1
|
Salavitabar A, Armstrong AK, Carrillo SA. Hybrid Interventions in Congenital Heart Disease. Interv Cardiol Clin 2024; 13:399-408. [PMID: 38839172 DOI: 10.1016/j.iccl.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Hybrid interventions in congenital heart disease (CHD) embody the inherent collaboration between congenital interventional cardiology and cardiothoracic surgery. Hybrid approaches to complex and common lesions provide the opportunity to circumvent the limitations of patient size, vascular access, severity of illness, and anatomy that would otherwise be prohibitive to surgical and percutaneous techniques alone. This review describes several important hybrid approaches to interventions in CHD.
Collapse
Affiliation(s)
- Arash Salavitabar
- The Heart Center, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Aimee K Armstrong
- The Heart Center, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA
| | - Sergio A Carrillo
- The Heart Center, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA
| |
Collapse
|
2
|
Kalfa D, Torres AJ. Indications and results for hybrid interventions in patients with congenital heart disease. Arch Cardiovasc Dis 2019; 113:96-103. [PMID: 31492537 DOI: 10.1016/j.acvd.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 11/28/2022]
Abstract
A hybrid therapy or procedure is a new treatment modality that develops by combining therapies from different subspecialties. In congenital heart disease, a growing number of such procedures have been described in recent decades, as a result of increasing collaboration between surgeons and interventionalists. The ideas behind these therapies include enabling the performance of procedures of different complexity in a less invasive manner, shortening procedural times, avoiding cardiopulmonary bypass, facilitating vascular access and decreasing the number of complications associated with more invasive approaches. Over the years, hybrid therapy has gained a place as a widely accepted therapeutic option for the management of several conditions in high-risk patients with congenital heart disease.
Collapse
Affiliation(s)
- David Kalfa
- Section of Congenital and Pediatric Cardiac Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Children's Hospital of NewYork-Presbyterian/Columbia University Medical Center, 10032 New York, NY, United States
| | - Alejandro J Torres
- Pediatric Cardiology Department, Children's Hospital of New York-Presbyterian/Columbia University Medical Center, 3959, Broadway BH2N, 10032 New York, NY, United States.
| |
Collapse
|
3
|
Zhou Y, Liu LX, Zhao F, Tang SH, Peng HL, Jiang YH. Effects of transthoracic device closure on ventricular septal defects and reasons for conversion to open-heart surgery: A meta-analysis. Sci Rep 2017; 7:12219. [PMID: 28939836 PMCID: PMC5610181 DOI: 10.1038/s41598-017-12500-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/08/2017] [Indexed: 12/30/2022] Open
Abstract
Transthoracic device closure (TTDC) is thought to be a promising technology for the repair of ventricular septal defects (VSDs). However, there is considerable controversy regarding the efficacy and safety of TTDC. The present study aimed to compare the benefits and safety of TTDC with those of conventional open-heart surgery (COHS) and analyze the associated factors causing complications, conversion to COHS and reoperation. Electronic database searches were conducted in PubMed, EMBASE, Cochrane Library, Clinicaltrials.gov and several Chinese databases. A total of 5 randomized controlled trials (RCTs), 7 cohort studies, 13 case-control studies, 129 case series and 13 case reports were included. Compared to COHS, TTDC exhibited superior efficacy with a significantly lower risk of post-operative arrhythmia; however, no significant differences in other outcomes were identified. Meta-regression analysis showed that perimembranous VSDs (pmVSDs), a smaller VSD, a smaller occluder, and a median or subxiphoid approach lowered the relative risk of several post-operative complications, conversion to COHS and reoperation. The current evidence indicates that TTDC is associated with a lower risk of post-operative arrhythmia and is not associated with an increased risk of complications. PmVSDs, a smaller VSD and occluder, and a median or subxiphoid approach correlate with better outcomes when using TTDC.
Collapse
Affiliation(s)
- Yang Zhou
- Department of Cardiothoracic Surgery, the People's Hospital of Leshan, Leshan, Sichuan Province, 614000, P.R. China
| | - Ling-Xi Liu
- Department of Cardiothoracic Surgery, the People's Hospital of Leshan, Leshan, Sichuan Province, 614000, P.R. China
| | - Fei Zhao
- Department of Cardiothoracic Surgery, the People's Hospital of Leshan, Leshan, Sichuan Province, 614000, P.R. China
| | - Shi-Hai Tang
- Department of Cardiothoracic Surgery, the People's Hospital of Leshan, Leshan, Sichuan Province, 614000, P.R. China
| | - Hua-Li Peng
- Department of Cardiothoracic Surgery, the People's Hospital of Leshan, Leshan, Sichuan Province, 614000, P.R. China
| | - Yun-Han Jiang
- Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, Chongqing, 400030, P.R. China.
| |
Collapse
|
4
|
Garg P, Bishnoi AK, Lakhia K, Surti J, Siddiqui S, Solanki P, Pandya H. Transverse Sternal Split: a Safe Mini-invasive Approach for Perventricular Device Closure of Ventricular Septal Defect. Braz J Cardiovasc Surg 2017; 32:184-190. [PMID: 28832796 PMCID: PMC5570392 DOI: 10.21470/1678-9741-2016-0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/07/2017] [Indexed: 11/17/2022] Open
Abstract
Objective Perventricular device closure of ventricular septal defect through midline
sternotomy avoids the cardiopulmonary bypass, however, lacks the cosmetic
advantage. Perventricular device closure of ventricular septal defect with
transverse split sternotomy was performed to add the cosmetic advantage of
mini-invasive technique. Methods Thirty-six pediatric patients with mean age 7.14±3.24 months and
weight 5.00±0.88 kg were operated for perventricular device closure
of ventricular septal defect through transverse split sternotomy in
4th intercostal space under transesophageal echocardiography
guidance. In case of failure or complication, surgical closure of
ventricular septal defect was performed through the same incision with
cervical cannulation of common carotid artery and internal jugular vein for
commencement of cardiopulmonary bypass. All the patients were
postoperatively followed, and then discharged from hospital due to their
surgical outcome, morbidity and mortality. Results Procedure was successful in 35 patients. Two patients developed transient
heart block. Surgical closure of ventricular septal defect was required in
one patient. Mean duration of ventilation was 11.83±3.63 hours. Mean
intensive care unit and hospital stay were 1.88±0.74 days and
6.58±1.38 days, respectively. There was no in-hospital mortality. A
patient died one day after hospital discharge due to arrhythmia. No patients
developed wound related, vascular or neurological complication. In a mean
follow-up period of 23.3±18.45 months, all 35 patients were doing
well without residual defect with regression of pulmonary artery
hypertension as seen on transthoracic echocardiography. Conclusion Transverse split sternotomy incision is a safe and effective alternative to a
median sternotomy for perventricular device closure of ventricular septal
defect with combined advantage of better cosmetic outcomes and avoidance of
cardiopulmonary bypass.
Collapse
Affiliation(s)
- Pankaj Garg
- Department of Cardiovascular and Thoracic Surgery of the U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Gujarat, India
| | - Arvind Kumar Bishnoi
- Department of Cardiovascular and Thoracic Surgery of the U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Gujarat, India
| | - Ketav Lakhia
- Department of Cardiac Anesthesia of the U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Gujarat, India
| | - Jigar Surti
- Department of Research of the U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Gujarat, India
| | - Sumbul Siddiqui
- Department of Cardiovascular and Thoracic Surgery of the U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Gujarat, India
| | - Parth Solanki
- Department of Cardiac Anesthesia of the U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Gujarat, India
| | - Himani Pandya
- Department of Research of the U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Gujarat, India
| |
Collapse
|
5
|
Gray RG, Menon SC, Johnson JT, Armstrong AK, Bingler MA, Breinholt JP, Kenny D, Lozier J, Murphy JJ, Sathanandam SK, Taggart NW, Trucco SM, Goldstein BH, Gordon BM. Acute and midterm results following perventricular device closure of muscular ventricular septal defects: A multicenter PICES investigation. Catheter Cardiovasc Interv 2017; 90:281-289. [PMID: 28805027 DOI: 10.1002/ccd.27121] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/28/2017] [Accepted: 04/13/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To describe acute and mid-term results of hybrid perventricular device closure of muscular ventricular septal defects (mVSDs). BACKGROUND Perventricular device closure of mVSDs can mitigate technical limitations of percutaneous closure and need for cardiopulmonary bypass or ventriculotomy with a surgical approach. METHODS This is a multicenter retrospective cohort study of patients undergoing hybrid perventricular mVSD device closure from 1/2004 to 1/2014. Procedural details, adverse events, outcomes, and follow-up data were collected. Patients were divided into two groups: (1) simple (mVSD closure alone) and (2) complex (mVSD closure with concomitant cardiac surgery). RESULTS Forty-seven patients (60% female) underwent perventricular mVSD device closure at a median age of 5.2 months (IQR 1.8-8.9) and weight of 5.1 kg (IQR 4.0-6.9). Procedural success was 91% [100% (n = 22) simple and 84% (n = 21/25) complex]. Adverse events occurred in 19% (9/47) [9% (2/22) simple and 28% (7/25) complex]. Hospital length of stay (LOS) was shorter in the simple vs. complex group (4 vs. 14 days, P < 0.01). At mid-term follow-up of 19.2 months (IQR 2.3-43) 90% of pts had complete mVSD closure; none developed late heart block, increased atrioventricular (AV) valve insufficiency or ventricular dysfunction. CONCLUSIONS Perventricular device closure of simple mVSD was associated with a high rate of procedural success, few adverse events, and short hospital LOS. Procedural adverse events were associated with the presence of concomitant complex surgery. Residual mVSD, AV valve insufficiency, or ventricular dysfunction were uncommon at mid-term follow-up. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
| | | | - Joyce T Johnson
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Aimee K Armstrong
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Michael A Bingler
- Division of Pediatric Cardiology, University of Missouri, Kansas City, Missouri
| | - John P Breinholt
- Division of Pediatric Cardiology, University of Texas Health Science Center, Houston, Texas
| | - Damien Kenny
- Rush University Medical Center, Chicago, Illinois
| | - John Lozier
- Division of Pediatric Cardiology, Mercy Medical Center, Des Moines, Iowa
| | - Joshua J Murphy
- Division of Pediatric Cardiology, St Louis Children's Hospital, St Louis, Missouri
| | - Shyam K Sathanandam
- Division of Pediatric Cardiology, Le Bonheur Children's Medical Center, Tennessee
| | | | - Sara M Trucco
- Division of Pediatric Cardiology, Children's Hospital of UPMC, Pittsburgh, Pennsylvania
| | - Bryan H Goldstein
- Division of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Ohio
| | - Brent M Gordon
- Division of Pediatric Cardiology, Loma Linda University Children's Hospital, California
| |
Collapse
|
6
|
Taqatqa AS, Caputo M, Kenny DP, Diab KA. Surgical repair of left ventricular pseudoaneurysm following perventricular device closure of muscular ventricular septal defect. J Card Surg 2016; 31:697-699. [PMID: 27600915 DOI: 10.1111/jocs.12840] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Left ventricular pseudoaneurysm formation following perventricular device closure of a muscular ventricular septal defect is a rare complication. We describe a case of left ventricular pseudoaneurysm in an infant with Swiss-cheese ventricular septal defects who initially underwent closure with an Amplatzer device using a hybrid approach. The pseudoaneurysm was successfully resected surgically.
Collapse
Affiliation(s)
- Anas S Taqatqa
- Rush Center for Congenital Heart Disease, Rush Congenital Echocardiography Laboratory, Rush University Medical Center, Chicago, Illinois
| | - Massimo Caputo
- Rush Center for Congenital Heart Disease, Rush Congenital Echocardiography Laboratory, Rush University Medical Center, Chicago, Illinois
| | - Damien P Kenny
- Rush Center for Congenital Heart Disease, Rush Congenital Echocardiography Laboratory, Rush University Medical Center, Chicago, Illinois
| | - Karim A Diab
- Rush Center for Congenital Heart Disease, Rush Congenital Echocardiography Laboratory, Rush University Medical Center, Chicago, Illinois.
| |
Collapse
|
7
|
Kang SL, Tometzki A, Caputo M, Morgan G, Parry A, Martin R. Longer-term outcome of perventricular device closure of muscular ventricular septal defects in children. Catheter Cardiovasc Interv 2015; 85:998-1005. [PMID: 25573696 DOI: 10.1002/ccd.25821] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 01/03/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe the longer-term clinical experience and follow-up with perventricular device closure of ventricular septal defects (VSD) in children. METHODS Between January 2005 and December 2013, muscular ventricular septal defect closure with the Amplatzer Muscular VSD Occluder was undertaken using a hybrid perventricular approach. Data including demographic, echocardiographic parameter, and clinical outcome were reviewed retrospectively. RESULTS Median age at the time of procedure was 8.9 months (range 1.9-31.0 months) and median weight was 6.6 kg (range 4.5-12.9 kg). All had a moderate to large muscular VSD, three had more than one VSD, four had previous coarctation repair, and five had previous pulmonary artery (PA) banding. A single Amplatzer muscular occluder (range 8-18 mm) was deployed in each patient without cardiopulmonary bypass under echocardiographic guidance. Two of ten patients subsequently required a short period of cardiopulmonary bypass for reconstruction of PA after de-banding and closure of atrial septal defect in one. Occluder removal was necessary in one patient due to entrapment of the tricuspid valve and progressive tricuspid regurgitation. This patient underwent surgical repair with a good result and no device-related valve damage. In the remaining nine patients, no severe complications such as device embolization, arrhythmia, or significant valve regurgitation were noted in the post-operative period or follow-up. At a median time of 6.5 years (range 0.9-8.4 years) post device implantation, complete closure was achieved in five patients and four had small residual leaks, which were not hemodynamically significant. CONCLUSION Perventricular muscular VSD closure is effective in small children with suitable muscular defects and may avoid the morbidity associated with cardiopulmonary bypass and conventional surgical repair. There have been no late complications with this approach.
Collapse
Affiliation(s)
- Sok Leng Kang
- Bristol Congenital Heart Centre, Bristol Royal Hospital for Children and Bristol Royal Infirmary, University Hospitals Bristol, NHS Foundation Trust, Bristol, United Kingdom
| | | | | | | | | | | |
Collapse
|
8
|
Mishra A, Shah R, Desai M, Chourasiya A, Patel H, Oswal N, Rodricks D. A simple surgical technique for closure of apical muscular ventricular septal defect. J Thorac Cardiovasc Surg 2014; 148:2576-9. [DOI: 10.1016/j.jtcvs.2014.02.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 02/04/2014] [Accepted: 02/10/2014] [Indexed: 10/25/2022]
|
9
|
Yin S, Zhu D, Lin K, An Q. Perventricular Device Closure of Congenital Ventricular Septal Defects. J Card Surg 2014; 29:390-400. [PMID: 24762039 DOI: 10.1111/jocs.12334] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Senlin Yin
- Department of Cardiovascular Surgery; Pediatric Heart Center of West China Hospital, Sichuan University; Chengdu Sichuan China
| | - Da Zhu
- Department of Cardiovascular Surgery; Pediatric Heart Center of West China Hospital, Sichuan University; Chengdu Sichuan China
| | - Ke Lin
- Department of Cardiovascular Surgery; Pediatric Heart Center of West China Hospital, Sichuan University; Chengdu Sichuan China
| | - Qi An
- Department of Cardiovascular Surgery; Pediatric Heart Center of West China Hospital, Sichuan University; Chengdu Sichuan China
| |
Collapse
|
10
|
Koneti NR, Verma S, Bakhru S, Vadlamudi K, Kathare P, Jagannath B. Epicardial deployment of right ventricular disk during perventricular device closure in a child with apical muscular ventricular septal defect. Ann Pediatr Cardiol 2014; 6:176-8. [PMID: 24688240 PMCID: PMC3957452 DOI: 10.4103/0974-2069.115275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a successful perventricular closure of an apical muscular ventricular septal defect (mVSD) by a modified technique. An eight-month-old infant, weighing 6.5 kilograms, presented with refractory heart failure. The transthoracic echocardiogram showed multiple apical mVSDs with the largest one measuring 10 mm. perventricular device closure using a 12 mm Amplatzer mVSD occluder was planned. The left ventricular disk was positioned approximating the interventricular septum; however, the right ventricular (RV) disk was deployed on the free wall of the RV due to an absent apical muscular septum and a small cavity at the apex. The RV disk of the device was covered using an autologous pericardium. His heart failure improved during follow-up.
Collapse
Affiliation(s)
| | - Sudeep Verma
- Department of Pediatric Cardiology, Care Hospital, Hyderabad, India
| | - Shweta Bakhru
- Department of Pediatric Cardiology, Care Hospital, Hyderabad, India
| | | | - Pallavi Kathare
- Department of Pediatric Cardiology, Care Hospital, Hyderabad, India
| | - Br Jagannath
- Department of Pediatric Cardiac Surgery, Care Hospital, Hyderabad, India
| |
Collapse
|
11
|
Trezzi M, Kavarana MN, Hlavacek AM, Bradley SM. Left ventricular pseudoaneurysm after perventricular ventricular septal defect device closure. J Card Surg 2013; 29:186-8. [PMID: 24131474 DOI: 10.1111/jocs.12226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Perventricular ventricular septal defect (VSD) closure has been adopted as a therapeutic option for selected patients with muscular VSDs. This technique may combine some of the advantages of surgical and interventional techniques. Complication rates have been low: only one case of procedure-related left ventricular (LV) pseudoaneurysm has been documented. We report the surgical repair for a LV pseudoaneurysm after perventricular VSD device closure.
Collapse
Affiliation(s)
- Matteo Trezzi
- Pediatric Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | | | | | | |
Collapse
|
12
|
Saunders AB, Carlson JA, Nelson DA, Gordon SG, Miller MW. Hybrid technique for ventricular septal defect closure in a dog using an Amplatzer® Duct Occluder II. J Vet Cardiol 2013; 15:217-24. [DOI: 10.1016/j.jvc.2013.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/24/2013] [Accepted: 06/26/2013] [Indexed: 11/29/2022]
|
13
|
Transcatheter closure as an alternative to surgical management in six cases of residual intramural ventricular septal defects after repair of conotruncal malformations. J Taibah Univ Med Sci 2012. [DOI: 10.1016/j.jtumed.2012.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
14
|
Thakkar B, Patel N, Shah S, Poptani V, Madan T, Shah C, Shukla A, Prajapati V. Perventricular device closure of isolated muscular ventricular septal defect in infants: a single centre experience. Indian Heart J 2012; 64:559-67. [PMID: 23253407 DOI: 10.1016/j.ihj.2012.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 07/17/2012] [Accepted: 09/04/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To evaluate prospective single centre experience of mid-term safety and efficacy of perventricular device closure of isolated large muscular ventricular septal defect (mVSD) in high-risk infants. BACKGROUND Surgical closures of large mVSD in infants represent a challenge with significant morbidity. METHODS Between August 2008-2010, perventricular closure was attempted in 24 infants of 6.01 ± 2.37 months age and 4.27 ± 0.56 kg weight under TEE guidance. RESULTS The device was successfully deployed in 21/24 infants. Size of mVSD was 8.42 ± 1.46 mm (6.1-12 mm). Mean procedure time was 28.8 ± 11.7 min. The closure rate was 84% immediately and 100% at 6 months. Four patients suffered major complications: 2-died, 1-esophageal perforation, 1-persistent CHB. At 26.23 ± 6.63 months follow-up two patients were symptomatic: 1-required device retrieval, 1-died of severe gastroenteritis. CONCLUSION Perventricular device closure of isolated mVSD appears feasible option at mid-term follow-up and may either substitute or complement the conventional surgical technique in selected cases depending on institutional paediatric cardiac surgery performance.
Collapse
Affiliation(s)
- Bhavesh Thakkar
- Department of Cardiology and Cardiothoracic Surgery, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, India.
| | | | | | | | | | | | | | | |
Collapse
|