title: Transcatheter device closure of perimembranous ventricular septal defect in children treated with prophylactic oral steroids: acute and mid-term results of a single-centre, prospective, observational study.
abstract: Background and Objective Although transcatheter closure of perimembranous ventricular septal defect is emerging as an accepted, viable alternative, conduction disturbances still remain a major concern. Although steroid treatment has shown encouraging results with complete recovery, efficacy of prophylactic use of steroids is still speculative. We aim to study the mid-term outcome of perimembranous ventricular septal defect closure in children who received prophylactic oral steroids. Materials and methods A prospective study was designed and antegrade device closure was attempted in eligible children who met the following inclusion criteria: age 3-18 years and weight >10 kg, defect diameter ⩽12 mm, and symptomatic, haemodynamic changes or history of infective endocarditis. Prophylactic steroid protocol consisted of 2 weeks oral prednisolone (1 mg/kg/day) initiated immediately after the procedure, and in the event of bradyarrhythmia it was escalated to 2 mg/kg. Patients were regularly followed-up at 1, 6, and 12 months and then annually. Patients with post-procedure heart block underwent Holter monitoring after a minimum of 1 year interval.
  
  
  RESULTS
  Between May, 2007 and August, 2012, successful device closure was accomplished in 290/297 patients. Mean age and weight were 9±3.12 years and 21±8.27 kg, respectively. The defect measured 5±1.38 mm on echocardiography. Mean fluoroscopy time was 12.98±8.64 minutes. Eight patients with major complications included one each with device embolisation, haemolysis, severe aortic regurgitation, and five with bradyarrhythmias, including complete atrioventricular block in three, Mobitz II in one, and bifascicular block in one. Patients with complete atrioventricular block responded to high-dose steroid and temporary pacemaker. Minor complications included post-procedure heart block (n=22) and blood loss (n=2). At 18.23±13.15 months follow-up, 8/27 (five major, 22 minor) with arrhythmia had persistent post-procedure heart block of no clinical consequences.
  
  
  CONCLUSIONS
  In our patient population, transcatheter device closure of the perimembranous ventricular septal defect with prophylactic oral steroid resulted in excellent closure rate and acceptably low incidence of conduction disturbances at mid-term follow-up.
authors.affiliation: 1Department of Pediatric Cardiology,U N Mehta Institute of Cardiology and Research CentreAhmedabad,Gujarat,India.
authors.forename: Bhavesh
authors.initials: B
authors.lastname: Thakkar
authors.affiliation: 2Department of Pediatrics,GMERS Medical College,Ahmedabad,Gujarat,India.
authors.forename: Nehal
authors.initials: N
authors.lastname: Patel
authors.affiliation: 1Department of Pediatric Cardiology,U N Mehta Institute of Cardiology and Research CentreAhmedabad,Gujarat,India.
authors.forename: Shomu
authors.initials: S
authors.lastname: Bohora
authors.affiliation: 1Department of Pediatric Cardiology,U N Mehta Institute of Cardiology and Research CentreAhmedabad,Gujarat,India.
authors.forename: Dharmin
authors.initials: D
authors.lastname: Bhalodiya
authors.affiliation: 1Department of Pediatric Cardiology,U N Mehta Institute of Cardiology and Research CentreAhmedabad,Gujarat,India.
authors.forename: Tarandeep
authors.initials: T
authors.lastname: Singh
authors.affiliation: 1Department of Pediatric Cardiology,U N Mehta Institute of Cardiology and Research CentreAhmedabad,Gujarat,India.
authors.forename: Tarun
authors.initials: T
authors.lastname: Madan
authors.affiliation: 1Department of Pediatric Cardiology,U N Mehta Institute of Cardiology and Research CentreAhmedabad,Gujarat,India.
authors.forename: Saurin
authors.initials: S
authors.lastname: Shah
authors.affiliation: 1Department of Pediatric Cardiology,U N Mehta Institute of Cardiology and Research CentreAhmedabad,Gujarat,India.
authors.forename: Vishal
authors.initials: V
authors.lastname: Poptani
authors.affiliation: 1Department of Pediatric Cardiology,U N Mehta Institute of Cardiology and Research CentreAhmedabad,Gujarat,India.
authors.forename: Anand
authors.initials: A
authors.lastname: Shukla
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D001145:Arrhythmias, Cardiac / Q000517:prevention & control*; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D011239:Prednisolone / Q000008:administration & dosage*; D011446:Prospective Studies; D011474:Prosthesis Design; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone
keywords: Perimembranous VSD; steroids; transcatheter closure