Long-Term Outcomes Following Transcatheter Closure of Small Perimembranous Ventricular Septal Defects

Transcatheter device closure is an off-label alternative therapy for perimembranous ventricular septal defect (PMVSD); we evaluated its long-term outcomes. Patients with PMVSDs who underwent transcatheter closure at our institutions between 2009 and 2016 were retrospectively reviewed. Patient demographics, procedural details, and follow-up outcomes were analysed. We identified 157 patients (51.6% male) with a median age of 7.4 years [interquartile range (IQR) 4-12] and median body weight of 23 kg (IQR 15-42.4) at procedure. Median defect diameter was 6 mm (IQR 5.0-8.0) and 4.0 mm (IQR 3.0-5.0) at the left and right ventricular side, respectively (mean Qp/Qs 1.5 +/- 0.6). Procedure success rate was 96.8%. Of five unsuccessful cases, two required surgery-one for gross haematuria and one for heart block-while three failed due to anatomical constraints. Median follow-up was 5 years (IQR 4.0-6.0). Post-closure, 53 patients (33.7%) had residual shunts (90.6% trivial-to-small and 9.4% moderate shunts, regressing to small by the 3 year follow-up). Residual shunts were significantly more frequent with Nit-Occlud (R) Le VSD coil (P < 0.05). New-onset tricuspid regurgitation (NTR) and aortic regurgitation (NAR) were observed in 33 (22%) and 15 (10.9%) patients, respectively. Severe NTR persisted in three patients (2.7%), while NAR was mostly trivial-to-mild, except in one case, requiring surgical correction 1 year post-procedure. Transcatheter closure of small PMVSDs is a valuable option for select patients using various devices. Nit-Occlud (R) Le VSD coil showed higher residual shunt rates. NAR and NTR are rare but require close monitoring, as improvement is expected over time.