The Paradox of Aortic Valve Prolapse in Transcatheter Closure of Ventricular Septal Defects

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Ventricular septal defects with aortic valve prolapse. Intervention: Deliberate device oversizing ('holding' strategy) vs. 'Clamping' strategy (standard sizing). Primary outcome: Device embolization and aortic regurgitation progression.

Ka‐Chun Un; Chun‐Ka Wong

doi:10.1016/j.jacasi.2026.08.002

September 5, 2026JACC AsiaOpen Access

The Paradox of Aortic Valve Prolapse in Transcatheter Closure of Ventricular Septal Defects

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Key result

Deliberate device oversizing to 'hold' rather than 'clamp' the aortic cusp during transcatheter VSD closure is associated with significantly lower rates of device embolization and aortic regurgitation progression.

Graphical abstract published by JACC Asia — Graphical abstract · Published by JACC Asia · CC BY-NC-ND

Key Points

Evaluate optimal device selection and positioning strategies to avoid aortic regurgitation and procedural failure during transcatheter ventricular septal defect closure with concomitant aortic valve prolapse.
Assessed anatomical mechanisms and clinical outcomes of transcatheter closure in ventricular septal defect patients with aortic rim deficiency and aortic valve prolapse.
Analyzed the effects of device-cusp interaction types, comparing cusps held synchronously versus those clamped by the occluder retention disc.
Device embolization and progressive aortic regurgitation occurred significantly more often when the retention disc clamped the aortic cusp rather than supporting it.
Deliberate device oversizing paradoxically decreased valve distortion by allowing the cusp to rest on the device waist, though excessive sizing carries risks of conduction system trauma.

PICO

P

Population

Ventricular septal defects with aortic valve prolapse

I

Intervention / Comparator

Deliberate device oversizing ('holding' strategy) vs 'Clamping' strategy (standard sizing)

O

Primary Outcome

Device embolization and aortic regurgitation progression

Limitations

Oversized devices may exert excessive radial force on the conduction system, potentially leading to transient or permanent conduction abnormalities like left bundle branch block.
Precise sizing and careful device selection remain challenging.
Lack of long-term follow-up data to determine the long-term function of the aortic valve.

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Implication

May support oversizing to reduce embolization and AR in transcatheter VSD closure with prolapse; hypothesis-generating pending prospective validation.

Abstract

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Cite This Study

Un et al. (2026) conducted an editorial in Ventricular septal defects with aortic valve prolapse. Deliberate device oversizing ('holding' strategy) vs. 'Clamping' strategy (standard sizing) was evaluated on Device embolization and aortic regurgitation progression. Deliberate device oversizing to 'hold' rather than 'clamp' the aortic cusp during transcatheter VSD closure is associated with significantly lower rates of device embolization and aortic regurgitation progression.

synapsesocial.com/papers/6ad115eb00741cc3fba7db64 https://doi.org/10.1016/j.jacasi.2026.08.002

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The Paradox of Aortic Valve Prolapse in Transcatheter Closure of Ventricular Septal Defects

Key Points

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The Paradox of Aortic Valve Prolapse in Transcatheter Closure of Ventricular Septal Defects

Key Points

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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