Percutaneous Ultrasound-Guided Closure of Perimembranous Ventricular Septal Defects in Children Using Bioabsorbable Occluders-Feasibility and 1-Year Follow-Up.

Background: To reduce complications associated with metal occluders, bioabsorbable occluders have been implanted for perimembranous ventricular septal defects (VSDs) via transthoracic approach. This study investigates the feasibility of echocardiography-guided percutaneous closure of perimembranous VSDs in children using bioabsorbable occluders, along with its 1-year follow-up outcomes.

Aims: To evaluate the feasibility and 1-year outcomes of echocardiography-guided percutaneous closure of perimembranous VSDs using bioabsorbable occluders in children.

Methods: Between April 2023 and March 2024, consecutive children with perimembranous VSDs underwent percutaneous closure using bioabsorbable occluders under echocardiography guidance alone were enrolled. Procedural success was defined as percutaneous device implantation under sole ultrasound guidance with residual shunt ≤ 2 mm and no severe in-hospital complications. Preoperative, intraoperative, and follow-up data were prospectively collected and analyzed.

Results: The study cohort comprised 14 children, including three with a subaortic rim ≤ 3 mm and one with a distance of ≤ 1 mm between the VSD and the tricuspid septal leaflet. All procedures were successful. Vascular access was via the femoral artery in six patients (42.9%) and femoral vein in eight patients (57.1%). No major complications occurred. A 2 mm residual shunt was noted in one patient (7.1%) and remained unchanged during the follow-up period. While new-onset mild/moderate tricuspid regurgitation occurred in three patients (21.4%), all cases showed improvement over time. At 1 year, no new onset aortic regurgitation or complete heart block were reported, and the occluders were largely absorbed.

Conclusion: Percutaneous closure of perimembranous VSDs in children using bioabsorbable occluders under echocardiography guidance is feasible, with promising 1-year outcomes.