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Ghosh RM, Mascio CE, Rome JJ, Jolley MA, Whitehead KK. Use of Virtual Reality for Hybrid Closure of Multiple Ventricular Septal Defects. JACC Case Rep 2021; 3:1579-1583. [PMID: 34729504 PMCID: PMC8543163 DOI: 10.1016/j.jaccas.2021.07.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022]
Abstract
A 28-month-old girl with multiple ventricular septal defects previously underwent surgical and transcatheter attempts at repair. Three-dimensional models were created from cardiac magnetic resonance–derived images. Viewing the models in virtual reality allowed the team to precisely locate the defects and decide on a hybrid transcatheter and surgical approach to ensure successful repair. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Reena M. Ghosh
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Address for correspondence: Dr Reena M. Ghosh, Division of Cardiology, Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, Pennsylvania 19104, USA. @ghoshrm
| | - Christopher E. Mascio
- Division of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jonathan J. Rome
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Matthew A. Jolley
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kevin K. Whitehead
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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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.
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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.
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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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