Challenges and Complications in Percutaneous Closure of Postoperative Residual Ventricular Septal Defects

Abstract

Objectives: Surgical intervention has historically been the primary approach for closing ventricular septal defects (VSDs) in patients with congenital heart disease. However, the emergence of minimally invasive techniques, such as percutaneous device closure, offers alternative treatment modalities. This retrospective descriptive cross-sectional study aims to assess the challenges and complications associated with percutaneous closure of postoperative residual VSDs.

Methodology: The study retrospectively analyzed medical records of patients who underwent percutaneous closure of postoperative residual VSDs between April 2016 and September 2019 at the Pediatric and Congenital Heart Disease department of Mashhad University of Medical Sciences. Data collected included patient demographics, echocardiographic findings before, during, and after surgery, as well as follow-up results. Transthoracic echocardiography (TTE) was utilized to assess residual VSD size, position, hemodynamic consequences, and associated lesions pre-procedure.

Results: Twelve patients with postoperative residual VSDs underwent percutaneous device closure, resulting in immediate closure in six cases, while minimal residual VSDs persisted in others. Follow-up duration averaged 23.50 ± 39.73 months, with no mortality reported during this period. Two adverse events, namely fever with chills and intravascular hemolysis, occurred in separate patients. Atrial and right ventricular dilatation was observed in three patients, while others exhibited normal heart chamber dimensions. Left ventricular ejection fraction (LVEF) remained within normal limits across all patients.

Conclusion: Percutaneous closure of postoperative residual VSDs represents a minimally invasive, effective, and safe alternative to traditional surgical approaches. Despite challenges, such as adverse events and residual shunting, percutaneous closure offers favorable outcomes, supporting its adoption as a viable treatment option.