Isolated VSD closure in children with mild aortic coarctation yielded 99.6% survival at 7 years and a 2.2% reintervention rate, with 76.1% achieving normalized isthmic velocity by 3 years.
Cohort (n=231)
Does isolated VSD closure lead to favorable hemodynamic and anatomic evolution of the aortic isthmus in children with mild aortic coarctation?
Isolated VSD closure in children with mild aortic coarctation promotes spontaneous hemodynamic and anatomical aortic remodeling, supporting a deferred-intervention strategy for the coarctation.
BACKGROUND Optimal management of ventricular septal defect (VSD) with mild aortic coarctation (isthmus velocity ≥1.50 m/s below intervention thresholds) remains contentious due to limited evidence on post-VSD-closure aortic remodeling. METHODS This retrospective cohort study analyzed 231 children with mild Aortic coarctation undergoing isolated VSD closure. Primary interests included survival, Aortic coarctation reintervention, longitudinal evolution of isthmic velocity and Z-scores, and predictors of persistent obstruction (velocity ≥1.50 m/s at 3-year follow-up). RESULTS At median 5.5 (4.3-6.4) years follow-up, survival was 99.6% (95% CI 96.9-99.9) at 7 years, while only 5 patients (2.2%) required aortic coarctation reintervention within 3.7 year. Isthmic velocity showed a triphasic trajectory: transient postoperative rise, rapid decline through 3 years (71.4% of total reduction), and subsequent stabilization. Anatomically, Z-scores demonstrated parallel catch-up growth, with the steepest improvement also within the first 3 years. Patients with a concomitant patent ductus arteriosus had lower preoperative velocity and greater early rise, but long-term outcomes matched those without patent ductus arteriosus. By 3-year follow-up, 76.1% of patients achieved normalized velocity (<1.50 m/s). Multivariable analysis identified elevated preoperative aortic valve velocity (OR 6.82, 95% CI 1.56-36.28; P=0.032) and a smaller preoperative isthmus Z-score (OR 0.77, 95% CI 0.63-0.94; P=0.028) as independent predictors of persistent obstruction. CONCLUSIONS Isolated VSD closure achieves coupled hemodynamic and anatomical aortic remodeling in most children with mild aortic coarctation, yielding excellent long-term survival and low reintervention rates. Elevated preoperative aortic valve velocity and a smaller isthmus Z-score identify high-risk patients who may benefit from intensified surveillance, supporting a physiology-guided, deferred-intervention strategy.
Hui et al. (Sun,) conducted a cohort in ventricular septal defect (VSD) with mild aortic coarctation (n=231). Isolated VSD closure was evaluated on survival at 7 years (95% CI 96.9-99.9). Isolated VSD closure in children with mild aortic coarctation yielded 99.6% survival at 7 years and a 2.2% reintervention rate, with 76.1% achieving normalized isthmic velocity by 3 years.