ARYA Atherosclerosis Journal

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

Document Type : Case Series

Authors

Fatemeh Doost-Mohammadi 1
Alireza Amirbeigi 1, 2
Reza Derakhshan 3

1 Clinical Research Development Unit, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran

2 Department of Surgery, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran

3 Department of Pediatrics, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

10.48305/arya.2026.45972.3133
Abstract
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.

Keywords

Heart Septal Defects
Ventricular
Cardiac Catheterization
Septal Occluder Device
Congenital Heart Defects
Treatment Outcome
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ARYA Atherosclerosis Journal
Volume 22, Issue 3
May and June 2026
Pages 1-12

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