Early Functional Recovery and Myocardial Deformation Improvement After Transcatheter VSD Closure: A 3D Speckle‐Tracking Echocardiography Study

BACKGROUND: Transcatheter closure of ventricular septal defects (VSDs) has become a widely accepted alternative to surgical repair, owing to its high success rates and lower risk of complications. Advances in three-dimensional (3D) echocardiography, including 3D speckle-tracking and global longitudinal strain analysis, now allow for detailed assessment of ventricular performance and provide valuable insights into left ventricular remodeling following transcatheter VSD closure. METHODS: This prospective observational study enrolled 56 children aged 2-16 years with congenital perimembranous or muscular VSD undergoing transcatheter device closure at Ain Shams University Hospitals, and 56 age- and sex-matched healthy controls. 3D speckle-tracking echocardiography (3D-STE) was performed at baseline and at six-month follow-up to quantify global longitudinal (GLS), circumferential (GCS), and radial strain (GRS), alongside LV volumes and ejection fraction. RESULTS: At six months, LV volumes showed no significant change; however, ventricular function improved significantly. Mean 3D ejection fraction improved from 55% ± 4% preoperatively to 58% ± 3% at six months (p = 0.001), with parallel improvement in GLS, GCS, and GRS (all p = 0.001). LV end-diastolic and end-systolic volumes did not change significantly at six months. CONCLUSION: This study demonstrates a significant improvement in 3D echocardiography-derived ejection fraction and global strain indices following transcatheter VSD closure, reflecting early favorable functional recovery and improved myocardial mechanics rather than complete structural reverse remodeling. These findings support transcatheter VSD closure as a safe and effective intervention with acceptable short-term outcomes, though longer follow-up is needed to determine whether volumetric reverse remodeling ensues.