Abstract
BackgroundVentricular septal defect (VSD) is the most common congenital heart disease. In patients with large VSD, left side chambers are subjected to volume overload with subsequent chambers dilatation and eccentric left ventricular hypertrophy. Percutaneous closure of VSD has been shown to be an effective method with equal safety and efficacy when compared to surgery. The effect of VSD closure on LV remodeling has been mainly assessed in patients treated with surgery and to date published data remain scarce. Therefore, we aim to evaluate the effect of percutaneous VSD closure on different LV parameters.ResultsSeventeen patients (median age 6 years (IQR 4.75–8 years), 70.6% females) who underwent percutaneous VSD closure were enrolled in the study. Sixteen patients (94%) had perimembranous VSD, and one patient had muscular VSD. The procedure was successful in all patients with no major complications. Nit Occlud® Lê coil device was implanted in 16 patients (94%), and one patient received Amplatzer PDA duct occlude device. At 6-months follow-up, there was a significant reduction in indexed LV dimensions [LVEDD/BSA (median 46.5 mm/m2 vs. 42.9 mm/m2, p = 0.03), LVESD/BSA (median 31.7 mm/m2 vs. 26.7 mm/m2, p = 0.02)], indexed LV volumes [LVEDV/BSA (median 52.6 ml/m2 vs. 37.3 ml/m2, p = 0.02), LVESV/BSA (median 31.7 ml/m2 vs. 23.3 ml/m2, p = 0.02)] and indexed LV mass (median 62.4 gm/m2 vs. 57.9 ml/m2, p = 0.01). There was a significant reduction in LVEDD Z-score (p = 0.01) and LVESD Z-score (p = 0.04). There was no significant change in LV EF.ConclusionsPercutaneous VSD closure is associated with improvement of various LV parameters with consequential favorable LV remodeling and function.
Highlights
Ventricular septal defect (VSD) is the most common congenital heart disease
In patients with large VSD associated with significant left to right shunt in the absence of pulmonary vascular disease, left side chambers are subjected to volume overload secondary to increased pulmonary blood flow and venous return
This will eventually lead to left side chambers dilatation and eccentric left ventricular hypertrophy due to amplification of left ventricular (LV) wall stress [3]
Summary
Ventricular septal defect (VSD) is the most common congenital heart disease. In patients with large VSD, left side chambers are subjected to volume overload with subsequent chambers dilatation and eccentric left ventricular hypertrophy. VSD occurs in various anatomic locations along the interventricular septum; perimembranous, muscular, In patients with large VSD associated with significant left to right shunt in the absence of pulmonary vascular disease, left side chambers are subjected to volume overload secondary to increased pulmonary blood flow and venous return. This will eventually lead to left side chambers dilatation and eccentric left ventricular hypertrophy due to amplification of left ventricular (LV) wall stress [3]. The effect of percutaneous closure of VSD on various LV parameters and its time course is not known, especially when associated with residual shunt and/or valvular regurgitation which may hinder complete removal of volume overload
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