Radiation dose typical values per procedure complexity for transcatheter ventricular septal defect closure in pediatrics

Abstract

This study aims to establish radiation dose typical values (TV) for ventricular septal defect (VSD) percutaneous closures based on patient-, device- and procedure-related characteristics. Clinical and exposure data were retrospectively reviewed for 92 consecutive pediatric patients with VSD in whom transcatheter closure attempt was undertaken between March 2016 and December 2019 at a single reference center. TV were derived as the median value of total air kerma-area product (PKA,T), air kerma at the patient entrance reference point, fluoroscopy time and number of frames. Statistical analyses were conducted to investigate the exposure variability according to patient, device- and procedure-related characteristics. For (5–< 15 kg) patients, TV were 27 Gy · cm2 in term of PKA,T for venous vs. 9 Gy · cm2 for arterial approach. For (15–< 30 kg) patients, TV were 53 Gy · cm2 for muscular vs. 18 Gy · cm2 for perimembranous defects and 36 Gy · cm2 for AmplatzerTM vs. 14 Gy · cm2 for the LifetechTM device. Procedures conducted with the assistance of a fellow, venous approach, muscular VSD, AmplatzerTM devices, and procedural incidents increased the exposure levels significantly. The established TV provide benchmarks on patient exposure per procedure complexity and should help promote better patient radiation protection.