Prediction model of residual shunt occurring after interventional closure of ventricular septal defect in child patients and the effect of residual shunt on the long-term prognosis
Objective To construct and validate a prediction model of residual shunt occurring after interventional closure of ventricular septal defect(VSD)in child patients,and to analyze the prognosis of the child patients with residual shunt.Methods A total of 178 child patients with VSD,who were admitted to the hospital to receive treatment from January 2017 to March 2023,were selected for this study.Adopting a 8:2 ratio,the child patients were randomly divided into the training set(n=144)and the validation set(n=34).Interventional closure of VSD was carried out in all the child patients.During the postoperative follow-up of 12 months,the occurrence of the residual shunt was recorded.The factors influencing the occurrence of residual shunt after interventional closure of VSD in child patients were analyzed.A prediction model for residual shunt after interventional closure of VSD in child patients was established and validated,and its efficacy was evaluated.The prognosis of the child patients having residual shunt was analyzed.Results Residual shunt occurred in 21 child patients(14.58％,21/144)in the training set and in 5 child patients(14.71％,5/34)in the validation set.Logistic regression analysis showed that the size of the base of VSD(OR=5.339,95％CI:2.197-12.975),pressure difference at the site of defect(OR=4.384,95％CI:1.804-10.655),and diameter of occluder(OR=4.707,95％CI:1.937-11.439)were the influencing factors for residual shunt occurring after interventional closure of VSD in child patients(P＜0.05).Taking the above influencing factors as the predictive variables,a nomogram prediction model was established.The verification results of the nomogram model showed that the C-index was 0.808(95％CI:0.761-0.839),and the correction curve for predicting residual shunt after interventional closure of VSD in child patients was close to the ideal curve(P＞0.05).ROC curve analysis of the training set indicated that the sensitivity,specificity and AUC of the nomogram model for predicting residual shunt after interventional closure of VSD in child patients were 80.95％,84.55％and 0.855(95％CI:0.774-0.937)respectively.ROC curve analysis of the validation set revealed that the sensitivity,specificity and AUC of the nomogram model for predicting residual shunt after interventional closure of VSD in child patients were 80.00％,86.21％and 0.871(95％CI:0.791-0.943)respectively.In the training set,21 child patients developed residual shunt,and in 14(66.67％)of them the residual shunt was healed spontaneously.The proportion of patients with a residual shunt size＞4mm in the residual shunt self-healing group was lower than that in the residual shunt no-healing group(P＜0.05).Conclusion The size of the base of VSD,the pressure difference at the site of defect,and the diameter of the occluder are the factors that affect the occurrence of residual shunt after interventional closure of VSD in child patients.The prediction model constructed on the above predictors has excellent efficacy in predicting the occurrence of residual shunt after interventional closure of VSD in child patients.In most child patients whose residual shunt size is＜4 mm,the residual shunt can heal spontaneously.
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