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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.
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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
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2
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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JACC Cardiovasc Interv 2024; 17:115-216. [PMID: 38099915 DOI: 10.1016/j.jcin.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California.
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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3
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Ghosh B, Sahai I, Agrawal G, Khadase S, Rao T, Lohakare A, Chaturvedi A, Gomase S. Experience of Percutaneous Closure of Ventricular Septal Defects in 140 Patients With Different Duct Occluders in a Tertiary Care Rural Hospital in Central India. Cureus 2023; 15:e42591. [PMID: 37641752 PMCID: PMC10460487 DOI: 10.7759/cureus.42591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Background Ventricular septal defects (VSDs) are the most common type of septal defects in early infants and are very complicated. This has paved the way for the development of new minimally invasive procedures for interventional cardiologists. This study presents our experience using duct occluders instead of conventional ventricular septal devices in the Department of Cardiology at Acharya Vinoba Bhave Rural Hospital (AVBRH) in central rural India. This study aimed to review success and complications and assess safety and its relation to age, sex, size of the VSDs, type of VSD, and types of devices used after transcatheter closure of perimembranous and muscular VSDs using various types of duct occluders. Methodology This retrospective study included patients who underwent percutaneous VSD device closure at the AVBRH between July 2017 and December 2020. We reviewed the patients' medical records to recognize imaging, clinical, and interventional data pre- and post-procedure and at the last follow-up. Results The success rate of VSD closure was 98.6%, one (0.7%) out of 81 females developed a complication due to device dislodgement, and one male aged six years (0.7%) out of 59 developed a post-procedural complication; hence, the total failure rate was 1.4%. The perimembranous type had no complication, and the muscular type had two (14.3%) unsuccessful procedures. Conclusion This study has concluded an impressive percentage of VSD closure, showing no mortality and low morbidity, using a percutaneous approach with different duct occluders. As the type of device used is not correlated with device failure and failure rate, duct occluders will be financially helpful in the closure of VSD in indicated patients.
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Affiliation(s)
- Benumadhab Ghosh
- Cardiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Isha Sahai
- Cardiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gajendra Agrawal
- Cardiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Satish Khadase
- Cardiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tarun Rao
- Cardiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akash Lohakare
- Cardiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anuj Chaturvedi
- Cardiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shantanu Gomase
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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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.
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Affiliation(s)
- Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Diab KA, Boujemline Y, Hijazi ZM. Update on shunt closure in neonates and infants. Expert Rev Cardiovasc Ther 2021; 19:475-492. [PMID: 33899641 DOI: 10.1080/14779072.2021.1922079] [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: 10/21/2022]
Abstract
Introduction: Cardiac defects that result in shunting are the most common types of congenital heart anomalies. Although these lesions can be simple, they can cause significant hemodynamic changes and can be challenging to manage in neonates and infants. Over the recent decades, the development of new transcatheter techniques and devices has made it safe and feasible to manage such defects when indicated, even in the smallest of patients. Understanding these interventional procedures is essential in order to manage those patients.Areas covered: In this article, we review the techniques and experience for closure of atrial septal defects, ventricular septal defects, patent ductus aarteriosus,as well as coronary arteriovenous malformations and fistulas in neonates and infants. Literature review of PubMed articles was performed through January 2021, with focus on the latest data and results of the usage of interventional techniques in treating these lesions specifically in this age-group.Expert opinion: Significant shunting lesions can be particularly challenging to manage in neonates and infants. Newer lower profile devices will likely continue to be developed in the future, allowing their use for transcatheter interventions in even smaller patients and those with more complex anatomy.
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Affiliation(s)
- Karim A Diab
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar
| | - Younes Boujemline
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar
| | - Ziyad M Hijazi
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar.,Weill Cornell Medical College, Doha, Qatar.,Weill Cornell Medical College, New York, NY, USA
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Ng LY, Al-Alawi K, Breatnach C, Nolke L, Redmond M, McCrossan B, Oslizlok P, Walsh KP, McGuinness J, Kenny D. Hybrid Subxiphoid Perventricular Approach as an Alternative Access in Neonates and Small Children Undergoing Complex Congenital Heart Interventions. Pediatr Cardiol 2021; 42:526-532. [PMID: 33263794 DOI: 10.1007/s00246-020-02510-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
The hybrid subxiphoid perventricular approach provides direct access through the heart and may alleviate the technical limitations of complex percutaneous interventions particularly in infants with low body weight. We present the outcomes from a tertiary cardiology center using this approach. We performed a retrospective review of all patients less than 15 kg who underwent a hybrid perventricular approach via a small subxiphoid incision. Medical records were reviewed to obtain clinical, demographic and outcome data. Seventeen patients underwent 18 hybrid perventricular procedures using a subxiphoid approach. Median age at time of procedure was 4.6 months (IQR = 1.6 to 18 months) and median weight was 6.2 kgs (IQR = 3.4 to 8.6 kgs). Six patients underwent hybrid pulmonary valve replacement (PVR), 5 patients underwent pulmonary outflow stenting, and 5 infants underwent hybrid ventricular septal defect (VSD) device closure. One patient with a single ventricle who did not tolerate a percutaneous approach underwent left pulmonary artery (LPA) stenting for severe LPA coarctation with subsequent right ventricular outflow tract (RVOT) stenting. One further patient underwent implantation of a larger diameter stent for pulmonary artery bifurcation stenosis. Procedure success rate was 89% with two of the VSD cases reverted to open surgical repair. There were no intra-procedural complications; however, one patient died within 72 h. Minor adverse events occurred in 2 patients including a wound infection in one patient with an immunodeficiency syndrome. Hybrid subxiphoid perventricular approach provides an excellent alternative access to the heart especially in low birth weight infants to prevent hemodynamic instability or in small children requiring large delivery sheaths.
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Affiliation(s)
- Li Yen Ng
- Children Health Ireland at Crumlin, Dublin, Ireland.
| | | | | | - Lars Nolke
- Children Health Ireland at Crumlin, Dublin, Ireland
| | - Mark Redmond
- Children Health Ireland at Crumlin, Dublin, Ireland
| | - Brian McCrossan
- Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
| | | | | | | | - Damien Kenny
- Children Health Ireland at Crumlin, Dublin, Ireland
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7
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Gil-Jaurena JM, Zunzunegui JL, Pérez-Caballero R, Pita A, Pardo C, Calle C, Murgoitio U, Ballesteros F, Rodríguez A, Medrano C. Hybrid Procedures. Opening Doors for Surgeon and Cardiologist Close Collaboration. Front Pediatr 2021; 9:687909. [PMID: 34386468 PMCID: PMC8353319 DOI: 10.3389/fped.2021.687909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Collaboration between cardiac surgeons and cardiologists can offer interventions that each specialist may not be able to offer on their own. This type of collaboration has been demonstrated with the hybrid Stage I in patients with hypoplastic heart syndrome. Since that time, a hybrid approach to cardiac interventions has been expanded to an incredible variety of potential indications. Methods: Seventy-one patients were scheduled for a hybrid procedure along 8 years. This was defined as close collaboration between surgeon and cardiologist working together in the same room, either cath-lab (27 patients) or theater (44 patients). Results: Six groups were arbitrarily defined. A: vascular cut-down in the cath-lab (27 neonates); B: bilateral banding (plus ductal stent) in hypoplastic left heart syndrome or alike (15 children); C: perventricular closure of muscular ventricular septal defect (10 cases); D: balloon/stenting of pulmonary branches along with major surgical procedure (12 kids); E: surgical implantation of Melody valve (six patients) and others (F, one case). Two complications were recorded: left ventricular free wall puncture and previous conduit tearing. Both drawbacks were successfully sort out under cardiopulmonary by-pass. Conclusion: Surgeon and cardiologist partnership can succeed where their isolated endeavors are not enough. Hybrid procedures keep on spreading, overcoming initial expectations. As a bridge to biventricular repair or transplant, bilateral banding plus ductal stent sounds interesting. Novel indications can be classified into different groups. Hybrid procedures are not complication-free.
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Affiliation(s)
- Juan-Miguel Gil-Jaurena
- Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - José-Luis Zunzunegui
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Pediatric Cardiology, Hospital Gregorio Marañón, Madrid, Spain
| | - Ramón Pérez-Caballero
- Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana Pita
- Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Carlos Pardo
- Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Corazón Calle
- Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Uxue Murgoitio
- Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Fernando Ballesteros
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Pediatric Cardiology, Hospital Gregorio Marañón, Madrid, Spain
| | - Alejandro Rodríguez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Pediatric Cardiology, Hospital Gregorio Marañón, Madrid, Spain
| | - Constancio Medrano
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Pediatric Cardiology, Hospital Gregorio Marañón, Madrid, Spain
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8
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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.
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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.
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Abstract
PURPOSE OF REVIEW The past couple of decades have brought tremendous advances to the field of pediatric and adult congenital cardiology. Recent collaborations between interventional cardiologists and cardiac surgeons have sparked novel innovative hybrid procedures that provide potentially safer, faster, and less invasive alternatives to the management of many diseases. This paper will review the most recent advances in hybrid interventions in the field of pediatric and adult congenital cardiology. RECENT FINDINGS The earliest experiences with hybrid interventions included intraoperative stenting of pulmonary arteries and perventricular device closure of ventricular septal defects. Newer hybrid interventions have focused on a hybrid approach to stage 1 palliation for infants with hypoplastic left heart syndrome and hybrid approaches to transcatheter pulmonary valve replacement in patients of all ages. Hybrid approaches to complex congenital heart disease are important in the management of congenital heart disease offering a less invasive approach, and novel hybrid procedures will likely be a focus of future research in this field.
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Affiliation(s)
- David W Bearl
- Division of Pediatric Cardiology, Duke University Hospital, 2301 Erwin Rd, Box 3090, Durham, NC, 27710, USA
| | - Gregory A Fleming
- Division of Pediatric Cardiology, Duke University Hospital, 2301 Erwin Rd, Box 3090, Durham, NC, 27710, USA.
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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.
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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.
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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.
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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
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Kim SH. Recent advances in pediatric interventional cardiology. KOREAN JOURNAL OF PEDIATRICS 2017; 60:237-244. [PMID: 29042864 PMCID: PMC5638720 DOI: 10.3345/kjp.2017.60.8.237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/01/2017] [Accepted: 07/09/2017] [Indexed: 01/27/2023]
Abstract
During the last 10 years, there have been major technological achievements in pediatric interventional cardiology. In addition, there have been several advances in cardiac imaging, especially in 3-dimensional imaging of echocardiography, computed tomography, magnetic resonance imaging, and cineangiography. Therefore, more types of congenital heart diseases can be treated in the cardiac catheter laboratory today than ever before. Furthermore, lesions previously considered resistant to interventional therapies can now be managed with high success rates. The hybrid approach has enabled the overcoming of limitations inherent to percutaneous access, expanding the application of endovascular therapies as adjunct to surgical interventions to improve patient outcomes and minimize invasiveness. Percutaneous pulmonary valve implantation has become a successful alternative therapy. However, most of the current recommendations about pediatric cardiac interventions (including class I recommendations) refer to off-label use of devices, because it is difficult to study the safety and efficacy of catheterization and transcatheter therapy in pediatric cardiac patients. This difficulty arises from the challenge of identifying a control population and the relatively small number of pediatric patients with congenital heart disease. Nevertheless, the pediatric interventional cardiology community has continued to develop less invasive solutions for congenital heart defects to minimize the need for open heart surgery and optimize overall outcomes. In this review, various interventional procedures in patients with congenital heart disease are explored.
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Affiliation(s)
- Seong-Ho Kim
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
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13
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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.
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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
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Agrawal H, Alkashkari W, Kenny D. Evolution of hybrid interventions for congenital heart disease. Expert Rev Cardiovasc Ther 2017; 15:257-266. [DOI: 10.1080/14779072.2017.1307733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Hitesh Agrawal
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Wail Alkashkari
- King Faisal Cardiac Center, King Saud Bin Abdulaziz University, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Damien Kenny
- Department of Cardiology, Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland
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15
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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.
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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.
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16
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Minimally Invasive Peratrial Device Closure of Perimembranous Ventricular Septal Defect Through a Right Infraaxillary Route: Clinical Experience and Preliminary Results. Ann Thorac Surg 2016; 103:199-204. [PMID: 27496627 DOI: 10.1016/j.athoracsur.2016.05.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 05/09/2016] [Accepted: 05/11/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Both percutaneous and perventricular device closures of perimembranous ventricular septal defects (PmVSD) present certain drawbacks. We report our experiences with a new, minimally invasive surgery using a peratrial device closure of PmVSD through a right infraaxillary route. METHODS Between January 2014 and October 2015, 145 patients (71 male, 74 female) with PmVSD, aged 0.5 to 9.7 years (mean 2.8 ± 2.2) and weighing between 6.1 kg and 43 kg (mean 14.0 ± 6.6 kg) were included in this study. In patients with left lateral position, a 2- to 3-cm incision was made along the right midaxillary line. The thoracic cavity was entered through the fourth intercostal space. With the help of transesophageal echocardiography guidance, a specially designed hollow probe was inserted into the right atrium. The probe was passed through the tricuspid valve into the right ventricle. The tip of the probe was adjusted to point to or cross the defect. A flexible guidewire was inserted into the left ventricle through the channel of the probe to establish a delivery pathway. Then, the device was deployed to close the defect. RESULTS A total of 142 cases (97.9%) were successfully occluded, whereas 3 cases failed and were converted to cardiopulmonary bypass operation through the original incision. The device size ranged from 4.0 to 10.0 mm (mean 5.1 ± 1.4 mm), and all devices were concentric. Follow-up in all patients ranged from 1.0 to 22.8 months (mean 9.9 ± 5.6) and revealed no evident valve regurgitation, no complete atrioventricular block, and no device dislocation. CONCLUSIONS This new minimally invasive technique of peratrial device closure through a right infraaxillary route under transesophageal echocardiography guidance was shown to be a safe, effective, feasible, and cosmetically superior treatment for PmVSD.
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17
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The Parable of the Errant Chest Drain in the Heart: Is There Only 1 Option? Ann Thorac Surg 2016; 102:311-3. [PMID: 27343503 DOI: 10.1016/j.athoracsur.2015.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 09/09/2015] [Accepted: 09/14/2015] [Indexed: 11/23/2022]
Abstract
Accidental intraventricular placement of a pericardiocentesis catheter is a rare but well-recognized complication. Failure to achieve adequate hemostasis in the ventricular wall on removal of the catheter can potentially result in fatal consequences. Here we describe a case in which a chest drain (10.2F) accidentally entered into the right ventricle while attempting to drain pleural fluid, and the entry site was sealed using an Amplatzer VSD occluder device (St. Jude Medical, St. Paul, MN).
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18
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Vida VL, Bacha E, Stellin G. Evolving hybrid approaches: the preservation of the ‘neglected’ pulmonary valve function in patients with congenital heart disease. Expert Rev Cardiovasc Ther 2016; 14:793-8. [DOI: 10.1586/14779072.2016.1162711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Holzer RJ, Sallehuddin A, Hijazi ZM. Surgical strategies and novel alternatives for the closure of ventricular septal defects. Expert Rev Cardiovasc Ther 2016; 14:831-41. [PMID: 27007884 DOI: 10.1586/14779072.2016.1169923] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A variety of therapies are available to close ventricular septal defects (VSDs). These include surgical closure on bypass, percutaneous device closure, as well as perventricular hybrid closure. Due to the incidence of heart block (1-5%) associated with percutaneous device closure of perimembranous VSDs, surgical closure presently remains the gold standard and preferred therapy for these defects. Therapeutic options are more varied for muscular VSDs. Beyond infancy, transcatheter closure offers excellent results with low morbidity and mortality, without the need for cardiopulmonary bypass. Infants however have a higher incidence of adverse events using a percutaneous approach. Large mid-muscular VSDs in infants can be treated successfully using a hybrid approach, surgical closure on bypass or a percutaneous approach. However, VSDs located apically or anteriorly are difficult to identify surgically and for these infants, perventricular hybrid closure should be considered as the preferred therapeutic modality. However, some VSD's also can be closed percutaneously.
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Affiliation(s)
- Ralf J Holzer
- a Division Chief Cardiology (Acting) , Sidra Medical and Research Center , Doha , Qatar
| | - Ahmad Sallehuddin
- b Cardiothoracic Department , Hamad Medical Corporation , Doha , Qatar
| | - Ziyad M Hijazi
- c Department of Pediatrics , Sidra Medical and Research Center , Doha , Qatar
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20
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Holoshitz N, Kenny D, Hijazi ZM. Hybrid interventional procedures in congenital heart disease. Methodist Debakey Cardiovasc J 2015; 10:93-8. [PMID: 25114760 DOI: 10.14797/mdcj-10-2-93] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The evolution of congenital cardiac surgery has seen significant innovative advances in collaborative efforts between congenital cardiac surgeons and interventionalists to provide the least invasive intervention with the greatest hemodynamic benefit for patients with congenital heart disease. This review looks at how this collaborative approach has evolved and is being applied to treat a number of congenital conditions across the age ranges.
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Affiliation(s)
| | - Damien Kenny
- Rush University Medical Center, Chicago, Illinois
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21
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Vida VL, Guariento A, Zucchetta F, Padalino MA, Milanesi O, Maschietto N, Stellin G. Combined Surgical and Interventional Approaches for Treating Patients with Congenital Heart Disease. J Card Surg 2015; 30:719-23. [PMID: 26174169 DOI: 10.1111/jocs.12595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS During the last decade the cooperation between surgeons and cardiologists has further expanded by combining surgical and interventional techniques (CCBSI) performed in the operating room, without the use of fluoroscopy. We sought to evaluate the results of our experience with CCBSI. METHODS All children with congenital heart disease (CHD) who underwent a CCBSI in the operating room between June 2007 and January 2014 were enrolled. RESULTS Sixty-eight patients were included. Median age at CCBSI was five months (range 1-48 months). The three main diagnoses leading to surgery included: (1) tetralogy of Fallot (TOF) (n = 40), (2) muscular ventricular septal defects (VSD) (n = 12), (3) single ventricle with pulmonary artery branch stenosis (n = 4). There were 72 catheter-based procedures associated with surgical maneuvres, including: (1) transatrial balloon dilation (BD) of the pulmonary valve (n = 45), (2) transinfundibular BD of the main pulmonary artery trunk (n = 12), (3) perventricular VSD closure with septal occluder (n = 8), (4) BD of pulmonary artery branches (n = 5), and other less common procedures (n = 2). There were no procedure-related complications and no hospital deaths. Median follow-up time was four years (range 0.95-7.9 years). There was one late death for respiratory distress after transapical balloon dilation of the aortic valve. One patient required BD and stenting of the left pulmonary artery branch 3.6 years after intraoperative BD for residual stenosis. CONCLUSIONS The CCBSI represents a safe and effective treatment for selected patients with complex CHD. It will be helpful in minimizing patients' surgical trauma and in shortening or avoiding the use of cardiopulmonary bypass.
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Affiliation(s)
- Vladimiro L Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Thoracic, Cardiac and Vascular Sciences, University of Padua, Padua, Italy
| | - Alvise Guariento
- Pediatric and Congenital Cardiac Surgery Unit, Department of Thoracic, Cardiac and Vascular Sciences, University of Padua, Padua, Italy
| | - Fabio Zucchetta
- Pediatric and Congenital Cardiac Surgery Unit, Department of Thoracic, Cardiac and Vascular Sciences, University of Padua, Padua, Italy
| | - Massimo A Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Thoracic, Cardiac and Vascular Sciences, University of Padua, Padua, Italy
| | - Ornella Milanesi
- Pediatric Cardiology Unit, Department of Paediatrics, University of Padua, Padua, Italy
| | - Nicola Maschietto
- Pediatric Cardiology Unit, Department of Paediatrics, University of Padua, Padua, Italy
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgery Unit, Department of Thoracic, Cardiac and Vascular Sciences, University of Padua, Padua, Italy
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22
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Bakos Z, Harnek J, Jenkins N, Johnson T, Strange J, Asimakopoulos G, Baumbach A, Kliger C, Ruiz CE. How should I treat an accidentally misplaced 8 Fr drainage catheter in the right ventricle? EUROINTERVENTION 2015; 10:768-70. [PMID: 24682506 DOI: 10.4244/eijv10i61a131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Zoltan Bakos
- Department of Coronary Heart Disease, Skane University Hospital, Lund, Sweden
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23
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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.
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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
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24
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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]
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25
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Elhmidi Y, Hoerer J, Lange R, Schreiber C. Muscular ventricular septal defect in a newborn with truncus arteriosus communis: perventricular transcatheter closure under echocardiographic guidance only, a case report. World J Pediatr Congenit Heart Surg 2014; 5:589-91. [PMID: 25324260 DOI: 10.1177/2150135114540308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of a 3.5-kg newborn presenting with a muscular ventricular septal defect (VSD) in the setting of truncus arteriosus communis (common arterial trunk). Reparative surgery using a hybrid approach included perventricular closure of the muscular VSD on the beating heart.
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Affiliation(s)
- Yacine Elhmidi
- Clinic for Cardiovascular Surgery, German Heart Center Munich at the Technical University, Germany
| | - Juergen Hoerer
- Clinic for Cardiovascular Surgery, German Heart Center Munich at the Technical University, Germany
| | - Rüdiger Lange
- Clinic for Cardiovascular Surgery, German Heart Center Munich at the Technical University, Germany DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Christian Schreiber
- Clinic for Cardiovascular Surgery, German Heart Center Munich at the Technical University, Germany
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26
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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
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27
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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.
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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
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Abstract
The diagnosis of double-outlet right ventricle (DORV) characterizes a complex heterogeneous group of congenital cardiac malformations for which multiple classification schemes have been used. A clear understanding of the anatomy is critical to understanding the physiologic consequences of the specific type of DORV. Perioperative considerations include the medical management of the patient during the preoperative period, anesthetic and surgical management, and postoperative care. Both anesthetic and surgical management strategies are very different depending on the type of DORV. Key principles for anesthetic management include balancing the systemic and pulmonary circulations, optimizing systemic cardiac output, and closely monitoring for impaired oxygen delivery to the tissues. Depending on the specific anatomy the patient is usually placed on a 1- or 2-ventricle pathway, and initial palliation may involve placement of a systemic arterial to pulmonary artery shunt or pulmonary artery banding. In some cases the child may undergo a complete repair during the first few months of life. Surgical outcomes, both short and long-term, are dependent on the type of DORV and surgical procedure done. These patients require long-term follow up and may present for surgical or catheter-based interventions as adults.
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Affiliation(s)
- James P Spaeth
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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29
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Butera G, Chessa M, Piazza L, Negura D, Micheletti A, Carminati M. Percutaneous closure of ventricular septal defects. Expert Rev Cardiovasc Ther 2014; 4:671-80. [PMID: 17081089 DOI: 10.1586/14779072.4.5.671] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Isolated ventricular septal defect is the most common form of congenital heart disease. Surgery has been performed for many years and is considered the gold standard for the treatment of ventricular septal defects. However, it is associated with morbidity and mortality. Less invasive techniques have been developed and currently percutaneous closure of muscular and perimembranous ventricular septal defects has to be considered a possible alternative to the standard surgical approach.
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Affiliation(s)
- Gianfranco Butera
- Istituto Policlinico San Donato, Pediatric Cardiology, Via Morandi, 30--20097 San Donato, Milanese, Italy.
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30
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Perventricular device closure of ventricular defects in 235 young children: a single-center experience. J Thorac Cardiovasc Surg 2013; 146:1551-3. [PMID: 24075562 DOI: 10.1016/j.jtcvs.2013.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 07/31/2013] [Accepted: 08/09/2013] [Indexed: 11/23/2022]
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32
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Holoshitz N, Ilbawi MN, Amin Z. Perventricular melody valve implantation in a 12 kg child. Catheter Cardiovasc Interv 2013; 82:824-7. [DOI: 10.1002/ccd.25044] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 05/16/2013] [Accepted: 05/19/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Noa Holoshitz
- Rush Center for Congenital and Structural Heart Disease; Rush University Medical Center; Chicago Illinois
| | - Michel N. Ilbawi
- Rush Center for Congenital and Structural Heart Disease; Rush University Medical Center; Chicago Illinois
| | - Zahid Amin
- Rush Center for Congenital and Structural Heart Disease; Rush University Medical Center; Chicago Illinois
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Haponiuk I, Chojnicki M, Jaworski R, Steffek M, Juscinski J, Sroka M, Fiszer R, Sendrowska A, Gierat-Haponiuk K, Maruszewski B. Hybrid approach for closure of muscular ventricular septal defects. Med Sci Monit 2013; 19:618-24. [PMID: 23892911 PMCID: PMC3735373 DOI: 10.12659/msm.883985] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The complexity of ventricular septal defects in early infancy led to development of new mini-invasive techniques based on collaboration of cardiac surgeons with interventional cardiologists, called hybrid procedures. Hybrid therapies aim to combine the advantages of surgical and interventional techniques in an effort to reduce the invasiveness. The aim of this study was to present our approach with mVSD patients and initial results in the development of a mini-invasive hybrid procedure in the Gdansk Hybrid Heartlink Programme (GHHP) at the Department of Pediatric Cardiac Surgery, Pomeranian Centre of Traumatology in Gdansk, Poland. MATERIAL AND METHODS The group of 11 children with mVSDs was enrolled in GHHP and 6 were finally qualified to hybrid trans-ventricular mVSD device closure. Mean age at time of hybrid procedure was 8.22 months (range: from 2.7 to 17.8 months, SD=5.1) and mean body weight was 6.3 kg (range: from 3.4 to 7.5 kg, SD=1.5). RESULTS The implants of choice were Amplatzer VSD Occluder and Amplatzer Duct Occluder II (AGA Med. Corp, USA). The position of the implants was checked carefully before releasing the device with both transesophageal echocardiography and epicardial echocardiography. All patients survived and their general condition improved. No complications occurred. The closure of mVSD was complete in all children. CONCLUSIONS Hybrid procedures of periventricular muscular VSD closure appear feasible and effective for patients with septal defects with morphology unsuitable for classic surgical or interventional procedures. The modern strategy of joint cardiac surgical and interventional techniques provides the benefits of close cooperation between cardiac surgeon and interventional cardiologist for selected patients in difficult clinical settings.
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Affiliation(s)
- Ireneusz Haponiuk
- Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Pomeranian Centre of Traumatology, Gdańsk, Poland.
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Fouilloux V, Bonello B, Gran C, Fraisse A, Macé L, Kreitmann B. Perventricular closure of muscular ventricular septal defects in infants with echocardiographic guidance only. World J Pediatr Congenit Heart Surg 2013; 3:446-51. [PMID: 23804906 DOI: 10.1177/2150135112447958] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report our experience with perventricular closure of muscular (apical) ventricular septal defects (VSDs) in small infants, with echocardiographic guidance only, in a nonhybrid suite. METHODS Eight infants with nine large muscular (apical) VSDs underwent perventricular device closure in a nonhybrid operating room, with transesophageal and epicardial echocardiography guidance, at a mean age and weight of 3.07 (0.3-7.28) months and 3.7 (2.5-6.2) kg, respectively. Five patients had multiple VSDs. Four had associated cardiac defects. RESULTS Nine Amplatzer muscular VSD devices with a mean size of 10 (4-14) mm were deployed. Seven patients were discharged from the intensive care unit with a mean length of stay of 8.6 days. Four patients had minimal postprocedural residual shunt; no one had a residual shunt at six-month follow-up. Mid-term results are excellent. CONCLUSION Perventricular closure is feasible under echocardiographic guidance only in small patients, even without hybrid suite. This may be a good approach for very symptomatic low-weight infants with apical VSD and may also be useful, in any center, at any time, and in any operating room, to treat an associated apical VSD, even unexpected.
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Affiliation(s)
- Virginie Fouilloux
- Department of Thoracic and Cardio-Vascular Surgery, Hôpital d'enfants de la Timone, Marseille, France
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Kitagawa T, Kitaichi T, Sugano M, Kurobe H. Techniques and results in the management of multiple muscular trabecular ventricular septal defects. Gen Thorac Cardiovasc Surg 2013; 61:367-75. [PMID: 23737104 DOI: 10.1007/s11748-013-0267-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Indexed: 10/26/2022]
Abstract
The management of patients with multiple muscular trabecular ventricular septal defects (VSDs) remains controversial. In the past two decades, innovative techniques including a right ventricular apical infundibulotomy and transcatheter, intraoperative and perventricular device closure have been exploited, and essential right atrial approach and limited apical left ventriculotomy have also been refined. However, specific management guidelines for this difficult disease have not been established. In this article, the benefits and drawbacks of each technique are reviewed and discussed. Primary repair for infants with multiple muscular trabecular VSDs was associated with good late outcomes. The right atrial approach was satisfactory for all muscular VSDs, excluding apical defects that were well seen through a limited apical ventriculotomy. Surgical closure of apical defects could be achieved safely and completely in early infancy through a limited apical left ventriculotomy or a right ventricular apical infundibulotomy. Further follow-up and prudent evaluations of ventriculotomy-associated morbidities are needed. Pulmonary artery banding should be limited to a small infant with complex associated defects. Percutaneous device closure, the most desirable option, is impractical due to limitations between the delivery system and access route. Intraoperative device closure appears less successful than device closure in the catheterization laboratory. Perventricular device closure has a significant advantage of being a non-bypass procedure approach. A less invasive strategy for "true" Swiss cheese septum is needed. All may have an important role, and results obtained by using these techniques are encouraging. These hybrid approaches will promise future success on management guidelines of multiple muscular trabecular VSDs.
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Affiliation(s)
- Tetsuya Kitagawa
- Department of Cardiovascular Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
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Kim SJ, Huh J, Song JY, Yang JH, Jun TG, Kang IS. The hybrid perventricular closure of apical muscular ventricular septal defect with Amplatzer duct occluder. KOREAN JOURNAL OF PEDIATRICS 2013; 56:176-81. [PMID: 23646056 PMCID: PMC3641314 DOI: 10.3345/kjp.2013.56.4.176] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 10/15/2012] [Accepted: 10/24/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE Apical muscular ventricular septal defects (MVSDs), especially in small infants, can be difficult to manage using surgical and percutaneous closure. An intraoperative perventricular procedure is a good option for closing apical MVSDs in small children with or without associated cardiac anomalies. We evaluated the results of hybrid perventricular closure of apical MVSDs performed using an Amplatzer duct occluder (ADO). METHODS We retrospectively reviewed the medical records of 5 patients who underwent hybrid perventricular closure of MVSDs with ADOs, from March 2006 to May 2011. The median patient age at the time of the procedure was 12 months (range, 25 days to 25 months), and the median body weight was 9.1 kg (range, 4.3 to 15 kg). Two patients had multiple ventricular septal defects (VSDs; additional perimembranous VSD in 1 patient and multiple MVSDs in the other) and 3 patients had associated cardiac anomalies; complete transposition of the great arteries in 1 patient and an atrial septal defect in 2 patients. All the procedures were performed on beating hearts, exception in 1 case. The ADO selected for the aortic side was at least 1 to 2 mm larger than the largest VSD in the left ventricle side. RESULTS The procedure was successful in all patients and each device was well positioned. During the median follow-up of 2.4 years, a small residual VSD was noted in 2 patients who had multiple VSDs and no leakage was seen in the other 3 patients. CONCLUSION Perventricular closure of MVSD with an ADO is a good option for patients with apical MVSD. However, careful manipulation is important, especially in the case of small infants.
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Affiliation(s)
- Soo Jin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Bishnoi RN, Coulson JD, Ringel RE. Recent advances in interventional pediatric cardiology. Adv Pediatr 2013; 60:187-200. [PMID: 24007845 DOI: 10.1016/j.yapd.2013.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Ram N Bishnoi
- Department of Pediatric Cardiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg Children's Center M2309, Baltimore, MD 21287, USA.
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Holzer RJ, Cheatham JP. Hybrid Procedures in Congenital Heart Disease: Hypoplastic Left Heart Syndrome/Muscular Ventricular Septal Defect/Stenting of Pulmonary Arteries. Interv Cardiol Clin 2013; 2:23-38. [PMID: 28581986 DOI: 10.1016/j.iccl.2012.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hybrid therapies have increased and offer a valuable alternative to standard catheter or surgical therapies in selected patient. These hybrid therapies often combine the best of both techniques, in particular for ventricular septal defect closure and intraoperative pulmonary artery stent placement. For patients with hypoplastic left heart syndrome, the hybrid approach is an important alternative therapeutic strategy, providing similar results to conventional Norwood-type palliation. Further studies are needed and are underway to evaluate the neurodevelopmental outcome in these patients.
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Affiliation(s)
- Ralf J Holzer
- Cardiac Catheterization & Interventional Therapy, Division of Cardiology, The Heart Center, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA.
| | - John P Cheatham
- Cardiac Catheterization & Interventional Therapy, Pediatrics & Internal Medicine, Cardiology Division, The Heart Center, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA
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Koneti NR. Hybrid muscular ventricular septal defect closure: surgeon or physician!! Indian Heart J 2012; 64:568-9. [PMID: 23253408 DOI: 10.1016/j.ihj.2012.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 10/24/2012] [Indexed: 11/17/2022] Open
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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.
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Affiliation(s)
- Bhavesh Thakkar
- Department of Cardiology and Cardiothoracic Surgery, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, India.
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A case of hybrid closure of a muscular ventricular septal defect: anatomical complexity and surgical management. Cardiol Young 2012; 22:356-9. [PMID: 22047614 DOI: 10.1017/s1047951111001545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Complex muscular ventricular septal defect poses difficult surgical management and is associated with high morbidity and mortality despite advancements in surgical therapy. Device closure of muscular ventricular septal defect has been encouraging and has been used in hybrid approach at a few centres. However, device closure has some limitations in patients with complex muscular ventricular septal defect. We report a case of perventricular device closure of a complex muscular ventricular septal defect in a beating heart with entrapped right ventricular disc and its surgical management.
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Yang Q, Zhang J, Jiang J. Intracoronary transplantation of genetically modified mesenchymal stem cells, a novel method to close muscular ventricular septal defects. Med Hypotheses 2011; 77:505-7. [PMID: 21788104 DOI: 10.1016/j.mehy.2011.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 05/03/2011] [Accepted: 06/03/2011] [Indexed: 02/05/2023]
Abstract
Muscular ventricular septal defects remain a challenge despite the progress in surgical and interventional closure of ventricular septal defects. Our hypothesis was inspired by the fact that more than two thirds of children with muscular ventricular septal defects experienced spontaneous closure. Therefore, we intend to induce the spontaneous closure of muscular ventricular septal defects by means of targeted intracoronary injection of mesenchymal stem cells which are genetically modified to enhance myocardial hypertrophy. The transplantation of bone marrow derived cells has been observed to be effective in improving tissue recovery and ameliorating cardiac function in patients and animal models with ischemic heart disease, acute myocarditis and dilated cardiomyopathy. We expect that the targeted intracoronary transplantation of genetically modified mesenchymal stem cells could enhance the tissue generation and myocardial hypertrophy simultaneously, which may lead to the closure of muscular ventricular septal defects in a way that imitate the spontaneous closure of ventricular septal defects.
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Affiliation(s)
- Qing Yang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
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Bendaly EA, Hoyer MH, Breinholt JP. Mid-term follow up of perventricular device closure of muscular ventricular septal defects. Catheter Cardiovasc Interv 2011; 78:577-82. [PMID: 21542116 DOI: 10.1002/ccd.23150] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 03/19/2011] [Indexed: 11/10/2022]
Affiliation(s)
- Edgard A Bendaly
- Department of Pediatric Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Cubeddu RJ, Hijazi ZM. Bailout perventricular pulmonary valve implantation following failed percutaneous attempt using the Edwards Sapien transcatheter heart valve. Catheter Cardiovasc Interv 2011; 77:276-80. [PMID: 20518008 DOI: 10.1002/ccd.22653] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Percutaneous pulmonary valve implantation has emerged as an attractive and less invasive alternative to open-heart surgery. Nevertheless, major technical challenges and procedural complications may still occur. We report a 44-year-old woman with severe dextroscoliosis, and history of Tetralogy of Fallot repair, who underwent an attempt at percutaneous implantation of a 23-mm Edwards SAPIEN transcatheter heart valve (THV) for recurrent stenosis of the right ventricle to pulmonary artery conduit. The procedure was complicated by valve migration into the right ventricle requiring emergent surgical removal using inflow-occlusion technique to avoid cardiopulmonary bypass. A hybrid off-pump perventricular approach was then used in the operating room to successfully implant a 26-mm Edwards Sapien THV under fluoroscopic guidance. © 2010 Wiley-Liss, Inc.
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Affiliation(s)
- Roberto J Cubeddu
- Division of Cardiology, Aventura Hospital and Medical Center of Miami, FL, USA
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Feltes TF, Bacha E, Beekman RH, Cheatham JP, Feinstein JA, Gomes AS, Hijazi ZM, Ing FF, de Moor M, Morrow WR, Mullins CE, Taubert KA, Zahn EM. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 2011; 123:2607-52. [PMID: 21536996 DOI: 10.1161/cir.0b013e31821b1f10] [Citation(s) in RCA: 484] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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46
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Guo QK, Lu ZQ, Cheng SF, Cao Y, Zhao YH, Zhang C, Zhang YL. Off-pump occlusion of trans-thoracic minimal invasive surgery (OPOTTMIS) on simple congenital heart diseases (ASD, VSD and PDA) attached consecutive 210 cases report: a single institute experience. J Cardiothorac Surg 2011; 6:48. [PMID: 21486486 PMCID: PMC3090330 DOI: 10.1186/1749-8090-6-48] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 04/13/2011] [Indexed: 11/21/2022] Open
Abstract
Objective This paper intends to report our experiences by using an operation of off-pump occlusion of trans-thoracic minimal invasive surgery (OPOTTMIS) on the treatment of consecutive 210 patients with simple congenital heart diseases (CHD) including atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA). Methods The retrospective clinical data of OPOTTMIS in our institute were collected and compared to other therapeutic measures adopted in the relevant literatures. After operation, all the patients received electrocardiography (ECG) and echocardiography (echo) once a month within the initial 3 months, and no less than once every 3 ~ 6 months later. Results The successful rate of the performed OPOTTMIS operation was 99.5%, the mortality and complication incidence within 72 hours were 0.5% and 4.8%, respectively. There were no major complications during peri-operation such as cardiac rupture, infective endocarditis, strokes, haemolysis and thrombosis. The post-operation follow-up outcomes by ECG and echo checks of 3 months to 5 years showed that there were no III° AVB, no obvious Occluder migration and device broken and no moderate cardiac valve regurgitation, except 1 VSD and 1 PDA with mild residual shunts, and 2 PDA with heart expansion after operation. However, all the patients' heart functions were in class I~II according to NYH standard. Conclusion The OPOTTMIS is a safe, less complex, feasible and effective choice to selected simple CHD patients with some good advantages and favorable short term efficacies.
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Affiliation(s)
- Qing-Kui Guo
- Department of Cardio-thoracic Surgery, Shanghai NO,6 People Hospital Affiliated Shanghai Jiao Tong University, NO, 600 Yishan Road, Shanghai, 86: 200233, China
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A novel method of hybrid intraoperative catheter-based closure of ventricular septal defects using the Amplatzer® PDA occluder. Catheter Cardiovasc Interv 2011; 77:557-63. [DOI: 10.1002/ccd.22649] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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48
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Michel-Behnke I, Ewert P, Koch A, Bertram H, Emmel M, Fischer G, Gitter R, Kozlik-Feldman R, Motz R, Kitzmüller E, Kretschmar O. Device closure of ventricular septal defects by hybrid procedures: A multicenter retrospective study. Catheter Cardiovasc Interv 2011; 77:242-51. [PMID: 20517999 DOI: 10.1002/ccd.22666] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ina Michel-Behnke
- Department of Pediatric Cardiology, Pediatric Heart Center, Giessen, Germany.
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Pedra SF, Jatene M, Pedra CA. Hybrid management of a large atrial septal defect and a patent ductus arteriosus in an infant with chronic lung disease. Ann Pediatr Cardiol 2010; 3:68-73. [PMID: 20814479 PMCID: PMC2921521 DOI: 10.4103/0974-2069.64358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We report a case wherein a dysmorphic four-month-old infant (weighing 4.5 kgs) with an 8 mm atrial septal defect (ASD), a 1.5 mm patent ductus arteriosus (PDA), a 2 mm mid-muscular ventricular septal defect (VSD) associated with chronic lung disease, and severe pulmonary hypertension, was successfully managed using a hybrid approach, without the use of cardiopulmonary bypass (CPB). Through a median sternotomy, the PDA was ligated and the ASD was closed with a 9 mm Amplatzer septal occluder implanted through peratrial access. The VSD was left untouched. Serial echocardiograms showed complete closure of the ASD and PDA, with progressive normalization of the pulmonary artery (PA) pressures within three months. The child rapidly gained weight and was weaned from sildenafil and oxygen administration. After 12 months, the VSD closed spontaneously and the child remained well, with normal PA pressures. A hybrid approach without the use of CPB should be considered in the management of infants with congenital heart disease, associated with chronic lung disease and pulmonary hypertension.
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Affiliation(s)
- Simone F Pedra
- Hospital do Coração da Associação Sanatório Sírio, São Paulo, Brazil
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Pedra CAC, Pedra SRF, Chaccur P, Jatene M, Costa RN, Hijazi ZM, Amin Z. Perventricular device closure of congenital muscular ventricular septal defects. Expert Rev Cardiovasc Ther 2010; 8:663-74. [PMID: 20450300 DOI: 10.1586/erc.10.31] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Muscular ventricular septal defects (MVSDs) account for approximately 20% of all congenital ventricular septal defects. Large defects in infants result in early heart failure, failure to thrive and pulmonary hypertension. Although percutaneous closure of MVSDs has been employed safely and effectively in children, adolescents and adults, its application in the small infant (weight <6 kg) carries a higher risk for complications including arrhythmias, hemodynamic compromise, cardiac perforation, tamponade and death. Perventricular closure of such defects, introduced by Amin and coworkers in the late 1990s, has become an attractive treatment modality for these small and high-risk patients. Experience worldwide has shown that the procedure is feasible, reproducible, safe and effective. In this article, the authors review the indications, the step-by-step technique and the results of perventricular closure of MVSDs using the AMPLATZER mVSD device (AGA Medical, MN, USA).
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Affiliation(s)
- Carlos A C Pedra
- Instituto Dante Pazzanese de Cardiologia, Av. Dr Dante Pazzanese 500, 14 andar, CEP 04012-180, São Paulo, Brazil
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