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Percutaneous Closure of Hemodynamically Significant Postoperative Residual Ventricular Septal Defects

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Abstract

The experience with percutaneous closure of postoperative residual ventricular septal defects (VSDs) is expanding with improved device technology and techniques. To report our experience with percutaneous closure of residual VSDs after cardiac surgeries. Retrospective clinical data review of patients who had percutaneous closure of postoperative residual VSDs at our institution between 2010 and 2022. Patients’ demographics, procedural, and follow-up data were looked at. Twelve patients (50% males) with a median age of 9.2 years (range 0.9–22) were identified. Baseline surgeries were 8 tetralogy of Fallot corrections, 2 pulmonary bandings for large muscular VSD (mVSD) including 1 coarctation repair, 1 atrioventricular septal defect repair, 1 sub-aortic membrane resection-induced iatrogenic VSD, 1 isolated VSD closure, and 1 additional mVSD. Median duration between baseline surgery and percutaneous VSD closure was 2.2 years (range 0.2–8.3). Residual VSD shunting was secondary to surgical patch leakage in 8/12 patients. The median angiographic defect diameter was 6.8 mm (range 4.8–14). The defect was balloon-calibrated in 3/12 patients. Defects were tackled retrogradely in 3/9 patients. Amplatzer Membranous VSD occluder (n = 1), Lifetech Multifunctional (n = 5), Membranous (n = 1) and muscular VSD occluders (n = 2) and Occlutech Membranous (n = 1) and Muscular (n = 2) VSD occluders were used. The procedure was successful in 10/12 patients. Two devices embolized to the pulmonary artery and were snare-retrieved. Both patients were referred for surgery. The median follow-up was 1.3 years (range 0.1–12). Six-month ultrasound showed one trivial residual shunt and one mild right ventricular outflow obstruction. One patient is receiving targeted therapy for pulmonary hypertension at 2 years of follow-up. Transcatheter closure of postoperative residual VSDs is a feasible yet challenging intervention. Procedural complications can be encountered.

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Authors and Affiliations

  1. Department of Pediatric Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey

    Osman Baspinar & Derya Aydin Sahin

  2. Department of Pediatric Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey

    Pelin Kosger

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  1. Osman Baspinar
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  2. Pelin Kosger
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  3. Derya Aydin Sahin
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Osman Baspinar, Pelin Kosger and Derya Aydin Sahin. The first draft of the manuscript was written by Pelin Kosger and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Pelin Kosger.

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Baspinar, O., Kosger, P. & Aydin Sahin, D. Percutaneous Closure of Hemodynamically Significant Postoperative Residual Ventricular Septal Defects. Pediatr Cardiol 45, 272–281 (2024). https://doi.org/10.1007/s00246-023-03366-9

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