Unplanned Surgery After Transcatheter Closure of Ventricular Septal Defect in Children: Causes and Risk Factors

Objectives: To evaluate the causes and risk factors of unplanned surgery after transcatheter closure of ventricular septal defect (VSD) in children.Methods: A total of 773 patients with VSD who had the devices transcatheter released between January 2013 and December 2018 in our institution were retrospectively reviewed. Univariate and multivariate analyses were used to identify the risk factors for unplanned surgery.Results: Twenty four patients (3.1%) underwent unplanned surgery after transcatheter closure of VSD. The most common cause for unplanned surgery was new-onset or worsening aortic regurgitation (14/24; 58.3%), followed by occluder migration (4/24; 16.7%), complete atrioventricular block (2/24; 8.3%), severe hemolysis (2/24; 8.3%), residual shunt (1/24; 4.2%), and occluder edge near the tricuspid valve chordae (1/24; 4.2%). Logistic regression analysis revealed that primary aortic valve prolapse (OR: 5.507, 95%CI: 1.673–18.123, P = 0.005); intracristal VSD (OR: 8.731, 95%CI: 2.274–33.527, P = 0.002); eccentric occluder (OR: 4.191, 95%CI: 1.233–14.246, P = 0.022); larger occluder size (OR: 1.645, 95%CI: 1.331–2.033, P < 0.001); and pulmonary artery systolic pressure ≥45 mmHg (OR: 4.003, 95%CI: 1.073–14.941, P = 0.039) were risk factors for unplanned surgery.Conclusions: New-onset or worsening aortic regurgitation was the primary cause for unplanned surgery after transcatheter closure of VSD in children. Primary aortic valve prolapse, intracristal VSD, eccentric occluder, larger occluder size, pulmonary artery systolic pressure ≥45 mmHg could increase the risk of unplanned surgery.

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Echocardiographic quantification of pulmonary artery systolic pressure in ventricular septal defect: Do calculations from Doppler interrogation across tricuspid regurgitation and ventricular septal defect correlate?

International Journal of Cardiology ◽

10.1016/j.ijcard.2015.08.181 ◽

2016 ◽

Vol 202 ◽

pp. 100-102 ◽

Cited By ~ 1

Author(s):

Vinay Panday ◽

Edgar Lik-Wu Tay ◽

Po Fun Chan ◽

James Wei -Luen Yip ◽

Kian Keong Poh

Keyword(s):

Ventricular Septal Defect ◽

Pulmonary Artery ◽

Tricuspid Regurgitation ◽

Septal Defect ◽

Systolic Pressure ◽

Pulmonary Artery Systolic Pressure

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Complete atrio-ventricular heart block, a not to be forgotten complication in transcatheter closure of perimembranous ventricular septal defect – a case report and review of literature

Cardiology in the Young ◽

10.1017/s1047951121001980 ◽

2021 ◽

pp. 1-4

Author(s):

Ming Chern Leong ◽

Mazeni Alwi

Keyword(s):

Ventricular Septal Defect ◽

Heart Block ◽

Septal Defect ◽

Transcatheter Closure ◽

Review Of Literature ◽

Device Closure ◽

Bundle Branch Block ◽

Know How ◽

Perimembranous Ventricular Septal Defect ◽

New Onset

Abstract Device occlusion of perimembranous ventricular septal defect is gaining popularity with the emergence of newer, softer occluders and improved technical know-how. We report a 26-year-old lady with a moderate size perimembranous ventricular septal defect who had a new onset of bundle branch block shortly after device closure. The patient subsequently developed a complete atrio-ventricular heart block.

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Doubly committed subarterial ventricular septal defect with prolapsed right coronary cusp with moderate aortic regurgitation

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v10i4.34561 ◽

2017 ◽

Vol 10 (4) ◽

pp. 240

Author(s):

Redoy Ranjan ◽

Asit Baran Adhikary ◽

Mohammad Rashal Chowdhury ◽

Md. Kabiruzzaman ◽

Md. Mushfiqur Rahman

Keyword(s):

Ventricular Septal Defect ◽

Aortic Regurgitation ◽

Septal Defect ◽

Systolic Pressure ◽

Failure To Thrive ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Pulmonary Artery Systolic Pressure ◽

Coronary Cusp ◽

Right Coronary Cusp

<p>A 4 year old girl was presented with the respiratory tract infection, breathlessness after taking meal, failure to thrive, abnormal movement of the chest on left side overlying the area of heart and systolic murmur. She developed these symptoms gradually for the last 3.5 years. Echocardiography revealed doubly committed subarterial ventricular septal defect with moderate aortic regurgitation. The size of the ventricular septal defect was 7 x 9 mm at the left ventricular outflow tract. The right coronary cusp of the aortic valve was prolapsed. Left atrium and left ventricle were dilated. The pulmonary artery systolic pressure was 35 mm Hg. The ventricular septal defect was closed with the standard surgical procedure using cardiopulmonary bypass followed by aortotomy and right atriotomy. Immediate post-operative period of this case was uneventful and the patient was discharged on 9<sup>th</sup> post-operative day. Follow-up echocardiography showed no residual ventricular septal defect or aortic regurgitation and the ventricular function was good.</p>

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Behavioural and emotional outcomes in school-aged children after surgery or transcatheter closure treatment for ventricular septal defect

Cardiology in the Young ◽

10.1017/s104795111300142x ◽

2013 ◽

Vol 24 (5) ◽

pp. 910-917 ◽

Cited By ~ 5

Author(s):

Guotao Guan ◽

Haiyan Liu ◽

Yulin Wang ◽

Bo Han ◽

Youpeng Jin

Keyword(s):

Risk Factors ◽

Ventricular Septal Defect ◽

Odds Ratio ◽

Septal Defect ◽

Transcatheter Closure ◽

Social Withdrawal ◽

Somatic Complaints ◽

Maternal Anxiety ◽

Behavioural Problems ◽

School Aged Children

AbstractObjectionWe aimed to assess and compare the behavioural and emotional outcomes of school-aged children after surgery or transcatheter closure for ventricular septal defect and investigate the risk factors for developing abnormal behavioural problems with the condition.MethodsIn this study, we included 29 children, including 20 boys, with ventricular septal defect who underwent surgery and 35 children, including 21 boys, who underwent transcatheter closure (6–13 years old) and their age- and sex-matched best friends (n = 56) and their parents. The Child Behavior Checklist was used to obtain standardised parents’ reports of behavioural and emotional problems in children. The 28-item version of the General Health Questionnaire was used to assess parents’ psychological distress. Pearson correlation and logistic regression were used to analyse risk factors for developing behaviour problems.ResultsBehavioural problems were greater for boys and girls undergoing surgery or transcatheter closure than controls. The behavioural problems were mainly depression, somatic complaints, and social withdrawal for boys and thought problems, depression, somatic complaints, and social withdrawal for girls. Depression and somatic complaints were greater for boys undergoing surgery than for boys undergoing transcatheter closure. Behavioural problems did not differ between treatment groups for girls. Risk factors for developing behavioural problems were age at the time of ventricular septal defect repair (p = 0.03; odds ratio = 2.35), skin scar (p = 0.04; odds ratio = 3.12), post-operative atrioventricular block (p = 0.03; odds ratio = 2.81), and maternal anxiety (p < 0.01; odds ratio = 4.5).ConclusionSchool-aged children who underwent repair of ventricular septal defect regardless of the type of treatment (surgery or transcatheter closure) exhibit internalising behavioural problems. Risk factors for developing problems are young age, scarring, post-operative atrioventricular block, and maternal anxiety. In particular, maternal anxiety is the most important risk factor.

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