ArticleFrontiers in cardiovascular medicine2026
Feasibility and short-term outcomes of transcatheter closure of moderate-to-large perimembranous ventricular septal defects in children using bioabsorbable occluders: a prospective case series.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: Transcatheter closure has become an important treatment modality for perimembranous ventricular septal defects (pmVSDs). However, conventional metallic occluders carry the risk of long-term complications. Fully bioabsorbable occluders offer a potential solution, yet their application in children with moderate-to-large pmVSDs remains under-reported. This study evaluated the feasibility and 1-year outcomes of transthoracic, transesophageal echocardiography (TEE)-guided implantation of a bioabsorbable occluder via a small subxiphoid incision in children with moderate-to-large pmVSDs. Methods: Children aged ≥1 year with moderate-to-large pmVSDs (defined as left ventricular defect diameter exceeding one-third of the aortic root diameter) who underwent TEE-guided transthoracic device closure using a bioabsorbable occluder between July 2024 and January 2025 were prospectively enrolled. Baseline characteristics, procedural data, and follow-up outcomes at 1, 3, 6, and 12 months were collected. The primary endpoints were technical success, valvular function, conduction disturbance, and occluder degradation. Results: Five children (mean age 2.4 ± 1.7 years; mean weight 12.6 ± 4.6 kg; mean defect diameter 8.8 ± 2.6 mm) were included. All implants were successful (technical success 100%). One patient with a multi-fenestrated defect had a 2 mm residual shunt immediately post-procedure, which resolved by 6 months. At 1 year, no patient developed new-onset or worsening aortic regurgitation (AR) or tricuspid regurgitation (TR), and none had complete atrioventricular block (cAVB). Quantitative echocardiographic analysis showed that occluder disc area decreased substantially at 1 year, indicating progressive absorption. Conclusions: TEE-guided transthoracic closure of moderate-to-large pmVSDs using a bioabsorbable occluder appears feasible in selected children. One-year follow-up data suggest favorable preservation of valvular and conduction function, with progressive occluder degradation. This approach may offer a minimally invasive alternative to surgery for this challenging population, although larger studies are warranted.
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