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Transcatheter device closure of perimembranous ventricular septal defect in children treated with prophylactic oral steroids: acute and mid-term results of a single-centre, prospective, observational study

Published online by Cambridge University Press:  24 June 2015

Bhavesh Thakkar ,
Nehal Patel ,
Shomu Bohora ,
Dharmin Bhalodiya ,
Tarandeep Singh ,
Tarun Madan ,
Saurin Shah ,
Vishal Poptani  and
Anand Shukla
Bhavesh Thakkar*
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research CentreAhmedabad, Gujarat, India
Nehal Patel
Affiliation:
Department of Pediatrics, GMERS Medical College, Ahmedabad, Gujarat, India
Shomu Bohora
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research CentreAhmedabad, Gujarat, India
Dharmin Bhalodiya
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research CentreAhmedabad, Gujarat, India
Tarandeep Singh
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research CentreAhmedabad, Gujarat, India
Tarun Madan
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research CentreAhmedabad, Gujarat, India
Saurin Shah
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research CentreAhmedabad, Gujarat, India
Vishal Poptani
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research CentreAhmedabad, Gujarat, India
Anand Shukla
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research CentreAhmedabad, Gujarat, India
*
Correspondence to: Dr B. Thakkar, Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Asarwa, Ahmedabad 380016, Gujarat, India. Tel: +91 9898022444; Fax: +91 (79) 22682092; E-mail: bthakkarin@yahoo.co.in
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Abstract

Background and Objective

Although transcatheter closure of perimembranous ventricular septal defect is emerging as an accepted, viable alternative, conduction disturbances still remain a major concern. Although steroid treatment has shown encouraging results with complete recovery, efficacy of prophylactic use of steroids is still speculative. We aim to study the mid-term outcome of perimembranous ventricular septal defect closure in children who received prophylactic oral steroids.

Materials and methods

A prospective study was designed and antegrade device closure was attempted in eligible children who met the following inclusion criteria: age 3–18 years and weight >10 kg, defect diameter ⩽12 mm, and symptomatic, haemodynamic changes or history of infective endocarditis. Prophylactic steroid protocol consisted of 2 weeks oral prednisolone (1 mg/kg/day) initiated immediately after the procedure, and in the event of bradyarrhythmia it was escalated to 2 mg/kg. Patients were regularly followed-up at 1, 6, and 12 months and then annually. Patients with post-procedure heart block underwent Holter monitoring after a minimum of 1 year interval.

Results

Between May, 2007 and August, 2012, successful device closure was accomplished in 290/297 patients. Mean age and weight were 9±3.12 years and 21±8.27 kg, respectively. The defect measured 5±1.38 mm on echocardiography. Mean fluoroscopy time was 12.98±8.64 minutes. Eight patients with major complications included one each with device embolisation, haemolysis, severe aortic regurgitation, and five with bradyarrhythmias, including complete atrioventricular block in three, Mobitz II in one, and bifascicular block in one. Patients with complete atrioventricular block responded to high-dose steroid and temporary pacemaker. Minor complications included post-procedure heart block (n=22) and blood loss (n=2). At 18.23±13.15 months follow-up, 8/27 (five major, 22 minor) with arrhythmia had persistent post-procedure heart block of no clinical consequences.

Conclusion

In our patient population, transcatheter device closure of the perimembranous ventricular septal defect with prophylactic oral steroid resulted in excellent closure rate and acceptably low incidence of conduction disturbances at mid-term follow-up.

Keywords

Perimembranous VSDsteroidstranscatheter closure
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 4 , April 2016 , pp. 669 - 676
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Copyright
© Cambridge University Press 2015 

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