Fate of Residual Patch Leak after Surgical Closure of Congenital Perimembranous Ventricular Septal Defects

Abstract

Abstract Introduction: Ventricular septal defects (VSDs) account for 50% of congenital heart defects (CHDs) in children. Moderate to large VSDs can lead to heart failure. To prevent future complications, surgical closure of moderate to large VSDs using patch material is considered the standard treatment in children within the first year of life. Objectives: We evaluated the fate of VSD patch leak and its impact on aortic and tricuspid valve regurgitation at 1 year after surgery. Methods: Patients with a perimembranous VSD who underwent surgery between January 2016 and December 2021 were included in the study. Demographic, echocardiographic, clinical and operative data were retrospectively reviewed. All patients’ echocardiographic images were analyzed at discharge and 3, 6, and 12 months after surgery. Echocardiography assessment focused on the degree of residual VSD (rVSD) patch leak and aortic and tricuspid regurgitation grade compared with preoperative echocardiography. Results: Seventy-one consecutive patients who underwent perimembranous VSD surgical closure were included. There was no mortality during follow-up. No patient required re-intervention. Forty-three patients (~ 61%) had no rVSD patch leak on discharge. On 12-month follow-up echocardiography, 67 patients (95.7%) had no rVSD patch leak. Aortic and tricuspid valve regurgitation significantly improved from discharge to 12 months after surgery. No relationship between the size of the patch leak and patient weight was identified (P value = > 0.005). Conclusions: We demonstrated that a less than 2 mm rVSD patch leak is benign in nature, has no impact on tricuspid or aortic valve function, and almost always decreases in severity or disappears.