Progression of aortic regurgitation following transcatheter closure of intracristal ventricular septal defects in children: a mid- to long-term follow-up study

Qiuman Li; Xu Zhang; Yukai Xu; Lingmei Zhou; Junjie Li; Zhiwei Zhang

doi:10.3389/fcvm.2023.1190013

Progression of aortic regurgitation following transcatheter closure of intracristal ventricular septal defects in children: a mid- to long-term follow-up study

Front Cardiovasc Med. 2023 May 3:10:1190013. doi: 10.3389/fcvm.2023.1190013. eCollection 2023.

Authors

Qiuman Li^#¹, Xu Zhang^#¹, Yukai Xu², Lingmei Zhou³, Junjie Li², Zhiwei Zhang²

Affiliations

¹ Department of Pediatric Cardiology, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou, China.
² Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
³ School of Medicine, South China University of Technology, Guangzhou, China.

^# Contributed equally.

Abstract

Background: Early surgical closure is warranted to prevent aortic valve lesion and aortic regurgitation (AR) in intracristal ventricular septal defects (icVSDs). Experiences for transcatheter device closure of icVSDs are still limited. Our objectives are to investigate AR progression following transcatheter closure of icVSDs in children and to explore the risk factors for AR progression.

Methods and results: From January 2007 to December 2017, 50 children with icVSD who had successfully undergone transcatheter closure were enrolled. With 4.0 (interquartile range: 3.0-6.2) years of follow-up, AR progression was observed in 20% (10/50) of patients after icVSD occlusion, among which 16% (8/50) remained in mild level and 4% (2/50) evolved to moderate. None progressed to severe AR. Freedom from AR progression was 84.0%, 79.5%, and 79.5% at 1, 5, and 10 years of follow-up. A multivariate Cox proportional-hazards model revealed that x-ray exposure time [hazard ratio (HR): 1.11, 95% confidence interval (CI): 1.04-1.18, P = 0.001] and the ratio of pulmonary to systemic blood flows (HR: 3.38, 95% CI: 1.11-10.29, P = 0.032) were independent predictors for AR progression.

Conclusions: Our study suggested that transcatheter closure of icVSD in children is safe and feasible in mid- to long-term follow-up. No serious AR progression occurred after icVSD device closure. Greater left-to-right shunting and longer x-ray exposure time were both risk factors for AR progression.

Keywords: aortic regurgitation; follow-up; intracristal ventricular septal defect; risk factor; transcatheter closure.

Grants and funding

ZZ received research grants from Science and Technology Planning Project of Guangdong Province (CN) (2015B070701008) and the Shenzhen San-Ming Project (H022017028). The funding organization played no role in the collection, analysis or interpretation of the data, and had no right to restrict the publishing of the manuscript.