Transcatheter Device Closure of Congenital Ventricular Septal Defects: Procedural Outcomes and Short-Term Experience from a Tertiary Care Center in Pakistan.

Abstract

Background: Congenital ventricular septal defects (VSDs) are the most common congenital cardiac anomalies and may lead to left ventricular volume overload, pulmonary hypertension, arrhythmias, heart failure, or Eisenmenger syndrome if untreated. While surgery remains the conventional treatment, transcatheter device closure offers a minimally invasive alternative with shorter hospitalization and reduced morbidity.

Methodology: This retrospective observational study was conducted at Lady Reading Hospital-MTI, Peshawar, Pakistan, and included all patients who underwent attempted transcatheter closure of congenital VSDs from January 2023 to January 2026. Patients with hemodynamically significant left-to-right shunts and anatomically suitable defects on echocardiography were included. Clinical, echocardiographic, and catheterization records were reviewed to assess defect characteristics, device selection, procedural success, immediate outcomes, and complications.

Results: A total of 41 patients underwent attempted transcatheter VSD closure, with ages ranging from 12 months to 47 years. Perimembranous VSDs accounted for 70.7% of cases and muscular VSDs for 29.3%. Procedural success was achieved in 90.2% (37/41), with complete or trivial residual shunting on immediate imaging. Partial right coronary cusp prolapse was observed in 34.1% of patients, without progression to significant aortic regurgitation after device deployment. Major complications included device embolization in 4.8%, significant residual shunt in 2.4%, mild left ventricular outflow tract obstruction in 2.4%, and procedure-related mortality in 2.4%. No new significant aortic regurgitation or complete atrioventricular block was observed.

Conclusion: Transcatheter VSD closure showed high procedural success and favorable short-term outcomes, supporting its role as a safe, effective, valve-preserving alternative to surgery in selected patients, including in resource-limited settings.