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Schittek J, Sachweh JS, Arndt F, Grafmann M, Hüners I, Kozlik-Feldmann R, Biermann D. Outcomes of Tricuspid Valve Detachment for Isolated Ventricular Septal Defect Closure. Thorac Cardiovasc Surg 2021; 69:e48-e52. [PMID: 34758490 PMCID: PMC8601706 DOI: 10.1055/s-0041-1735457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Partial detachment of the septal and anterior leaflets of the tricuspid valve (TV) is a technique to visualize a perimembranous ventricular septal defect (VSD) for surgical closure in cases where the VSD is obscured by TV tissue. However, TV incision bears the risk of causing relevant postoperative TV regurgitation and higher degree atrioventricular (AV) block. A total of 40 patients were identified retrospectively in our institution who underwent isolated VSD closure between January 2013 and August 2015. Visualization of the VSD was achieved in 20 patients without and in 20 patients with additional partial detachment of the TV. The mean age of patients with partial tricuspid valve detachment (TVD) was 0.7 ± 0.1 years compared with 1 ± 0.3 years (
p
= 0.22) of patients without TVD. There was no difference in cardiopulmonary bypass time between patients of both groups (123 ± 11 vs. 103 ± 5 minutes,
p
= 0.1). Cross-clamp time was longer if the TV was detached (69 ± 5 vs. 54 ± 4 minutes,
p
= 0.023). There was no perioperative mortality. Echocardiography at discharge and after 2.5 years (2 months–6 years) of follow-up showed neither a postoperative increase of tricuspid regurgitation nor any relevant residual shunt. Postoperative electrocardiograms were normal without any sign of higher degree AV block. TVD offers enhanced exposure and safe treatment of VSDs. It did not result in higher rates of TV regurgitation or relevant AV block compared with the control group.
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Affiliation(s)
- John Schittek
- Surgery for Congenital Heart Disease, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Jörg S Sachweh
- Surgery for Congenital Heart Disease, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Florian Arndt
- Department for Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Maria Grafmann
- Department for Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Ida Hüners
- Surgery for Congenital Heart Disease, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Rainer Kozlik-Feldmann
- Department for Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Daniel Biermann
- Surgery for Congenital Heart Disease, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Hamburg, Germany
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The Fate of the Tricuspid Valve After the Transatrial Closure of the Ventricular Septal Defect. Ann Thorac Surg 2018; 106:1229-1233. [DOI: 10.1016/j.athoracsur.2018.04.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 11/18/2022]
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Pourmoghadam KK, Boron A, Ruzmetov M, Suguna Narasimhulu S, Kube A, O’Brien MC, DeCampli WM. Septal Leaflet Versus Chordal Detachment in Closure of Hard-to-Expose Ventricular Septal Defects. Ann Thorac Surg 2018; 106:814-821. [DOI: 10.1016/j.athoracsur.2018.02.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/07/2018] [Accepted: 02/26/2018] [Indexed: 11/27/2022]
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Fraser CD, Zhou X, Palepu S, Lui C, Suarez-Pierre A, Crawford TC, Magruder JT, Jacobs ML, Cameron DE, Hibino N, Vricella LA. Tricuspid Valve Detachment in Ventricular Septal Defect Closure Does Not Impact Valve Function. Ann Thorac Surg 2018; 106:145-150. [DOI: 10.1016/j.athoracsur.2018.02.075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/02/2018] [Accepted: 02/26/2018] [Indexed: 10/17/2022]
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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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Russell HM, Forsberg K, Backer CL, Wurlitzer KC, Kaushal S, Mavroudis C. Outcomes of Radial Incision of the Tricuspid Valve for Ventricular Septal Defect Closure. Ann Thorac Surg 2011; 92:685-90; discussion 690. [DOI: 10.1016/j.athoracsur.2011.03.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 02/25/2011] [Accepted: 03/07/2011] [Indexed: 11/26/2022]
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Kumar N, Dixit S, Agrawal R, Verma RK, Krishna V, Sahni JL. Temporary tricuspid valve leaflet detachment for closure of perimembranous ventricular septal defect: Early experiences. Indian J Thorac Cardiovasc Surg 2010. [DOI: 10.1007/s12055-009-0032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Pande S, Majumdar G, Agarwal SK, Kundu A, Kale N. Anatomical Exposure of Ventricular Septal Defect. Heart Lung Circ 2007; 16:322-3. [PMID: 17347045 DOI: 10.1016/j.hlc.2006.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2006] [Revised: 10/14/2006] [Accepted: 10/19/2006] [Indexed: 11/25/2022]
Abstract
The ventricular septal defect approached through the right atrium is associated with inadequate exposure and thus difficulty in its closure. The retraction, to expose the defect, leads to distortion of anatomy and a limitation of space to operate. We propose a simple procedure of retracting sutures to expose the defect without this limitation.
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Affiliation(s)
- Shantanu Pande
- Department of Cardio-vascular and Thoracic Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
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Bol Raap G, Meijboom FJ, Kappetein AP, Galema TW, Yap SC, Bogers AJJC. Long-term follow-up and quality of life after closure of ventricular septal defect in adults. Eur J Cardiothorac Surg 2007; 32:215-9. [PMID: 17566753 DOI: 10.1016/j.ejcts.2007.04.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Revised: 04/13/2007] [Accepted: 04/16/2007] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To study patients who underwent surgical closure of a congenital ventricular septal defect (VSD) and presenting at adult age. METHODS AND RESULTS A retrospective study was carried out of 28 patients (15 male) operated upon between 1980 and 2004. Patients were investigated by echocardiography, ECG and assessed for quality of life by a questionnaire. The indication for surgery was volume overload in 11 patients, endocarditis in 8, aortic valve regurgitation in 8 and the combination of a VSD with subvalvular aortic stenosis in 1. Follow-up was complete with a mean duration of follow-up of 13 years. There was no early or late mortality. One patient was reoperated for recurrent VSD. Twenty-five patients underwent echocardiography, which revealed a trivial residual VSD in two and mild aortic regurgitation in 10 (40%) patients. One patient was in atrial fibrillation. Health related quality of life in the dimensions cognitive functioning and sleep differed significantly from that of the general population. CONCLUSION With a relative difference in indications for closure of a VSD in adulthood, surgical closure of VSD at adult age is an adequate and safe procedure, with good results on long-term follow-up. Progression of aortic valve regurgitation is a matter of concern.
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Affiliation(s)
- Goris Bol Raap
- Department of Cardiothoracic Surgery, Thoraxcentre, Erasmus MC University Hospital, Rotterdam, The Netherlands.
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Bol Raap G, Koning AHJ, Scohy TV, ten Harkel ADJ, Meijboom FJ, Kappetein AP, van der Spek PJ, Bogers AJJC. Virtual reality 3D echocardiography in the assessment of tricuspid valve function after surgical closure of ventricular septal defect. Cardiovasc Ultrasound 2007; 5:8. [PMID: 17306019 PMCID: PMC1810238 DOI: 10.1186/1476-7120-5-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Accepted: 02/16/2007] [Indexed: 05/13/2023] Open
Abstract
Background This study was done to investigate the potential additional role of virtual reality, using three-dimensional (3D) echocardiographic holograms, in the postoperative assessment of tricuspid valve function after surgical closure of ventricular septal defect (VSD). Methods 12 data sets from intraoperative epicardial echocardiographic studies in 5 operations (patient age at operation 3 weeks to 4 years and bodyweight at operation 3.8 to 17.2 kg) after surgical closure of VSD were included in the study. The data sets were analysed as two-dimensional (2D) images on the screen of the ultrasound system as well as holograms in an I-space virtual reality (VR) system. The 2D images were assessed for tricuspid valve function. In the I-Space, a 6 degrees-of-freedom controller was used to create the necessary projectory positions and cutting planes in the hologram. The holograms were used for additional assessment of tricuspid valve leaflet mobility. Results All data sets could be used for 2D as well as holographic analysis. In all data sets the area of interest could be identified. The 2D analysis showed no tricuspid valve stenosis or regurgitation. Leaflet mobility was considered normal. In the virtual reality of the I-Space, all data sets allowed to assess the tricuspid leaflet level in a single holographic representation. In 3 holograms the septal leaflet showed restricted mobility that was not appreciated in the 2D echocardiogram. In 4 data sets the posterior leaflet and the tricuspid papillary apparatus were not completely included. Conclusion This report shows that dynamic holographic imaging of intraoperative postoperative echocardiographic data regarding tricuspid valve function after VSD closure is feasible. Holographic analysis allows for additional tricuspid valve leaflet mobility analysis. The large size of the probe, in relation to small size of the patient, may preclude a complete data set. At the moment the requirement of an I-Space VR system limits the applicability in virtual reality 3D echocardiography in clinical practice.
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Affiliation(s)
- Goris Bol Raap
- Department of Cardiothoracic Surgery, Erasmus MC University Hospital, Rotterdam, The Netherlands
| | - Anton HJ Koning
- Department of Bioinformatics, Erasmus MC University Hospital, Rotterdam, The Netherlands
| | - Thierry V Scohy
- Department of Anesthesiology, Erasmus MC University Hospital, Rotterdam, The Netherlands
| | - A Derk-Jan ten Harkel
- Department of Pediatric Cardiology, Erasmus MC University Hospital, Rotterdam, The Netherlands
| | - Folkert J Meijboom
- Department of Cardiology, Erasmus MC University Hospital, Rotterdam, The Netherlands
| | - A Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus MC University Hospital, Rotterdam, The Netherlands
| | - Peter J van der Spek
- Department of Bioinformatics, Erasmus MC University Hospital, Rotterdam, The Netherlands
| | - Ad JJC Bogers
- Department of Cardiothoracic Surgery, Erasmus MC University Hospital, Rotterdam, The Netherlands
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van den Bosch AE, Ten Harkel DJ, McGhie JS, Roos-Hesselink JW, Simoons ML, Bogers AJJC, Meijboom FJ. Feasibility and Accuracy of Real-time 3-Dimensional Echocardiographic Assessment of Ventricular Septal Defects. J Am Soc Echocardiogr 2006; 19:7-13. [PMID: 16423663 DOI: 10.1016/j.echo.2005.07.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Indexed: 12/01/2022]
Abstract
The aim of this study was to evaluate feasibility, accuracy, and clinical applicability of real-time (RT) transthoracic 3-dimensional (3D) echocardiography (3DE) in the determination of the position, size, and shape of a ventricular septal defect (VSD). In all, 34 patients (age: 2 months-46 years), who were scheduled for surgical closure of a VSD, were enrolled in the study. VSD localization, shape, and dimensions were assessed and compared with measurements performed by the surgeon. Acquisition of RT-3DE datasets was feasible in 30 of 34 (88%) patients. Duration of 3D data acquisition was 6 +/- 2 minutes. Reconstruction time was 23 +/- 16 minutes. Localization and number of VSD were determined correctly by RT-3DE in all patients. There was a good correlation for VSD measurements between RT-3DE and operation (r = 0.95). RT-3DE allows accurate determination of VSD size, shape, and location. The short acquisition time and acceptable reconstruction time make this technique clinically applicable.
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12
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Aeba R, Katogi T, Hashizume K, Koizumi K, Iino Y, Mori M, Yozu R. Liberal use of tricuspid valve detachment for transatrial ventricular septal defect closure. Ann Thorac Surg 2003; 76:1073-7. [PMID: 14529988 DOI: 10.1016/s0003-4975(03)00723-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although temporary tricuspid valve detachment is useful for improved visualization of ventricular septal defect through right atriotomy, liberal use of this adjunct is not widely supported, mainly because of concerns about iatrogenic complications such as heart blocks and tricuspid valve dysfunction. The objective of this study was to determine whether liberal use of this adjunct can improve operative outcome. METHODS Between January 1997 and March 2002, trans-atrial closure of isolated ventricular septal defect (conoventricular or canal type) was performed in 87 consecutive patients. Tricuspid valve detachment was used in 4 out of 44 patients (prudent-use group) and 19 out of 43 patients (liberal-use group) in the first and second half of this period, respectively (p = 0.0002). Patient demographics and use of other surgical and cardiopulmonary bypass techniques remained virtually unchanged during this period. RESULTS In the prudent-use group, there was one operative death with prolonged bypass time and one residual defect that required reoperation; neither of these patients underwent tricuspid valve detachment. All other patients (both groups) were free from mortality and clinically significant complications, including heart block, tricuspid regurgitation, and residual defect. The liberal-use group had shorter cardiopulmonary bypass time than the prudent-use group (59 +/- 14 vs 67 +/- 22 minutes, p = 0.037). CONCLUSIONS Tricuspid valve detachment should be used liberally for moderate- or even low-difficulty exposure of ventricular septal defect, regardless of patient background, because it is a safe and effective adjunct that can improve speed, programmability, reproducibility, and reliability.
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Affiliation(s)
- Ryo Aeba
- Division of Cardiovascular Surgery, Keio University, Tokyo, Japan.
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13
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Maile S, Kadner A, Turina MI, Prêtre R. Detachment of the anterior leaflet of the tricuspid valve to expose perimembranous ventricular septal defects. Ann Thorac Surg 2003; 75:944-6. [PMID: 12645721 DOI: 10.1016/s0003-4975(02)04668-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Detachment of the septal leaflet of the tricuspid valve has been described for better access to perimembranous ventricular septal defects. Detachment confined to the anterior leaflet is less known, although it provides a better exposure of the subaortic area and puts less jeopardy on the conduction tissues. METHODS Data regarding 49 consecutive patients who had congenital perimembranous ventricular septal defect closure were retrospectively reviewed. Thirty-three patients (67%) underwent temporary detachment of the anterior leaflet of the tricuspid valve. The defect was closed with a Gore-Tex patch and a continuous suture. In 10 patients (29%), concomitant right ventricular outflow tract enlargement was performed. Follow-up was obtained in every patient (median time, 11 months; range, 2 to 26 months). RESULTS No early or late death occurred. Closure of the ventricular septal defect was complete, with no more than trivial residual jet leaks found in perioperative echocardiography. All patients were in sinus rhythm. The tricuspid valve never showed more than mild insufficiency after repair. No patient showed subaortic obstruction. CONCLUSIONS Detachment of the anterior leaflet of the tricuspid valve to expose the ventricular septal defect is a safe approach that allows rapid closure of the defect with a continuous suture and provides excellent results.
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Affiliation(s)
- Silke Maile
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
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Koshy S, Sunil GS, Anil SR, Dhinakar S, Shivaprakasha K, Rao SG. Tricuspid valve detachment for transatrial closure of ventricular septal defects. Asian Cardiovasc Thorac Ann 2002; 10:314-7. [PMID: 12538275 DOI: 10.1177/021849230201000407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tricuspid leaflet detachment improves visualization and accuracy of closure of ventricular septal defects via the transatrial route. Between July 1998 and March 2001, surgical correction was performed in 296 cases of isolated ventricular septal defect, 215 cases of tetralogy of Fallot, and 16 cases of double-outlet right ventricle. Of these, 132 patients (79 with isolated ventricular septal defect, 49 with tetralogy of Fallot, and 4 with double-outlet right ventricle) underwent transatrial repair with temporary detachment of tricuspid leaflets for ventricular septal defect closure. The septal leaflet was detached in most cases, with anterior or posterior leaflets being detached when indicated. Median duration of intensive care was 3.6 days, and median hospital stay was 7 days. There was no incidence of tricuspid regurgitation attributable to leaflet detachment, as confirmed by postoperative echocardiography. Reoperation was not required for a residual defect or tricuspid regurgitation. The benefits of temporary leaflet detachment for transatrial repair of various difficult defects far outweigh the risk of postoperative tricuspid regurgitation.
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Affiliation(s)
- Sajan Koshy
- Division of Pediatric Cardiac Surgery, Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Center, Kochi, Cochin, Kerala 682026, India
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15
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Bol-Raap G, de Jong PL, Bogers AJ. Temporary tricuspid detachment in closure of ventricular septal defect. Ann Thorac Surg 2001; 71:1067. [PMID: 11269442 DOI: 10.1016/s0003-4975(00)02555-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Gaynor JW, O'Brien JE, Rychik J, Sanchez GR, DeCampli WM, Spray TL. Outcome following tricuspid valve detachment for ventricular septal defects closure. Eur J Cardiothorac Surg 2001; 19:279-82. [PMID: 11251266 DOI: 10.1016/s1010-7940(01)00577-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Detachment of the septal leaflet of the tricuspid valve from the annulus (TVD) has been used to improve visualization of ventricular septal defects (VSDs), but may be associated with increased operative time, heart block, and the development of tricuspid regurgitation (TR). METHODS Patients undergoing VSD closure between 1/1/96 and 31/12/99 were retrospectively reviewed. Follow-up was obtained from the patients' cardiologists. RESULTS Transatrial VSD closure was performed in 172 patients with TVD in 36 (21%) at the surgeon's discretion. The leaflet incision was repaired with a separate suture (22) or with the VSD patch suture (14). Additional procedures including arch augmentation, closure of atrial septal defects, and closure of additional VSDs were performed in 93 (68%) non-TVD patients and 20 (56%) TVD patients. The median age was 6.2 months (range 1 day to 46 years) and the median weight was 5.9 kg (range 1.5-71.5 kg). Cardiopulmonary bypass (CPB) time was 64+/-24 min and cross-clamp time was 34+/-16 min. One hospital death occurred in an infant with tracheal stenosis. No child in either group developed complete heart block. The median duration of postoperative stay was 4 days (range 2-49 days). There were no differences in CPB time, cross-clamp time or postoperative stay between the TVD and non-TVD groups (P>0.1 for all). At a mean follow-up of 17+/-15 months, there have been two late deaths unrelated to cardiac disease. No child in the TVD group required reoperation for residual VSD, compared to three in the non-TVD group. No child in the TVD group has greater than mild TR, but six in the non-TVD group have greater than mild TR. No child in either group has undergone reoperation for TR. CONCLUSIONS TVD is a safe, effective technique to improve visualization of VSD and is not associated with heart block, increased operative time, or TR. TVD may result in improved preservation of tricuspid valve architecture and decrease the incidence of significant postoperative TR.
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Affiliation(s)
- J W Gaynor
- Division of Pediatric Cardiothoracic Surgery, The Cardiac Center at The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, 19104, Philadelphia, PA, USA.
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17
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Kapoor L, Gan MD, Bandyhopadhyay A, Das MB, Chatterjee S. Improved exposure of isolated perimembranous ventricular septal defects. Ann Thorac Surg 2000; 69:291-2. [PMID: 10654544 DOI: 10.1016/s0003-4975(99)01224-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We describe an alternative step in the transatrial approach to the repair of ventricular septal defects. We temporarily detach the chorda of the obscuring tricuspid valve from its attachment to the septum to expose the ventricular septal defect.
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Affiliation(s)
- L Kapoor
- Department of Cardiac Surgery, B.M. Birla Heart Research Centre, Calcutta, India.
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18
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Tatebe S, Miyamura H, Watanabe H, Sugawara M, Eguchi S. Closure of isolated ventricular septal defect with detachment of the tricuspid valve. J Card Surg 1995; 10:564-8. [PMID: 7488779 DOI: 10.1111/j.1540-8191.1995.tb00633.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Detachment of the septal leaflet of the tricuspid valve is an alternative technique for obtaining complete visualization of a perimembranous ventricular septal defect (VSD) in cases where the VSD is obscured by the chordae tendineae or a pouch formation of the septal leaflet. This method presents theoretical concerns because it has the potential for causing postoperative valvular insufficiency. We therefore evaluated valvular function in patients who underwent VSD closure with detachment of the tricuspid valve. In a consecutive series of 153 patients who underwent VSD closure using a transatrial approach, 13 had incision of the tricuspid valve. Follow-up echocardiographic studies were performed on these patients at least 1 year following operation. There were no operative deaths. Color Doppler echocardiography revealed no residual shunt in any of these patients. Ten patients had no evidence of tricuspid stenosis or regurgitation. One patient had trivial tricuspid regurgitation. Moderate tricuspid regurgitation was observed in two patients of these, one patient was a small infant who had a VSD complicated by pulmonary hypertension. The other patient had a VSD with a mitral cleft, pulmonary hypertension, and Down's syndrome. The incised tricuspid valve was resuspended by solely running sutures. In conclusion, detachment of the tricuspid valve is a safe and useful method for adequate exposure of a VSD. However, this method should be avoided in patients with Down's syndrome and in small infants. Furthermore, repair of the incised valve should not be performed using only running sutures.
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Affiliation(s)
- S Tatebe
- Department of Thoracic and Cardiovascular Surgery, Niigata University School of Medicine, Japan
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