Risk Factors of Long-Term Sequelae After Transcatheter Closure of Perimembranous Ventricular Septal Defect in Young Children

• Published in: Circulation Journal Vol. 88; no. 5; pp. 663 - 671
• Main Authors: Chiu, Shuenn-Nan, Lin, Hsin-Chia, Lu, Chun-Wei, Fu, Chun-Min, Chin, Chia-Yi, Wang, Jou-Kou, Huang, Shu-Chien, Wu, Mei-Hwan, Chen, Yih-Sharng, Lin, Ming-Tai, Chen, Chun-An, Chou, Heng-Wen, Hsu, Jui-Yu, Chang, Ya-Mei
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 25.04.2024
• Subjects: Age Factors; Aortic regurgitation; Aortic Valve Insufficiency - etiology; Cardiac Catheterization - adverse effects; Child; Child, Preschool; Female; Follow-Up Studies; Heart Septal Defects, Ventricular - surgery; Humans; Male; Postoperative Complications - etiology; Residual shunt; Retrospective Studies; Risk Factors; Septal Occluder Device - adverse effects; Time Factors; Transcatheter closure; Treatment Outcome; Ventricular septal defect; Young children; Young children; Residual shunt; Transcatheter closure; Ventricular septal defect; Aortic regurgitation
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-23-0891

Background: Complications arising from transcatheter closure of perimembranous ventricular septal defects (pmVSD) in children, such as residual shunts and aortic regurgitation (AR), have been observed. However, the associated risk factors remain unclear. This study identified risk factors linked with residual shunts and AR following transcatheter closure of pmVSD in children aged 2–12 years.Methods and Results: The medical records of 63 children with pmVSD and a pulmonary-to-systemic blood flow ratio <2.0 who underwent transcatheter closure between 2011 and 2018 were analyzed with a minimum 3-year follow-up. The success rate of transcatheter closure was 98.4%, with no emergency surgery, permanent high-degree atrioventricular block, or mortality. Defects ≥4.5 mm had significantly higher odds of persistent residual shunt (odds ratio [OR] 6.85; P=0.03). The use of an oversize device (≥1.5 mm) showed a trend towards reducing residual shunts (OR 0.23; P=0.06). Age <4 years (OR 27.38; 95% confidence interval [CI] 2.33–321.68) and perimembranous outlet-type VSD (OR 11.94, 95% CI 1.10–129.81) were independent risk factors for AR progression after closure.Conclusions: Careful attention is crucial for pmVSDs ≥4.5 mm to prevent persistent residual shunts in transcatheter closure. Assessing AR risk, particularly in children aged <4 years, is essential while considering the benefits of pmVSD closure.