Transcatheter Closure of Residual and Iatrogenic Ventricular Septal Defects: Tertiary Center Experience and Outcome

Pediatr Cardiol. 2022 Feb;43(2):308-323. doi: 10.1007/s00246-021-02722-x. Epub 2021 Sep 8.

Abstract

Residual or iatrogenic ventricular septal defects (VSDs) may result in significant hemodynamic effect. This study aimed to review our center experience in transcatheter closure of post-surgical and post-intervention residual and iatrogenic VSDs and to report on their 12-month long-term outcome. All patients who underwent transcatheter closure of residual/iatrogenic VSDs after surgical or transcatheter CHD interventions between January-2015 and January-2020 were included. Patients' medical records were reviewed and analyzed. Twenty-three patients with a mean age of 14.3 ± 8.8 years were included. The VSD was residual in 18 (78.3%) patients and iatrogenic in 5 (21.7%) patients, post-operative in 19 (82.6%) patients and post-transcatheter in 4 (17.4%) patients. The VSD site was peri-membranous in 9 (39.1%) patients, high-muscular in 6 (26.1%) patients, mid-muscular in 4 (17.4%) patients, and Gerbode shunt in 4 (17.4%) patients. The QP/QS ratio was 2.5 ± 0.7, and the VSD diameter was 6.1 ± 2.1 mm. Most, 16 (71.43%) patients underwent antegrade device deployment, and 7 (28.57%) patients underwent retrograde transaortic device deployment with 3 (13.0%) patients required two devices. Amplatzer™ Muscular VSD devices were used in 16 (69.6%) patients, Amplatzer™ Duct occlude-I devices were used in 4 (17.4%) patients, and Amplatzer™ Duct Occluder-II devices were used in 3 (13.0%) patients with a mean device size of 8.8 ± 2.8 mm. Procedural and fluoroscopy times were 55.1 ± 16.2 and 16.3 ± 4.0 min respectively. During follow-up (23.3 ± 15.9 months), no patient required re-intervention or exhibited mortality. Transcatheter closure of post-operative and post-intervention residual/iatrogenic VSDs represents a safe, feasible, and effective therapeutic approach.

Keywords: Iatrogenic ventricular septal defects; Post-intervention Ventricular Septal Defect; Post-operative ventricular septal defect; Residual ventricular septal defects; Ventricular septal defects.

MeSH terms

  • Adolescent
  • Adult
  • Cardiac Catheterization / adverse effects
  • Child
  • Child, Preschool
  • Heart Septal Defects, Ventricular* / diagnostic imaging
  • Heart Septal Defects, Ventricular* / surgery
  • Humans
  • Iatrogenic Disease
  • Retrospective Studies
  • Septal Occluder Device* / adverse effects
  • Treatment Outcome
  • Young Adult