1
|
Song J. Percutaneous Transcatheter Closure of Congenital Ventricular Septal Defects. Korean Circ J 2023; 53:134-150. [PMID: 36914603 PMCID: PMC10011220 DOI: 10.4070/kcj.2022.0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/27/2022] [Indexed: 02/17/2023] Open
Abstract
Ventricular septal defects (VSDs) are the most common kind of congenital heart disease and, if indicated, surgical closure has been accepted as a gold-standard treatment. However, as less-invasive methods are preferred, percutaneous device closure has been developed. After the first VSD closure was performed percutaneously by Lock in 1988, both techniques and devices have developed consistently. A perventricular approach for closure of muscular VSD in small patients and the closure of perimembranous VSD using off-label devices are key remarkable developments. Even though the Amplatzer membranous VSD occluder (Abbott) could not be approved for use due to the high complete atrioventricular conduction block rate, other new devices have shown good results for closure of perimembranous VSDs. However, the transcatheter technique is slightly complicated to perform, and concerns about conduction problems after VSD closure with devices remain. There have been a few reports demonstrating successful closure of subarterial-type VSDs with Amplatzer devices, but long-term issues involving aortic valve damage have not been explored yet. In conclusion, transcatheter VSD closure should be accepted as being as effective and safe as surgery but should only be performed by experienced persons and in specialized institutes because the procedure is complex and requires different techniques. To avoid serious complications, identifying appropriate patient candidates for device closure before the procedure is very important.
Collapse
Affiliation(s)
- Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
2
|
Transcatheter closure of muscular ventricular septal defects using the Cardi-O-Fix plug. Cardiol Young 2021; 31:1472-1475. [PMID: 33616030 DOI: 10.1017/s1047951121000482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the safety and efficacy of the Cardi-O-Fix plug used for the treatment of muscular ventricular septal defects. METHODS We retrospectively reviewed the medical records of five patients with muscular ventricular septal defects who underwent transcatheter closure using the Cardi-O-Fix Plug, from November 2017 to August 2019. The median age was 5.1 years (range: 3.2-6.5). Their median body weight was 18.1 kg (range: 13.4-21.8). All the patients underwent detailed two-dimensional Doppler and colour flow imaging by transthoracic echocardiography. The left ventricular median defect size of the muscular ventricular septal defects was 5.6 mm (range: 5.3-7.0). The right ventricular median defect size of the muscular ventricular septal defects was 3.9 mm (range: 3.3-4.7). All the procedures were performed on beating hearts. RESULTS All the patients underwent successful device implantation with no displacement or detachment, they have complete echocardiographic closure at the 1-year follow-up. There were no occluder-related arrhythmia, chordae tendineae rupture, tricuspid insufficiency, aortic regurgitation, haemolysis, or embolisation. CONCLUSIONS Application of the Cardi-O-Fix plug appears to be a feasible, safe, and effective treatment option for patients with muscular ventricular septal defects. Longer follow-up periods are warranted to prove the conclusion for long-term outcomes.
Collapse
|
3
|
Randall J, Morgan G, Zablah J. Using the new Amplatzer Trevisio delivery cable to facilitate closure of atrial and ventricular shunts. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2020.101307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
4
|
Narin N, Pamukcu O, Tuncay A, Baykan A, Sunkak S, Tasci O, Uzum K, Saltık L. Percutaneous Ventricular Septal Defect Closure in Patients Under 1 Year of Age. Pediatr Cardiol 2018. [PMID: 29541816 DOI: 10.1007/s00246-018-1852-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Untreated ventricular septal defect (VSD) is an important cause of congestive heart failure in early infancy. Growth is impaired in this population, and surgical closure is challenging because of congestion in the lungs, making infants prone to respiratory infection, and because of their poor nutritional status. The aim of this study is to share our experience with percutaneous VSD closure in patients under 1 year of age. Patients with hemodynamically significant left-to-right shunt, less than 1 year of age, and with VSD diameter ≤ 6 mm were retrospectively included in the study between December 2014 and January 2017. The median length of follow-up was 8.5 (4-14.2) months. Twelve patients from 2 to 12 months of age, with a median weight of 6.75 (5.4-8) kg, were included. The mean VSD diameter as measured by angiography from the left ventricle side was 4.7 ± 0.25 mm, and from the right ventricle side was 3.4 ± 1.1 mm. All were of a perimembranous type except three, which were muscular. All defects were closed with the Amplatzer Duct Occluder II (ADO II) or the ADO II-additional size. The mean fluoroscopy duration and total radiation dose were 22.6 ± 18.7 min and 1674 ± 851 cGy/min, respectively. No aortic regurgitation associated with device closure was seen in any of the patients. Complete atrioventricular block occurred in one patient 6 months after the procedure, and was treated with a permanent pacemaker. VSD closure is challenging, regardless of whether a surgical or percutaneous procedure is used. The risks are higher for children younger than 1 year with low body weight. Percutaneous closure, which carries similar risks but is less invasive than surgery, may be the preferred alternative in early infancy.
Collapse
Affiliation(s)
- Nazmi Narin
- Division of Pediatric Cardiology, Erciyes University School of Medicine, 38039, Kayseri, Turkey
| | - Ozge Pamukcu
- Division of Pediatric Cardiology, Erciyes University School of Medicine, 38039, Kayseri, Turkey.
| | - Aydin Tuncay
- Division of Cardiovascular Surgery, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ali Baykan
- Division of Pediatric Cardiology, Erciyes University School of Medicine, 38039, Kayseri, Turkey
| | - Suleyman Sunkak
- Division of Pediatric Cardiology, Erciyes University School of Medicine, 38039, Kayseri, Turkey
| | - Onur Tasci
- Division of Pediatric Cardiology, Erciyes University School of Medicine, 38039, Kayseri, Turkey
| | - Kazim Uzum
- Division of Pediatric Cardiology, Erciyes University School of Medicine, 38039, Kayseri, Turkey
| | - Levent Saltık
- Division of Pediatric Cardiology, Cerrahpasa University School of Medicine, Istanbul, Turkey
| |
Collapse
|
5
|
Daley M, Brizard CP, Konstantinov IE, Brink J, Kelly A, Jones B, Zannino D, d'Udekem Y. Outcomes of Patients Undergoing Surgical Management of Multiple Ventricular Septal Defects. Semin Thorac Cardiovasc Surg 2018; 31:89-96. [PMID: 29601908 DOI: 10.1053/j.semtcvs.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2018] [Indexed: 11/11/2022]
Abstract
Surgical treatment of multiple ventricular septal defects (VSDs) has advanced significantly in recent years, yet remains technically challenging. With high rates of complications and reoperations, we sought to assess the outcomes of patients undergoing a variety of management techniques for multiple VSDs. From 1988 to 2015, 157 consecutive patients underwent surgical management of multiple VSDs at a median age of 2.2 months (2 days-16 years). Sixty-nine patients (44%) had exclusively multiple VSDs, 62 patients (39%) had multiple VSDs with concomitant intracardiac anomalies, and 26 patients (17%) had multiple VSDs with aortic arch anomalies. The predominant techniques used at the initial operations were patch closure (84 patients), pulmonary artery band (83 patients), suture closure (37 patients), and sandwich technique (13 patients). Eighteen patients underwent ventriculotomies. There were 3 hospital deaths (2%). Mean follow-up time was 8.6 ± 6 years (1 day-22 years). Four patients died during follow-up, whereas freedom from reoperations was 52% (95% confidence interval 42-61%) at 16 years. Freedom from reoperation was significantly lower in the 1988-2002 era than in the post-2002 era (38% vs 73%, P = 0.016). Pacemaker implantation was ultimately required in 9% (14 of 150) of patients. No deleterious impact of a ventriculotomy could be detected. Surgical treatment of multiple VSDs can be performed with excellent short- and long-term survival, and normal late functional outcome, however, carries a significant rate of reoperation. The recent inclusion of absorbable pulmonary artery bands and the sandwich technique appear safe and are useful adjuncts in these patients.
Collapse
Affiliation(s)
- Michael Daley
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Johann Brink
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Andrew Kelly
- Department of Cardiology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Bryn Jones
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Diana Zannino
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
| |
Collapse
|
6
|
Narın N, Pamukcu O, Sunkak S, Uzum K, Baykan A. Percutaneous VSD closure of a baby weighed 3 kg. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2017. [DOI: 10.1016/j.ijcac.2017.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
7
|
Haas NA, Kock L, Bertram H, Boekenkamp R, De Wolf D, Ditkivskyy I, Freund MW, Gewillig M, Happel CM, Herberg U, Karthasyan E, Kozlik-Feldmann R, Kretschmar O, Kuzmenko Y, Milanesi O, Mueller G, Pongiglione G, Schubert S, Tarusinov G, Kampmann C. Interventional VSD-Closure with the Nit-Occlud ® Lê VSD-Coil in 110 Patients: Early and Midterm Results of the EUREVECO-Registry. Pediatr Cardiol 2017; 38:215-227. [PMID: 27847970 DOI: 10.1007/s00246-016-1502-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/26/2016] [Indexed: 11/25/2022]
Abstract
In August 2010, the Nit-Occlud® Lê (EUREVECO) became available for transcatheter coil occlusion of ventricular septal defects (VSDs). Retrospective European Registry for VSD Closure using the Nit-Occlud® Lê-VSD-Coil; analysis of the feasibility, results, safety and follow-up of VSD-closure over a 3-year period in 18 European centers. In 102 of 111 patients (female 66), successful VSD closure was performed (mean age 8.2 years, mean weight 28.82 kg), 81 perimembranous VSDs (48 with aneurysm), 30 muscular VSDs, mean procedure time was 121.1 min, and mean fluoroscopy time was 26.3 min. Short- and midterm term follow-up was possible in 100/102 patients, there was 1 embolization and 1 explantation after 24 months. Immediate complete closure occurred in 49 of 101 patients (48.5%), trivial residual shunt was present in 51 (50.0%), closure rate was 95% after 6 months and 97% after 1 year. Out of the 102 patients, there were 2 severe complications (1.8%) (1 severe hemolysis, 1 embolization) and 8 moderate/transient (=7.2%) including 1 transient AV block. During a mean follow-up period of 31.3 months (range 24-48) and a total follow-up time of 224.75 patient years, no further problems occurred. VSD closure with the Nit-Occlud® Lê VSD coil is feasible and safe with a minimal risk of severe side effects. The long-term effects and safety require further clinical follow-up studies.
Collapse
Affiliation(s)
- Nikolaus A Haas
- Department for Congenital Heart Defects, Heart and Diabetes Center North Rhine Westphalia, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
- Department of Pediatric Cardiology and Pediatric Intensive Care, Klinikum der Ludwigs Maximilian Universität München, Munich, Germany.
| | - Laura Kock
- Department for Congenital Heart Defects, Heart and Diabetes Center North Rhine Westphalia, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Harald Bertram
- Department of Pediatric Cardiology and Pediatric Intensive Care, Children's Hospital Hannover Medical School, Hannover, Germany
| | - Regina Boekenkamp
- Department for Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Daniel De Wolf
- Department for Pediatric Cardiology, Ghent University Hospital, UZ Ghent, Ghent, Belgium
| | - Igor Ditkivskyy
- Department of Interventional Cardiology, National Amosov Institute of Cardio-Vascular Surgery, Kiev, Ukraine
| | - Matthias W Freund
- Department for Pediatric Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marc Gewillig
- Department for Pediatric Cardiology, University Hospital Leuven, Louvain, Belgium
| | - Christoph M Happel
- Department for Congenital Heart Defects, Heart and Diabetes Center North Rhine Westphalia, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Ulrike Herberg
- Department for Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Edvard Karthasyan
- Center for Congenital Heart Defects and Pediatric Cardiology, Research Institution for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Rainer Kozlik-Feldmann
- Department of Pediatric Cardiology and Pediatric Intensive Care, Klinikum der Ludwigs Maximilian Universität München, Munich, Germany
| | - Oliver Kretschmar
- Department for Pediatric Cardiology/Congenital Heart Defects, University Children's Hospital Zurich, Zurich, Switzerland
| | - Yulia Kuzmenko
- Department of Pediatric Cardiology, The Scientific Practical Children's Cardiac Center, Kiev, Ukraine
| | - Ornella Milanesi
- Department of Women and Children's Health Pediatric Cardiac Unit, University Hospital of Padova, Padua, Italy
| | - Goetz Mueller
- Department for Pediatric Cardiology, University Heart Centre Hamburg, Hamburg, Germany
| | - Giacomo Pongiglione
- Department for Pediatric Cardiology and Pediatric Cardiac Surgery, Bambino Gesú Children's Hospital, Rome, Vatican, Italy
| | - Stephan Schubert
- Department for Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Gleb Tarusinov
- Center for Congenital Heart Defects, Pediatric Cardiology, Heart Centre Duisburg, Evangelic Hospital Niederrhein, Duisburg, Germany
| | - Christoph Kampmann
- Department for Pediatric Cardiology, University Children's Hospital, Mainz, Germany
| |
Collapse
|
8
|
Abstract
Percutaneous closure of muscular ventricular septal defects has been well described and has not attracted the same controversy or scrutiny as perimembranous defect closure. Therefore, the development of specifically designed devices has been limited. We report the first use of the Occlutech® muscular ventricular septal defect device. Does its design add any significant benefit?
Collapse
|
9
|
Baruteau AE, Pass RH, Thambo JB, Behaghel A, Le Pennec S, Perdreau E, Combes N, Liberman L, McLeod CJ. Congenital and childhood atrioventricular blocks: pathophysiology and contemporary management. Eur J Pediatr 2016; 175:1235-1248. [PMID: 27351174 PMCID: PMC5005411 DOI: 10.1007/s00431-016-2748-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 06/13/2016] [Accepted: 06/16/2016] [Indexed: 02/07/2023]
Abstract
UNLABELLED Atrioventricular block is classified as congenital if diagnosed in utero, at birth, or within the first month of life. The pathophysiological process is believed to be due to immune-mediated injury of the conduction system, which occurs as a result of transplacental passage of maternal anti-SSA/Ro-SSB/La antibodies. Childhood atrioventricular block is therefore diagnosed between the first month and the 18th year of life. Genetic variants in multiple genes have been described to date in the pathogenesis of inherited progressive cardiac conduction disorders. Indications and techniques of cardiac pacing have also evolved to allow safe permanent cardiac pacing in almost all patients, including those with structural heart abnormalities. CONCLUSION Early diagnosis and appropriate management are critical in many cases in order to prevent sudden death, and this review critically assesses our current understanding of the pathogenetic mechanisms, clinical course, and optimal management of congenital and childhood AV block. WHAT IS KNOWN • Prevalence of congenital heart block of 1 per 15,000 to 20,000 live births. AV block is defined as congenital if diagnosed in utero, at birth, or within the first month of life, whereas childhood AV block is diagnosed between the first month and the 18th year of life. As a result of several different etiologies, congenital and childhood atrioventricular block may occur in an entirely structurally normal heart or in association with concomitant congenital heart disease. Cardiac pacing is indicated in symptomatic patients and has several prophylactic indications in asymptomatic patients to prevent sudden death. • Autoimmune, congenital AV block is associated with a high neonatal mortality rate and development of dilated cardiomyopathy in 5 to 30 % cases. What is New: • Several genes including SCN5A have been implicated in autosomal dominant forms of familial progressive cardiac conduction disorders. • Leadless pacemaker technology and gene therapy for biological pacing are promising research fields. In utero percutaneous pacing appears to be at high risk and needs further development before it can be adopted into routine clinical practice. Cardiac resynchronization therapy is of proven value in case of pacing-induced cardiomyopathy.
Collapse
Affiliation(s)
- Alban-Elouen Baruteau
- Cardiovascular and Cell Sciences Research Center, St George’s University of London, London, UK
- LIRYC Institute, CHU Bordeaux, Department of Pediatric Cardiology, Bordeaux-II University, Bordeaux, France
- Service de Cardiologie Pédiatrique, Hôpital du Haut Lévèque, Institut Hospitalo-Universitaire LIRYC (Electrophysiology and Heart Modeling Institute), 5 avenue de Magellan, 33600 Pessac, France
| | - Robert H. Pass
- Division of Pediatric Electrophysiology, Albert Einstein College of Medicine, Montefiore Children’s Hospital, Bronx, NY USA
| | - Jean-Benoit Thambo
- LIRYC Institute, CHU Bordeaux, Department of Pediatric Cardiology, Bordeaux-II University, Bordeaux, France
| | - Albin Behaghel
- CHU Rennes, Department of Cardiology, LTSI, INSERM 1099, Rennes-1 University, Rennes, France
| | - Solène Le Pennec
- CHU Rennes, Department of Cardiology, LTSI, INSERM 1099, Rennes-1 University, Rennes, France
| | - Elodie Perdreau
- LIRYC Institute, CHU Bordeaux, Department of Pediatric Cardiology, Bordeaux-II University, Bordeaux, France
| | - Nicolas Combes
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Leonardo Liberman
- Morgan Stanley Children’s Hospital, Division of Pediatric Cardiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY USA
| | - Christopher J. McLeod
- Mayo Clinic, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN USA
| |
Collapse
|