Retrograde transcatheter closure of perimembranous and muscular ventricular septal defects in pediatric and adult patients: 12month outcomes in a case series of 60 patients from Iran.

BACKGROUND

Conventional antegrade transcatheter closure of ventricular septal defects (VSDs) requires prolonged fluoroscopy and risks right-heart complications. This study evaluated the safety, efficacy, and 12-month outcomes of the retrograde approach using direct left ventricular access in pediatric and adult patients.

METHODS

Between January 2022 and June 2024, 60 consecutive Iranian patients (median age 10 years, range 1-40 years) with perimembranous (n = 48) or muscular (n = 12) VSDs underwent retrograde transcatheter closure using LifeTech occluders via bilateral femoral arterial access and left-sided transthoracic echocardiography at two centers in Kerman, Iran.

RESULTS

Technical success was 100%, with 95% achieved on the first attempt. Median defect size was 6.2 mm (range 2.8-11 mm). The Qp/Qs ratio decreased from 2.2 ± 0.5 to 1.1 ± 0.2 (P < 0.001), and ejection fraction increased from 58.5 ± 7.2% to 62.2 ± 6.5% (P < 0.05). Mean fluoroscopy time was 13.3 ± 4.1 minutes, radiation dose was 2.8 ± 1.1 mGy, and hospital stay was 1.2 ± 0.5 days. Minor complications occurred in five patients (8.3%; all Clavien-Dindo Grade I) and resolved without sequelae. At 12-month follow-up with cardiac CT or MRI in all patients, no device migration, embolization, aortic erosion, or significant residual shunt was observed.

CONCLUSION

Retrograde transcatheter VSD closure appears to be safe and effective, and it may be reducing radiation exposure safe and highly effective, significantly reducing radiation exposure, making it a potential attractive alternative to conventional techniques in children and pediatric and adult patients.