long-term follow-up of transcatheter ventricular septal defect closure in children, and comparison of single-hole versus multi-holes ventricular septal defects

Background: evaluation of complications after transcatheter ventricular septal defect (vsd) closure in long-term follow-up and large samples of children is limited. objectives: we compared the residual shunt after transcatheter closure in vsds with a single hole and multiple holes, a new task that has not been done so far. methods: this retrospective study included all patients who underwent transcatheter device closure for vsd in a tertiary cardiovascular center from 2009 to 2020. follow-up evaluation using transthoracic echocardiography (tte) and electrocardiogram (ecg) was performed at 1, 6, 12 months, and annually after the procedure. results: a total of 409 patients underwent transcatheter vsd closure. the mean age was 7 years (2 - 15 years), and the median follow-up duration was 48 months (1 - 10 years). the number of patients with a singular vsd was 259 (63.4%), and those with multiple exit holes were 150 (36.6%). the incidence of a residual shunt immediately after implantation was significantly higher in vsds with multiple holes than those with a single hole (p = 0.008). during the follow-up, the residual shunts decreased in the group of vsds with a single hole. forty-five patients (11%) and 16 patients (4%) had a new-onset of mild and moderate tricuspid regurgitation (tr), respectively, and it decreased dramatically over time. only 1 patient showed a new-onset mild aortic regurgitation (ar). the most crucial complication shown in 2 patients was a persistent complete heart block. conclusions: ventricular septal defects with multiple exit holes are a risk factor for a residual shunt. after transcatheter vsd closure, the residual shunt in patients with a multiple-hole vsd was significantly higher (p = 0.008). although tr may increase during the procedure, it decreases dramatically over time. interestingly, patients who had pre-procedure tricuspid or aortic regurgitation disappeared after 2 years of the procedure. the most important complication was a complete heart block in 2 patients.