Somatic growth before and after interventional closure of small and medium sized VSDs using Nit-Occlud Lê Coil

Introduction: Ventricular septal defects (VSDs) with large left to right shunt cause heart failure, failure to thrive and pulmonary hypertension. Closure is indicated early in life. Closure of VSDs with medium sized shunt is often advised but closure of small defects a controversial issue. The purpose of this study is to analyse the effect of interventional VSD closure on somatic growth in consideration of shunt volume.

Methods: Analysis of weight and length development in 33 patients before and after VSD closure using Nit-Occlud Lê Coil at a mean age of 6.4±3.8 years. Comparison of growth parameters from birth until VSD closure and last follow-up in consideration of shunt volume of small (Qp/Qs <1.5) and medium sized defects (Qp/Qs > 1.5 without pulmonary hypertension).

Results: Safe and successful VSD closure in all patients. Twenty-three patients received closure for small, ten for medium sized VSDs. At time of birth the deviation of weight and length from normal as expressed by weight and length for age z-scores were comparably reduced to healthy standard population in both groups. Reduction of weight and length for age persist until defect closure. After closure significant improvement of weight development appeared after a midterm follow-up of 2.2±1.4 years in both groups (small VSDs: from -0.8±1.2 to -0.5±1.4, p<0.05; medium VSDs: from -1.0±1.8 to -0.5±1.2, p<0.05), whereas length for age z-scores did not change. Left to right shunt volume and catch-up growth did not correlate in this population.

Conclusions: Interventional closure of small and medium sized VSDs by Nit-Occlud Lê VSD Coil in pediatric patients is safe and improves weight development in the midterm follow-up independently from shunt volume.