Impact of Transcatheter Perimembranous Ventricular Septal Defect Closure on Tricuspid Regurgitation and Cardiac Remodeling in Pediatric Patients: A Prospective Observational Study

Background: Tricuspid regurgitation (TR) secondary to perimembranous ventricular septal defect (pmVSD) is commonly observed in pediatric patients and may improve following defect closure. This study aimed to evaluate the impact of transcatheter pmVSD closure on the severity of TR and cardiac remodeling in children . Methods: A prospective observational study was conducted on 55 pediatric patients with hemodynamically significant pmVSD and at least mild TR, treated at Minya University Hospital and the National Heart Institute between September 2023 and March 2025. Patients underwent transcatheter closure under echocardiographic and fluoroscopic guidance. Transthoracic echocardiography was performed at baseline, follow-ups at 1, and 6 months assessed TR severity, left ventricular end diastolic/systolic dimensions (LVEDD, LVESD), and ejection fraction (LVEF). Statistical analyses used (SPSS v26). Results: Significant reductions in TR severity were observed post-procedure: The tricuspid regurgitation jet area reduced from 4.63 cm² to 1.16 cm², mild TR decreased from 2.98 cm² to 0.72 cm², moderate TR from 6.6 cm² to 1.2 cm², and severe TR from 10.4 cm² to 4.2 cm² at 6 months (all p<0.001 ). Left ventricular dimensions improved markedly after 6 months, with LVEDD decreasing from 43.18 mm to 39.4 mm and LVESD from 26.8 mm to 23.8 mm (both p<0.001 ). LVEF increased from 65.3% to 67.1% ( p<0.001 ). No residual shunts were reported. Only two patients (3.6%) experienced minor complications. Conclusion: Transcatheter closure appears to be safe and effective treatment for PmVSD associated with TR, with favorable clinical and functional outcomes.