery systolic pressures close to the left ventricular and aortic systolic pressures should be closed. Since the first case was reported in 1988 and had satisfactory results, catheter-based therapies have demonstrated promising results in comparison to surgery (3,4) . Our study aimed to evaluate the safety, efficacy, and outcomes of transcatheter closure of VSDs and to detect the predictors of success and risk factors of failure of transcatheter closure of VSDs among studied population in Pediatric Cardiac Catheter Unit in children's Hospital, Ain Shams University.…”