Predictors Of Residual VSD After Surgical Versus Transcatheter Closure

Abstract

Background: Ventricular septal defect (VSD) repair is a frequently performed cardiac procedure in children, and it is associated with a extremely low likelihood of experiencing post-operative complications. Aim of the study: to identify the incidence of residual shunt across interventricular septum after surgical repair or device closure of isolated VSD or associated with another congenital anomaly. Methods: This is a retrospective study included 60 patients undergoing closure of VSD between January 2021 and January 2023 in National Heart Institute. They were divided into 2 groups: Group I underwent surgical closure (30 patients) and group II underwent transcatheter closure (30 patients). Transeophageal echocardiogram (TEE) was done directly post-operative. Patients with residual shunt were called, to be re-evaluated with TEE. Results: Group I had 16 female patients (53.3%). The mean age was 2.47 ± 2.14 years, the mean weight was 11.38 ± 4.17 Kg, the mean height was 81.68 ± 15.76 cm and the mean body surface area was 0.48 ± 0.10 M2.The Types of VSD were outlet in 13 patients (43.3%), perimembranous in 12 patients (40%), inlet in 3 patients (10%) and muscular in 2 patients (6.7%). The mean size of VSD was 7.88 ± 2.01 cm. A residual shunt was diagnosed in 15 patients (50%) with the mean size of residual shunt was 2.06 ± 0.97 mm. In follow-up TEE, residual shunt was diagnosed in 9 patients (30%) with mean size of residual shunt was 1.43 ± 0.61 mm. Group II had 15 female patients (50.0%). The mean age was 8.49 ± 4.99 years, the mean weight was 27.08 ± 14.69 Kg, the mean height was 121.63 ± 27.14 cm and the mean BSA was 0.94 ± 0.35 M2. The types of VSD were perimembranous in 19 patients (63.3%) and muscular in 11 patients (36.7%). The mean size of VSD was 5.47 ± 1.36 cm. A residual shunt was diagnosed in 9 patients (30%) with the mean size of residual shunt was 1.0 ± 0.0 mm. In follow-up TEE, residual shunt was diagnosed in 2 patients (6.7%) with mean size of residual shunt was 1.0 ± 0.0 mm. Univariate and multivariate regression analyses regarding residual VSD shunt revealed that size of VSD was a predictive factor in surgical or device closure of VSD. Conclusion: Postoperative echocardiograms routinely show residual VSD following surgical or transcatheter closure. The size of the VSD was found to be an independent factor contributing to the presence of residual VSD in both surgical and transcatheter closure procedures.