Evaluation of Left Ventricular Function Following Surgical Versus Interventional Ventricular Septal Defects Closure in Children: A Double Center Study in Egypt

Abstract

Ventricular septal defect (VSD) is the most common congenital heart disease in pediatrics, and its closure can be achieved either surgically or via transcatheter intervention. Both approaches effectively eliminate left-to-right shunting but may have different impacts on early and late left ventricular (LV) function. Objective: to assess the early and follow-up changes in left ventricular systolic function and ventricular dimensions after surgical versus transcatheter closure of isolated ventricular septal defects (VSDs), as well as the time required for recovery of left ventricular systolic function and structural reverse remodeling following defect closure. Methods: This record-based study included 50 children aged 6 months to 5 years who underwent isolated VSD closure (25 surgical, 25 transcatheter) at two centers in Egypt between 2019 and 2025. Anthropometric, Clinical, and comprehensive echocardiographic data were systematically collected and reviewed. Statistical analysis was performed using appropriate parametric and non-parametric tests, with significance set at p ≤ 0.05. Results: Both groups demonstrated significant improvement in LV dimensions and PAP over time (p<0.001). However, the surgical group exhibited a more pronounced early decline in EF (61.88 ± 3.07%) compared to the transcatheter group (66.20 ± 2.36%, p<0.001). Recovery of LV systolic function occurred significantly faster in the transcatheter group (3.28 ± 1.06 months) than in the surgical group (9.36 ± 0.95 months, p<0.001). Intensive care unit ICU stay was significantly longer in the surgical group (p<0.001). At follow-up, both groups showed recovery of LV function, although EF remained slightly higher in the transcatheter group (p=0.037). Larger VSD size was significantly associated with greater reductions in LV dimensions and PAP (p<0.001). Conclusion: Both surgical and transcatheter VSD closure are effective in achieving favorable long-term cardiac reverse remodeling and functional recovery. However, transcatheter closure is associated with milder early LV decline in function, faster recovery of LV systolic function, and shorter hospital stay. These findings support the preference for transcatheter intervention in appropriately selected patients.