Retrograde transcatheter closure of perimembranous and muscular ventricular septal defects in pediatric and adult patients: 12month outcomes in a case series of 60 patients from Iran.

BACKGROUND: Conventional antegrade transcatheter closure of ventricular septal defects (VSDs) requires prolonged fluoroscopy and risks right-heart complications. This study evaluated the safety, efficacy, and 12-month outcomes of the retrograde approach using direct left ventricular access in pediatric and adult patients. METHODS: Between January 2022 and June 2024, 60 consecutive Iranian patients (median age 10 years, range 1-40 years) with perimembranous (n = 48) or muscular (n = 12) VSDs underwent retrograde transcatheter closure using LifeTech occluders via bilateral femoral arterial access and left-sided transthoracic echocardiography at two centers in Kerman, Iran. RESULTS: Technical success was 100%, with 95% achieved on the first attempt. Median defect size was 6.2 mm (range 2.8-11 mm). The Qp/Qs ratio decreased from 2.2 ± 0.5 to 1.1 ± 0.2 (P < 0.001), and ejection fraction increased from 58.5 ± 7.2% to 62.2 ± 6.5% (P < 0.05). Mean fluoroscopy time was 13.3 ± 4.1 minutes, radiation dose was 2.8 ± 1.1 mGy, and hospital stay was 1.2 ± 0.5 days. Minor complications occurred in five patients (8.3%; all Clavien-Dindo Grade I) and resolved without sequelae. At 12-month follow-up with cardiac CT or MRI in all patients, no device migration, embolization, aortic erosion, or significant residual shunt was observed. CONCLUSION: Retrograde transcatheter VSD closure appears to be safe and effective, and it may be reducing radiation exposure safe and highly effective, significantly reducing radiation exposure, making it a potential attractive alternative to conventional techniques in children and pediatric and adult patients.