Percutaneous Closure of Perimembranous Outlet Ventricular Septal Defect with Partial Right Coronary Cusp Prolapse: A Single-Center Experience.
Keywords:
Ventricular Septal Defect, Perimembranous Outlet, Right Coronary Cusp Prolapse, Transcatheter Closure, KONAR-MF Occluder, Aortic RegurgitationAbstract
Background: Perimembranous ventricular septal defects (PmVSD) with outlet extension and partial right coronary cusp (RCC) prolapse are a difficult category for transcatheter closure due to their closeness to the aortic valve. This study describes our single-center experience with percutaneous device closure in a high-risk group.
Methodology: A retrospective analysis was conducted on all patients who underwent attempted transcatheter closure of perimembranous outlet VSD with partial RCC prolapse at Lady Reading Hospital MTI Peshawar between January 2022 and June 2025. Demographic, procedural, and follow-up data were reviewed.
Results: A total of 34 patients (mean age 8.5 years, range 2-22 years; 52.9% male) had attempted device closure. The median left ventricular defect size was 6.2 mm (range 4-10 mm). The KONAR-MF multipurpose occluder was employed in 82.4% of instances, with the remaining using the Amplatzer duct occluder II. The procedure was successful in 91.2% (31/34) of the patients. Three procedures were halted due to device-related aortic regurgitation. Complete closure was observed in 77.4% of cases at discharge, which increased to 93.5% at 6-month follow-up. Of the 31 successful procedures, eight patients (25.8%) had pre-existing mild AR that remained stable throughout follow-up; two additional patients (6.5%) developed new-onset mild aortic regurgitation post-procedure. No patient developed moderate or severe AR. There were no occurrences of total heart block, device embolization, or significant vascular problems.
Conclusion: In conclusion, percutaneous closure of perimembranous outlet VSD with partial RCC prolapse is feasible and safe in selected patients, with high procedural success and acceptable complication rates. Careful patient selection, suitable device selection, and cautious technique are required for best results in this difficult population.
