Hekim Yilmaz Emine, Yucel Ilker Kemal, Surucu Murat, Karadag Huseyin, Demir Ibrahim Halil, Cicek Murat, Aydemir Numan Ali, Celebi Ahmet
Department of Pediatric Cardiology, Dr. Siyami Ersek Training and Research Hospital for Cardiology and Cardiovascular Surgery, İstanbul, Turkey.
Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Training and Research Hospital for Cardiology and Cardiovascular Surgery, İstanbul, Turkey.
Catheter Cardiovasc Interv. 2025 Oct;106(4):2160-2173. doi: 10.1002/ccd.70020. Epub 2025 Jul 29.
Perventricular device closure of muscular VSD in small infants is a less invasive option than surgical closure under cardiopulmonary bypass and offers better outcomes than palliative pulmonary artery banding. However, the specific risk factors that could affect procedural success and optimal outcomes have not been comprehensively examined in prior studies. The aim of this study is to analyze the risk factors for procedural failure and nonoptimal outcome in perventricular device closure of muscular VSD.
Results of perventricular closure of muscular VSD in infants over 17 years at a tertiary center were retrospectively analyzed. The procedure was considered successful if the occluder could be placed in correct position without significant residual shunt. Optimal outcome was defined as uneventful course after successful device implantation.
A perventricular approach was required for 27 significant defects in 24 infants aged 3-7, median 5 months, and weighing 3.2-5.3, median 4.3 kg. The procedure was successful in 23 of the 27 defects (85%) and the outcome was optimal in 19 of the 24 infants (79.1%). There was no significant difference between the successful and unsuccessful groups in terms of age, body weight, defect locations, presence of single vs multiple large defects, and device types used. Larger defects (≥ 12 mm) and larger devices (≥ 14 mm) were significantly more common in both the procedural failure and non-optimal outcome groups. Both the success and optimal outcomes of the procedure were negatively impacted by the proximity of the defect to the moderator band of the RV.
Procedural success and outcomes in perventricular device closure of muscular VSDs in small infants are negatively impacted by larger defects requiring ≥ 14 mm devices and the proximity of the defect to the moderator band. Both factors may hinder the proper opening of the RV disc and prevent adequate conforming to the smaller RV size in these infants.
