Transcatheter interventional management of postoperative residual shunt lesion after congenital cardiac surgery

Background: Congenital heart defects can be effectively managed through a variety of approaches, including conservative treatment, surgery, or interventional procedures. Complex defects, such as ventricular or atrial septal defects and patent ductus arteriosus, often necessitate congenital cardiac surgery for correction. Residual lesions refer to defects that persist after surgery or develop later on. Hemodynamically significant residual shunts should be addressed through either transcatheter interventions or redo surgery. Transcatheter closure is increasingly favored as it is less invasive, has a high safety profile, and typically results in lower morbidity, faster recovery times, and reduced costs compared to traditional redo open-heart surgery. This approach allows for effective management of congenital heart defects while minimizing the impact on the patient's overall health. This study aimed to understand the outcomes of these transcatheter management strategies, providing insight into effective clinical practices for managing post-surgical congenital cardiac shunt lesions.

Methods: The patients who developed residual lesion after cardiac surgical correction of shunt lesion like ventricular septal defect (VSD), arterial switch operation (ASO) with atrial septal defect (ASD), ASD with mitral valve cleft, patent ductus arteriosus (PDA) ligation were included. This is a prospective observational study which was done in National Heart Foundation Hospital & Research Institute during 2014 August to 2024 September.

Results: Among the seven patients with post-operative residual shunt lesions, four were male and three were female, with a median age of 11 years, ranging from 1 to 28 years. Six of these patients (85.7%) underwent elective closures, while one required an emergency intervention (14.3%). On average, the interval between surgery and the subsequent transcatheter intervention was 6.6 years, with a range from 15 days to 13 years. The average hospital stay across all cases was 7 days, varying from 4 to 22 days, and the follow-up duration averaged 5.84 years. Among these patients, one individual with VSD had a residual shunt. Importantly, there were no vascular access-related complications, postprocedural heart block, hemolysis, significant new valvular regurgitation, or procedure-related mortality.

Conclusion: Transcatheter-based interventions are typically the first-line treatment for newly diagnosed cases.  Here a few rare interventional techniques have demonstrated successfully resolved complex surgical complications, ensuring optimal patient outcomes with minimal risks.