SPC365

Percutaneous Closure of Perimembranous Ventricular Septal Defects in a Pediatric Cohort: Single-Center Experience

Session: Sessão de Comunicações Orais 06 – Fechar as lacunas: soluções percutâneas na cardiopatia congénita e estrutural
Speaker: Manuela da Silva Lopes

Congress: CPC 2026
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 20. Congenital Heart Disease and Pediatric Cardiology
Subtheme: 20.4 Congenital Heart Disease – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Manuela Lopes; Sofia Rito; Filipa Curinha; Diogo Faim; Joana Marinho; Patrícia Vaz Silva; António Pires

<p style="margin-left:95px; text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,&quot;sans-serif&quot;"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;">Background:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"> Percutaneous closure of perimembranous ventricular septal defects (pmVSD) in children is a minimally invasive alternative to surgery. Evaluating real-world outcomes, case selection, and complications is essential to optimize results.</span></span></span></span></p>

<p style="margin-left:95px; text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,&quot;sans-serif&quot;"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;">Aims:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"> To assess procedural success, safety, and short-term hemodynamic outcomes of percutaneous pmVSD closure in a pediatric cohort at a single center.</span></span></span></span></p>

<p style="margin-left:95px; text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,&quot;sans-serif&quot;"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;">Methods: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;">Retrospective analysis of all consecutive pediatric patients undergoing percutaneous pmVSD closure between May 2023 and November 2025. Demographics, echocardiographic parameters, procedural details, and clinical outcomes were collected.</span></span></span></span></p>

<p style="margin-left:95px; text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,&quot;sans-serif&quot;"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;">Results:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"> Twenty procedures were performed in 19 patients (11 male), with a median age of 4 years (IQR 2&ndash;6) and a median weight of 14.3 kg (IQR 11.5&ndash;15.7). Median anatomic VSD diameter was 7 mm (IQR 6&ndash;10), and median effective orifice diameter was 5 mm (IQR 4-6.8).</span></span> <span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;">Half of the cohort had a moderate VSD, while 35% had a large defect. Most defects were aneurysmal (74%). One patient, treated with a Lifetech Konar-MF&trade; multi-fenestrated occluder (LT-MFO), required reintervention due to a significant residual shunt, and an Amplatzer Duct Occluder II device was subsequently placed. All other patients were treated with LT-MFO. </span></span></span></span></p>

<p style="margin-left:95px; text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,&quot;sans-serif&quot;"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;">Device implantation was succeeded in 17 patients (85%). Procedures were performed under transesophageal echocardiogram guidance. &nbsp;Of the 3 unsuccessful cases, two had markedly high VSD/Ar (0.7), resulting in inadequate device adaptation, and one experienced an acute ischemic event during delivery system advancement, resulting in death prior to implantation. Among the 17 patients, one major complication occurred (device embolization requiring surgery). Minor complications included moderate tricuspid regurgitation (n=4), moderate aortic insufficiency (n=1), and partial femoral artery thrombosis (n=1). Median hospital stay was 3 days. </span></span></span></span></p>

<p style="margin-left:95px; text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,&quot;sans-serif&quot;"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;">Significant hemodynamic improvement was observed at 1-month follow-up. The median left ventricle end-diastolic diameter Z-score decreased from 2.7 (IQR 1.4&ndash;3.4) to 1.1 (IQR 0.5&ndash;2.1) (p=0.002). Similarly, the main pulmonary artery diameter Z-score decreased from 2.2 (IQR 1.7&ndash;2.8) to 1.4 (IQR 0.6&ndash;2.1) (p=0.001). A small residual shunt was present in 12 patients (71%).</span></span></span></span></p>

<p style="margin-left:95px; text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,&quot;sans-serif&quot;"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;">Conclusion:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"> Percutaneous pmVSDs closure is an effective and safe procedure in children, resulting in significant hemodynamic improvement and short <span style="color:black">hospitalization stays.</span> The complication rate is low and comparable to published data, highlighting the importance of case selection and operator expertise for optimal outcomes.</span></span></span></span></p>