الفهرس 
Assessment of Residual Shunting Following Surgical or Trans Catheter Device Closure of Perimemberanous Ventricular Septal Defects in Children
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Abstract
Surgical repair for the VSD has been the golden standard treatment.
With the development of various device, trans catheter device closure of VSD has
gradually become an alternative to conventional surgical repair, especially in
patients with perimembranous defects with a promising success rate of closure.
Objective: Assess the incidence of residual shunt following trans catheter device
closure in comparison to surgical closure of pm ventricular septal defects in
children.
Methodology: This study is a retrospective study conducted on 200 pediatric
patients post isolated pm VSD closure (100 post-surgical cases, 100 post catheter
case). They were followed up over 24 months post intervention for assessment of
residual shunting, possibility and timing of spontaneous closure, other early and
late postoperative complications including, valves insufficiency, complete
atrioventricular block (CAVB), ventricular dysfunction, blood transfusion, length
of hospital stay and outcome in both groups in comparison to each other.
Results: Our study revealed that 24 %(n=24) of postoperative cases had a
residual defect at immediate postoperative assessment, all of them sealed
spontaneously during the first 6 postoperative months, with only one post
catheter case with trivial residual defect, and still present. 4%(n=4) with
CAVB and permanent pacemaker among the surgical cases in opposite to
none of the catheter group. As regarding the aortic insufficiency, 3% of post
catheter cases developed new aortic valve regurge with trivial to mild severity
(2 of them improved during the follow up), in comparison to none of the
surgical cases. Blood transfusion, length of hospital stay was significantly
more among the surgical cases. We have no mortality in both groups.
Conclusion : Our study suggests that there is no significant difference between
percutaneous and surgical closure of pmVSDs in terms of early (up to 30 days)
efficacy and safety in well-selected patients. Furthermore, percutaneous closure is
associated with decreased hospital stay, which could potentially be cost saving.