Key result
Children with multiple-hole ventricular septal defects had a significantly higher incidence of residual shunting immediately after transcatheter closure compared to those with single-hole defects (P = 0.008).
Why the study?
Complication data following transcatheter VSD closure in large pediatric cohorts over long-term follow-up were limited, and residual shunts had not been compared between single-hole and multi-hole defects.
Does transcatheter closure of multiple-hole VSDs increase the risk of residual shunt compared to single-hole VSDs in children?
Cohort (n=409)
No
Does transcatheter closure of multiple-hole VSDs increase the risk of residual shunt compared to single-hole VSDs in children?
p-value: p=0.008
Transcatheter closure of multiple-hole VSDs is associated with a significantly higher risk of residual shunt compared to single-hole VSDs, though procedure-related tricuspid regurgitation decreases dramatically over time.
Residual shunt assessment after pediatric transcatheter VSD closure warrants prospective validation; leaves open whether multiple-hole defects differ from single-hole defects.
Background: Evaluation of complications after transcatheter ventricular septal defect (VSD) closure in long-term follow-up and large samples of children is limited. Objectives: We compared the residual shunt after transcatheter closure in VSDs with a single hole and multiple holes, a new task that has not been done so far. Methods: This retrospective study included all patients who underwent transcatheter device closure for VSD in a tertiary cardiovascular center from 2009 to 2020. Follow-up evaluation using transthoracic echocardiography (TTE) and electrocardiogram (ECG) was performed at 1, 6, 12 months, and annually after the procedure. Results: A total of 409 patients underwent transcatheter VSD closure. The mean age was 7 years (2 - 15 years), and the median follow-up duration was 48 months (1 - 10 years). The number of patients with a singular VSD was 259 (63.4%), and those with multiple exit holes were 150 (36.6%). The incidence of a residual shunt immediately after implantation was significantly higher in VSDs with multiple holes than those with a single hole (P = 0.008). During the follow-up, the residual shunts decreased in the group of VSDs with a single hole. Forty-five patients (11%) and 16 patients (4%) had a new-onset of mild and moderate tricuspid regurgitation (TR), respectively, and it decreased dramatically over time. Only 1 patient showed a new-onset mild aortic regurgitation (AR). The most crucial complication shown in 2 patients was a persistent complete heart block. Conclusions: Ventricular septal defects with multiple exit holes are a risk factor for a residual shunt. After transcatheter VSD closure, the residual shunt in patients with a multiple-hole VSD was significantly higher (P = 0.008). Although TR may increase during the procedure, it decreases dramatically over time. Interestingly, patients who had pre-procedure tricuspid or aortic regurgitation disappeared after 2 years of the procedure. The most important complication was a complete heart block in 2 patients.
No takes yet. Share an insight, caveat, or question.
Mortezaeian et al. (2022) conducted a cohort in Ventricular Septal Defect (n=409). Multiple-hole ventricular septal defect vs. Single-hole ventricular septal defect was evaluated on Residual shunt immediately after implantation (p=0.008). Children with multiple-hole ventricular septal defects had a significantly higher incidence of residual shunting immediately after transcatheter closure compared to those with single-hole defects (P = 0.008).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: