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

Abstract

Introduction

Ventricular septal defects (VSDs) account for 50% of congenital heart defects in children. Surgical closure of moderate to large VSDs using patch material is considered the standard treatment in children to prevent future complications.

Objectives

We evaluated the fate of VSD patch leak and its impact on aortic and tricuspid valve regurgitation at one year after surgery.

Methods

This retrospective study consisted of patients with a perimembranous VSD who underwent surgery between January 2016 and July 2021. Demographic, echocardiographic, clinical, and operative data were retrospectively reviewed. All patients’ echocardiographic images were analyzed at discharge, 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 reviewed. No patient required reintervention. There was one early mortality during follow-up. Of the 70 patients with complete follow-up, 24 patients (34.33%) had a 1–2 mm rVSD patch leak and 4 patients (5.7%) had a 2–3 mm rVSD patch leak at the time of discharge. At 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. The size of the patch leak did not affect patients’ weight gain (P ≥ .05).

Conclusions

We demonstrated that a 2 mm or less rVSD patch leak is benign, has no impact on tricuspid or aortic valve function, no impact on weight gain, and almost always decreases in severity or disappears.