Abstract
BackgroundThis is a case-control study conducted on 30 children, 15 with VSD who performed VSD transcatheter device closure (group A) and 15 controls of matching age and gender (group B), in the period between September 2015 and February 2018. We aimed to assess the global left ventricular (LV) systolic function by 2D speckle tracking before and after ventricular septal defect (VSD) transcatheter closure, in comparison to normal controls. All patients were subjected to full history taking; general and cardiac examination; ECG; CXR; full transthoracic echocardiographic examination, including VSD number, size, and site; LV dimensions and volumes; estimated pulmonary artery pressure; right ventricular size and function; left ventricular circumferential; and radial strain imaging by 2D speckle tracking. Patients who had ventricular septal defect closed were reassessed by transthoracic echocardiography after 3 months.ResultsThe study included 15 children with VSD: 3 males and 12 females; their age ranged from 2 to 13 years; all had subaortic VSD except for 1 who had apical muscular VSD: VSD size ranged from 3 to 8 mm; PFM coil was used to close defect in all patients except for 2 patients who had an Amplatzer duct occlude I (ADOI) device, and 1 patient needed an additional vascular plug after significant hemolysis. Pre-procedurally, group A had a significantly higher LVEDD, LVESD, and LVEDV than group B. Mean circumferential strain was significantly higher (more negative) in group A than that in group B either pre- or post-procedure. Post-procedurally, there was a significant decrease in circumferential strain (less negative) and a significant increase in radial strain (more positive).ConclusionFollowing transcatheter VSD closure, there is a significant decrease in LV circumferential strain and a significant increase in LV radial strain, which conclude a decrease in LV volume overload with the improvement of its contractility.
Highlights
This is a case-control study conducted on 30 children, 15 with ventricular septal defect (VSD) who performed VSD transcatheter device closure and 15 controls of matching age and gender, in the period between September 2015 and February 2018
Ventricular septal defect (VSD) is the most common congenital heart disease accounting for 40% of all congenital heart diseases
All patients were subjected to full history taking including age, gender, history of parents’ consanguineous marriage, drug intake during pregnancy or exposure to irradiation, recurrent chest infection, delayed growth milestones, history of dyspnea, previous catheterization or surgery, time of VSD transcatheter closure, and cardiac catheterization details
Summary
This is a case-control study conducted on 30 children, 15 with VSD who performed VSD transcatheter device closure (group A) and 15 controls of matching age and gender (group B), in the period between September 2015 and February 2018. We aimed to assess the global left ventricular (LV) systolic function by 2D speckle tracking before and after ventricular septal defect (VSD) transcatheter closure, in comparison to normal controls. It is classified according to its relation to septum as inlet, trabecular, outlet, and membranous septum [2]. Another classification is based on VSD location on the right surface of the interventricular septum as single or multiple, Management in the infant and child depends on symptoms; children with small asymptomatic defects need no medical management and are unlikely to need any intervention. Any patient needing significant medical management should be referred for surgical assessment [4]
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