Tesis

Analisis Faktor-faktor yang berhubungan dengan Luaran Jangka Pendek Intervensi Penutupan Perkutan Defek Septum Ventrikel Sub-arterial Doubly Committed menggunakan KONAR-MF Occluder = Analysis of Factors Associated with Short Term Outcome after Percutaneous Closure in Sub-arterial Doubly Committed Ventricular Septal Defect (SADC VSD) using KONAR-MF Occluder.

Latar Belakang: Defek septum ventrikel (DSV) tipe Sub-arterial Doubly Committed (SADC) adalah defek yang jarang menutup spontan dibandingkan tipe lainnya dan seringkali ditemukan bersama dengan komorbid lain seperti prolaps/regurgitasi katup aorta. Data tentang prediktor luaran tindakan penutupan perkutan DSV SADC pada populasi Asia masih terbatas hingga saat ini. Tujuan: Mengetahui faktor yang berhubungan terhadap luaran intervensi penutupan perkutan DSV tipe SADC dalam jangka pendek (3-6 bulan). Metode: Penelitian ini merupakan studi retrospektif observasional jangka pendek yang melibatkan 108 pasien dengan DSV SADC. Dilakukan analisis data terhadap luaran berupa kejadian regurgitasi aorta baru atau progresif, pirau residual, dan embolisasi device. Parameter subjek dasar bersama dengan parameter ekokardiografi serta prosedur kateterisasi (pendekatan dan teknik penutupan device) dianalisis secara multivariat untuk mengetahui hubungan independen setiap variabel. Hasil: Didapatkan nilai median usia 7 (1 – 57) tahun, jenis kelamin laki laki 55 orang (50,9%) dan perempuan 53 (49,1%). Kejadian regurgitasi aorta awitan baru ataupun progresif 23 orang, regurgitasi aorta awitan baru yang didominasi oleh derajat ringan (95,2%). Pirau residual pada 52,7% subjek (seluruhnya trivial/mild). Kejadian embolisasi device sebanyak 5 orang (4,6%). Terdapat hubungan antara prolaps RCCD index ≥0.3 dengan kejadian regurgitasi aorta progresif atau awitan baru (OR 8,07; 95% CI 2,24 – 29,04; p=0,001). Terdapat hubungan antara regurgitasi aorta yang telah ada sebelumnya dengan pirau residual (OR 3,09: 95% CI 1,33–7,19; p=0,009). Terdapat hubungan antara gradien trans DSV ≥105 mmHg dan waist-defect ratio ≤1,3 dengan kejadian embolisasi device (OR 11,46; 95% CI 1,15 – 114,16; p=0,038) dan (OR 11,46; 95% CI 1,15 – 114,16; p=0,038) Kesimpulan: Terdapat hubungan antara prolaps RCCD index ≥0.3 dengan kejadian regurgitasi aorta progresif atau awitan baru. Terdapat hubungan antara regurgitasi aorta yang telah ada sebelumnya dengan pirau residual. Terdapat hubungan antara gradien trans VSD ≥105 mmHg dan waist-defect ratio ≤1,3 dengan kejadian embolisasi device pada evaluasi jangka pendek pasca penutupan defek perkutan.
Kata kunci: Defek septum ventrikel, sub-arterial doubly committed, intervensi perkutan, regurgitasi aorta, dislodge device, pirau residual


Background: Subarterial doubly committed (SADC) ventricular septal defect (VSD) is less likely to undergo spontaneous closure compared with other VSD types and is frequently associated with comorbidities such as aortic valve prolapse and regurgitation. Data on predictors of outcomes following percutaneous closure of SADC VSD in Asian populations remain limited. Objective: To identify factors associated with short-term outcomes (3–6 months) following percutaneous closure of SADC-type VSD. Methods: This retrospective observational short-term study included 108 patients with SADC VSD. Outcomes of interest comprised new-onset or progressive aortic regurgitation, residual shunt, and device embolization. Baseline subject characteristics, echocardiographic parameters, and catheterization-related variables (including procedural approach and device deployment techniques) were analyzed using multivariate analysis to determine independent associations with each outcome. Results: The median age was 7 years (range 1 –57 years); 55 patients (50.9%) were male and 53 (49.1%) were female. New-onset or progressive aortic regurgitation occurred in 23 patients, with new-onset regurgitation predominantly mild in severity (95.2%). Residual shunts were observed in 52.7% of subjects, all classified as trivial or mild. Device embolization occurred in 5 patients (4.6%). An RCCD index ≥0.3 was significantly associated with new-onset or progressive aortic regurgitation (OR 8.07; 95% CI 2.24–29.04; p=0.001). Pre-existing aortic regurgitation was associated with residual shunt (OR 3.09; 95% CI 1.33–7.19; p=0.009). A trans-VSD gradient ≥105 mmHg and a waist-to-defect ratio ≤1.3 were associated with device embolization (OR 11.46; 95% CI 1.15–114.16; p=0.038 for both). Conclusion: An RCCD index ≥0.3 is associated with new-onset or progressive aortic regurgitation following percutaneous closure of SADC VSD. Pre-existing aortic regurgitation is associated with residual shunt, while a high trans-VSD gradient and a low waist-to-defect ratio are associated with device embolization in short-term follow-up after percutaneous defect closure.
Keywords: Ventricular septal defect; subarterial doubly committed; percutaneous intervention; aortic regurgitation; device embolization; residual shunt.