Transcatheter closure of perimembranous ventricular septal defects in children using a wire-drifting technique

  AIM  To explore the feasibility and safety of transcatheter closure of perimembranous ventricular septal defects (PmVSD) using a wire-drifting technique in children.

  METHODS  We retrospectively analyzed 256 pediatric patients diagnosed with PmVSD who underwent interventional treatment in our center from December 2011 to December 2019. Based on the method used for arteriovenous loop establishment during the procedure, the patients were divided into the conventional technique group and the wire-drifting technique group. Comparison between the two groups was made in the success rate of the procedure and one-time arteriovenous loop establishment, the operation time, the incidence of severe arrhythmia during the procedure and the incidence of new postoperative arrhythmia and tricuspid regurgitation (TR).

  RESULTS  In total, 127 of the 132 patients (97.0%) in the conventional technique group and 121 of the 124 patients (97.6%) in the wire-drifting technique group achieved procedural success, with no significant difference between the two groups. The wire-drifting technique group had a higher success rate in one-time arteriovenous loop establishment (96.7% vs. 87.4%, P<0.05). The procedure time was respectively with no statistical difference. Among the patients with successful procedure, the incidence of severe arrhythmia during the procedure in the wire-drifting technique group was significantly lower than that in the conventional technique group (7.1% vs. 0%, P<0.05). There was no atrioventricular block in the wire-drifting technique group during the procedure. There was no significant difference in the incidence of new-onset arrhythmias between the two groups (6.3% vs. 6.6%,). During the 2-year follow-up period, aggravated (mild to moderate) TR was observed in 2 patients (3.9%) in the conventional technique group and it was not observed in the wire-drifting technique group.

  CONCLUSION  Transcatheter closure of PmVSD with the wire-drifting technique is safe and effective in children. In PmVSD interventional treatment, it can replace traditional methods to establish arteriovenous loop, which reduces the stimulation of catheters and guidewires on the surrounding tissues of the defect, thereby reducing the occurrence of intraoperative atrioventricular block.