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<p>Transcatheter device closure is an off-label alternative therapy for perimembranous ventricular septal defect (PMVSD); we evaluated its long-term outcomes. Patients with PMVSDs who underwent transcatheter closure at our institutions between 2009 and 2016 were retrospectively reviewed. Patient demographics, procedural details, and follow-up outcomes were analysed. We identified 157 patients (51.6% male) with a median age of 7.4&#xa0;years [interquartile range (IQR) 4–12] and median body weight of 23&#xa0;kg (IQR 15–42.4) at procedure. Median defect diameter was 6&#xa0;mm (IQR 5.0–8.0) and 4.0&#xa0;mm (IQR 3.0–5.0) at the left and right ventricular side, respectively (mean Qp/Qs 1.5 ± 0.6). Procedure success rate was 96.8%. Of five unsuccessful cases, two required surgery—one for gross haematuria and one for heart block—while three failed due to anatomical constraints. Median follow-up was 5&#xa0;years (IQR 4.0–6.0). Post-closure, 53 patients (33.7%) had residual shunts (90.6% trivial-to-small and 9.4% moderate shunts, regressing to small by the 3&#xa0;year follow-up). Residual shunts were significantly more frequent with Nit-Occlud® Lê VSD coil (P &lt; 0.05). New-onset tricuspid regurgitation (NTR) and aortic regurgitation (NAR) were observed in 33 (22%) and 15 (10.9%) patients, respectively. Severe NTR persisted in three patients (2.7%), while NAR was mostly trivial-to-mild, except in one case, requiring surgical correction 1&#xa0;year post-procedure. Transcatheter closure of small PMVSDs is a valuable option for select patients using various devices. Nit-Occlud® Lê VSD coil showed higher residual shunt rates. NAR and NTR are rare but require close monitoring, as improvement is expected over time.</p>

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Long-Term Outcomes Following Transcatheter Closure of Small Perimembranous Ventricular Septal Defects

  • 期刊论文

  • 发表日期：

    2025年4月11日

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  • Worakan Promphan,
  • Kanjarut Wongwaitaweewong,
  • Aishath Eleena,
  • Supaporn Roymanee,
  • Jirayut Jarutach,
  • Rujira Buntharikpornpun,
  • Suppalak Puttharak,
  • Panthip Patrakunwiwat,
  • Pimpak Prachasilchai

摘要

Transcatheter device closure is an off-label alternative therapy for perimembranous ventricular septal defect (PMVSD); we evaluated its long-term outcomes. Patients with PMVSDs who underwent transcatheter closure at our institutions between 2009 and 2016 were retrospectively reviewed. Patient demographics, procedural details, and follow-up outcomes were analysed. We identified 157 patients (51.6% male) with a median age of 7.4 years [interquartile range (IQR) 4–12] and median body weight of 23 kg (IQR 15–42.4) at procedure. Median defect diameter was 6 mm (IQR 5.0–8.0) and 4.0 mm (IQR 3.0–5.0) at the left and right ventricular side, respectively (mean Qp/Qs 1.5 ± 0.6). Procedure success rate was 96.8%. Of five unsuccessful cases, two required surgery—one for gross haematuria and one for heart block—while three failed due to anatomical constraints. Median follow-up was 5 years (IQR 4.0–6.0). Post-closure, 53 patients (33.7%) had residual shunts (90.6% trivial-to-small and 9.4% moderate shunts, regressing to small by the 3 year follow-up). Residual shunts were significantly more frequent with Nit-Occlud® Lê VSD coil (P < 0.05). New-onset tricuspid regurgitation (NTR) and aortic regurgitation (NAR) were observed in 33 (22%) and 15 (10.9%) patients, respectively. Severe NTR persisted in three patients (2.7%), while NAR was mostly trivial-to-mild, except in one case, requiring surgical correction 1 year post-procedure. Transcatheter closure of small PMVSDs is a valuable option for select patients using various devices. Nit-Occlud® Lê VSD coil showed higher residual shunt rates. NAR and NTR are rare but require close monitoring, as improvement is expected over time.