Risk Factors and Long-Term Outcomes of Tricuspid Regurgitation After Transcatheter Closure of Pediatric Perimembranous Ventricular Septal Defects

Background Transcatheter closure of perimembranous ventricular septal defects in children is a highly effective procedure, but it can result in tricuspid regurgitation (TR). The associated risk factors and long-term outcomes of TR following the procedure are not well understood.METHODS AND RESULTS This retrospective study included 1343 pediatric patients (age, 4.41 +/- 2.56 years) who underwent successful transcatheter perimembranous ventricular septal defect closure between 2002 and 2022, with a median follow-up of 78 (range, 12-244) months. TR was evaluated using echocardiography, and multivariate logistic regression was performed to identify independent risk factors of postprocedural TR. Postprocedural TR occurred in 12.1% of patients, including 143 new-onset cases and 20 with progressed preexisting TR. The majority of cases (86.5%) were mild, while 20 were moderate, and 2 were severe requiring surgical intervention. Most TR cases (84%) developed within 24 hours after the procedure. A higher right disc diameter-to-body weight ratio was identified as an independent risk factor of TR (odds ratio, 2.816 [95% CI, 1.315-6.032]). During follow-up, 71.8% of TR cases improved or resolved, though moderate TR persisted in 7 cases, and 1 progressed to severe TR requiring surgery 2 years after the procedure.Conclusions TR following perimembranous ventricular septal defect closure is common but typically mild and often resolves over time. A larger right disc diameter relative to body weight significantly increases the risk of TR, emphasizing the importance of careful device sizing, particularly in lighter patients. Long-term follow-up is crucial to detect potential late progression of TR.