1
|
Huang LL, Chen M, Zeng DC, Su CX, Jiang CL, Zheng BS, Wu J, Li SK. Comparison of perventricular and percutaneous ultrasound-guided device closure of perimembranous ventricular septal defects. Front Cardiovasc Med 2023; 10:1281860. [PMID: 38028455 PMCID: PMC10657817 DOI: 10.3389/fcvm.2023.1281860] [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: 08/23/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background Ultrasound-guided percutaneous device closure of perimembranous ventricular septal defects (PmVSD) is a minimally invasive recent treatment approach. Perventricular PmVSD device closure is an emerging radiation-free intervention, yet it comes with certain limitations. No studies compared both of these treatment approaches. Methods We performed a retrospective institutional data comparison of percutaneous (PCP Group, n = 138) and perventricular (PVP Group, n = 67) ultrasound-guided device closure procedures in 205 patients with PmVSD between March 2017 and December 2022. Results Patients of the PCP and PVP groups had a median age of 4.9 years (IQR, 3.1-14.0) and 5.3 years (IQR, 3.4-13.1) respectively. The median PmVSD diameter in the PCP Group was 4.0 mm (IQR, 3.3-5.3) and 5.2 mm (IQR, 4.0-7.0) in the PVP Group (p = 0.001). There was no significant difference in success rates between the PCP and PVP Groups (intention-to-treat population, 88.4% vs. 92.5%, p = 0.36; as-treated population, 88.4% vs. 89.3%, p = 0.84). 5/8 failed percutaneous cases that were shifted to the perventricular approach were successful. Compared to the PVP Group, patients of the PCP group experienced a significant decrease in ventilation time, drainage volume, and postoperative hospital stay (p < 0.001). The median follow-up period was 24 months (IQR, 6-42) for the PCP group and 61 months (IQR, 53-65) for the PVP group. The overall severe adverse event rate was 0% in the PCP group and 3.0% in the PVP group. Conclusions Perventricular and percutaneous ultrasound-guided device closure of PmVSD are both effective and safe treatment options. The percutaneous approach offers less trauma and faster recovery and may be the preferred approach in selected patients.
Collapse
Affiliation(s)
- Liu Liu Huang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Mai Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - De Cai Zeng
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chun Xiao Su
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chun Lan Jiang
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bao Shi Zheng
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ji Wu
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shi Kang Li
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
2
|
Song S, Shao Z, Liang W, Dong H, Li B, Zhao L, Li M, Fan T. Peratrial device closure of perimembranous ventricular septal defects via a small right subaxillary incision: Midterm results in patients <12 months of age. Int J Cardiol 2023; 372:50-54. [PMID: 36460210 DOI: 10.1016/j.ijcard.2022.11.060] [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] [Received: 07/25/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Both percutaneous and perventricular device closures of perimembranous ventricular septal defects (Pm-VSDs) are alternatives to surgical procedures,but they all present certain drawbacks. OBJECTIVE To report our clinical experiences and midterm follow-up results of minimally invasive peratrial device closure of Pm-VSDs under the guidance of transesophageal echocardiography(TEE) in patients <12 months of age. METHODS Between January 2015 and December 2020,268 patients <12 months of age with Pm-VSDs underwent peratrial device closure in our institute. The procedure was performed under TEE guidance via a small right subaxillary incision. The delivery pathways is established by manipulating the hollow probe, and then the device is installed. RESULTS A total of 263 cases (98.1%) underwent successful closure, whereas five cases failed and were converted to cardiopulmonary bypass operation via the original incision during the procedure. The mean age was 9.5 ± 2.0 months and the mean body weight was 8.8 ± 1.4 kg. The mean diameter of the VSD was 4.4 ± 0.5 mm. One patient (0.4%) underwent a second thoracotomy for postoperative intercostal hemorrhage on the second day after surgery. The mean diameter of the occluder size was 5.5 ± 0.6 mm. During the follow-up (4.3 ± 1.4 y), there was no mortality, no new aortic valve regurgitation and atrioventricular block. CONCLUSION Peratrial device closure of Pm-VSDs via the right subaxillary route under TEE guidance is safe and effective at midterm follow-up, confirming this is an valuable alternative method for patients <12 months of age.
Collapse
Affiliation(s)
- Shubo Song
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Zehua Shao
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Weijie Liang
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Haoju Dong
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Bin Li
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Liyun Zhao
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Menghao Li
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Taibing Fan
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China.
| |
Collapse
|
3
|
Yu J, Shi Z, Qian J, Ma L, Zhang B, Ying L, Shu Q. Analysis and comparison of failure causes of minimally invasive surgical closure of ventricular septal defects in children. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000432. [PMID: 36817712 PMCID: PMC9933489 DOI: 10.1136/wjps-2022-000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 12/26/2022] [Indexed: 02/04/2023] Open
Abstract
Objectives The aims of the present study were to explore the causes of minimally invasive surgical ventricular septal defect (VSD) closure failure under transesophageal echocardiography guidance and thus to improve the success rate of surgical VSD closure. Methods From January 2015 to December 2019, 522 children with VSD underwent minimally invasive surgical closure. Nineteen procedures (3.64%) were unsuccessful. The failure causes, VSD locations and surgical incision approaches were retrospectively analyzed. Results Among the 19 patients (3.64%) with unsuccessful outcomes, 18 were switched to cardiopulmonary bypass (CPB) surgery, and 1 was closed successfully using an occlusion device a year later. The causes of failure included occlusion device shedding or shifting (n=6), failure of the guidewire (or the sheath) to pass through a small defect (n=5), device-related valve regurgitation (n=4), significant residual shunt (n=2), ventricular fibrillation (n=1), and continuous sharp blood pressure decreases (n=1). Patients with high VSD had a slightly higher failure rate than those with perimembranous VSD (p=0.049), and its key reason is the high proportion of occlusion device shedding or shifting (p=0.001). No significant difference in the failure rate was found between patients with different surgical incision approaches. Conclusions Minimally invasive surgery has a high success rate for perimembranous VSDs. Occlusion device shedding or shifting is the most common cause of failure. The shedding or shifting risk of eccentric occlusion devices being used only for high VSDs is much greater than that of concentric occlusion devices being used for perimembranous VSDs, which increases the risk of conversion to CPB surgery for high VSDs.
Collapse
Affiliation(s)
- Jin Yu
- Department of Ultrasound Diagnosis, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China,Department of Pediatric Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhuo Shi
- Department of Pediatric Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China,Department of Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jingjing Qian
- Department of Ultrasound Diagnosis, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China,Department of Pediatric Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lianglong Ma
- Department of Pediatric Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China,Department of Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Baofu Zhang
- Department of Ultrasound Diagnosis, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Liyang Ying
- Department of Pediatric Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China,Department of Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qiang Shu
- Department of Pediatric Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| |
Collapse
|
4
|
Song S, Shao Z, Fan T, Li B, Liang W, Dong H, Wu K, Hu M, Han Y, Cui C. Favorable mid-term performance of fully biodegradable implantable device for ventricular septal defect closure. JTCVS Tech 2022; 17:133-137. [PMID: 36820343 PMCID: PMC9938384 DOI: 10.1016/j.xjtc.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/22/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives To assess the mid-term safety and efficacy of transthoracic perimembranous ventricular septal defect (Pm-VSD) closure using a new biodegradable device. Implantation entailed right subaxillary minithoracotomy under transesophageal echocardiography guidance. Methods Between October 2019 and January 2020, 13 patients (males, 5; mean age, 3.6 ± 2.5 years) with Pm-VSDs underwent transthoracic device closures at Zhengzhou University Central China Fuwai Hospital as described previously. Delivery pathways were established by manipulating a hollow probe from right atrium through tricuspid valve to right ventricle and then through VSDs to left ventricle, whereupon installation took place. Results All occluder implantations were successfully executed. Mean defect size was 4.1 ± 1.0 mm, and mean device waist size was 5.2 ± 1.1 mm. One patient (7.7%) with 1.5-mm residual shunt showed complete closure at discharge. There was 1 instance of postoperative incomplete right bundle branch block, which converted to complete right bundle branch block at month 1. During patient follow-up (mean, 24.6 ± 0.8 months), no device dislocations, new residual shunts, new valvular regurgitation, or detectable atrioventricular block ensued. Conclusions Closure of Pm-VSDs using a novel, fully biodegradable occluder in the manner described has proven safe and effective at mid-term follow-up. Long-term safety and efficacy of this device must be further corroborated in a large patient cohort going forward.
Collapse
Affiliation(s)
- Shubo Song
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Zehua Shao
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Taibing Fan
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China,Address for reprints: Taibing Fan, Prof, Department of Children's Heart Center, Zhengzhou University People's Hospital, No. 7 Weiwu Rd, Zhengzhou 450000, China.
| | - Bin Li
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Weijie Liang
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Haoju Dong
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Kaiyuan Wu
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Manman Hu
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Yu Han
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Cunying Cui
- Department of Ultrasound, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| |
Collapse
|
5
|
Liu Z, Yang J, Chen Y. The Chinese Experience of Imaging in Cardiac Intervention: A Bird's Eye Review. J Thorac Imaging 2022; 37:374-384. [PMID: 36162061 DOI: 10.1097/rti.0000000000000680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recent scientific and technological advances have greatly contributed to the development of medical imaging that could enable specific functions. It has become the primary focus of cardiac intervention in preoperative assessment, intraoperative guidance, and postoperative follow-up. This review provides a contemporary overview of the Chinese experience of imaging in cardiac intervention in recent years.
Collapse
Affiliation(s)
- Zinuan Liu
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital
- Medical School of Chinese PLA, Beijing, P.R. China
| | - Junjie Yang
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital
| | - Yundai Chen
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital
| |
Collapse
|
6
|
Yu J, Ye J, Zhang Z, Yang X, Ma L, Qian J, Zhao L, Qiang S. Value of transesophageal echocardiography in device closure of perimembranous ventricular septal defects in children via ultra‐minimal trans intercostal incision. J Card Surg 2022; 37:1171-1179. [PMID: 35188288 DOI: 10.1111/jocs.16311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/21/2021] [Accepted: 12/07/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Jin Yu
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Ultrasound Diagnosis, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Jingjing Ye
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Ultrasound Diagnosis, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Zewei Zhang
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Xiuzhen Yang
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Ultrasound Diagnosis, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Lianglong Ma
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Jingjing Qian
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Ultrasound Diagnosis, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Lei Zhao
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Ultrasound Diagnosis, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Shu Qiang
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| |
Collapse
|
7
|
Incision Choice for Transthoracic Device Closure of Ventricular Septal Defect: Reply. Ann Thorac Surg 2020; 111:1739. [PMID: 33217394 DOI: 10.1016/j.athoracsur.2020.08.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 08/20/2020] [Indexed: 11/21/2022]
|
8
|
Value of echocardiography for mini-invasive per-atrial closure of perimembranous ventricular septal defect. Int J Cardiovasc Imaging 2020; 37:117-124. [PMID: 32803483 DOI: 10.1007/s10554-020-01967-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to assess the value of echocardiography for intraoperative guidance during closure of perimembranous ventricular septal defects (pmVSD) and to assess outcomes of these patients. We identified and assessed 78 patients who underwent 2- and 3-dimensional echocardiography-guided mini-invasive per-atrial closure of pmVSD in the cardiac surgery department of our institution, from February 2016 to August 2018, and 76 patients who underwent transcatheter closure of VSD guided by fluoroscopy at the pediatric department (percutaneous control group). All the patients underwent echocardiography. Their clinical data were retrospectively reviewed and analyzed. All patients were followed up using transthoracic echocardiography (TTE) for a maximum of 24 months after the closure. All patients underwent successful device implantation. Echocardiography showed that the major immediate complications included residual shunt, pericardial effusion, and tricuspid regurgitation in the per-atrial group. During the mid-term follow-up period, TTE revealed that the most common complication was tricuspid regurgitation (non-preexisting). There were no cases of VSD recurrence, device displacement, valvular injury, malignant arrhythmias, hemolysis, or death. Moreover, according to the TTE data, the intracardiac structure of the patients were improved. Compared to the control group, the intracardiac manipulation time was shorter and the number of patients with residual shunts, redeployment of devices, or immediate new tricuspid regurgitations was fewer when using 2- and 3-dimensional echocardiography. However, the procedure time in the per-atrial group was slightly longer than that in the control group. Two- and 3-dimensional echocardiography are feasible monitoring tools during mini-invasive per-atrial VSD closure. The short- and mid-term follow-up showed satisfactory results compared to fluoroscopy.
Collapse
|
9
|
Wang S, Ouyang W, Liu Y, Zhang F, Guo G, Zhao G, Pan X. Transcatheter perimembranous ventricular septal defect closure under transthoracic echocardiographic guidance without fluoroscopy. J Thorac Dis 2018; 10:5222-5231. [PMID: 30416769 DOI: 10.21037/jtd.2018.08.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Transcatheter device closure has become an alternative therapy for ventricular septal defect (VSD). This study aimed to investigate the feasibility and safety of transcatheter perimembranous VSD (pm-VSD) closure under transthoracic echocardiography (TTE) guidance alone. Methods Between October 2012 and July 2016, 118 patients with pm-VSD underwent an attempt of transcatheter device closure for pm-VSD through the femoral artery under TTE guidance alone. Patients were followed-up at 1, 3, 6, and 12 months after the procedure and yearly after discharge. Results The mean age was 11.7±12.5 years (range, 1.0-53.0 years) and the mean body weight was 32.2±21.6 kg (range, 11.5-102.0 kg). The mean diameter of the VSD was 4.0±1.1 mm (range, 3.0-8.0 mm). Transcatheter device closure under TTE guidance alone was successful in 111 patients. The average procedural time was 44.9±7.3 minutes (range, 29.0-65.0 minutes). All 111 patients were followed-up for 3.4±2.3 years. At the last follow-up, two patients had a residual shunt smaller than 2 mm, seven patients had right bundle branch block (RBBB) including one patient with complete RBBB, six patients had mild or less tricuspid regurgitation, and two patients still had trivial aortic regurgitation including one patient that had it before the procedure. Occluder malposition, complete atrioventricular block, or other complications were not observed. Conclusions Transcatheter pm-VSD closure can be successfully performed under TTE guidance alone with outcomes similar to those achieved with fluoroscopic guidance in selected patients with weight more than 10 kg and VSD smaller than 8 mm. However, long-term follow-up in a large number of patients would be necessary.
Collapse
Affiliation(s)
- Shouzheng Wang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Wenbin Ouyang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Yao Liu
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Fengwen Zhang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Gaili Guo
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Guangzhi Zhao
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Xiangbin Pan
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| |
Collapse
|
10
|
Chen Q, Qiu HF, Zhang GC, Chen LW. Intraoperative Device Closure of a Perimembranous Ventricular Septal Defect Using the Right Thoracic Ventricle Approach. Ann Thorac Surg 2018; 107:817-822. [PMID: 30312613 DOI: 10.1016/j.athoracsur.2018.08.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/14/2018] [Accepted: 08/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study compared the safety and effectiveness of intraoperative device closure of a perimembranous ventricular septal defect (pmVSD) using the right thoracic minimal incision to right ventricle and lower midline sternotomy to right ventricle approaches. METHODS We retrospectively analyzed the clinical data of 46 patients who underwent intraoperative device closure of a pmVSD through the right thoracic minimal incision to right ventricle route (group 1) and 52 patients who underwent intraoperative device closure of a pmVSD through a minimal incision in the lower sternum (group 2) at our hospital from March 2016 to March 2017. In group 1, a right thoracic minimal incision to the fourth intercostal space was used to establish a delivery system through the right ventricle to complete pmVSD closure. RESULTS In group 1, intraoperative device closure of the pmVSD was successful in 44 patients and was converted to open surgery in 2 patients (a delivery system could not be established in the one, and a significant residual shunt was present in the other). In group 2, the corresponding numbers of patients were 50 and 2, respectively. Neither group exhibited serious adverse effects, including dislocation of the occluder, third-degree atrioventricular block, or new onset of aortic valve regurgitation during the perioperative period or during a median follow-up period of 1 to 2 years. CONCLUSIONS Intraoperative device closure of a pmVSD through the right thoracic minimal incision to right ventricle approach is safe and effective. This procedure can avoid some of the shortcomings caused by sternotomy, uses an incision with an improved cosmetic appearance, and is worth recommendation.
Collapse
Affiliation(s)
- Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Han-Fan Qiu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.
| | - Gui-Can Zhang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| |
Collapse
|
11
|
Lei Q, Wei XC, Huang KL, Yu T, Zhang XS, Huang HL, Guo HM. Intraoperative Implantation of Temporary Endocardial Pacing Catheter During Thoracoscopic Redo Tricuspid Surgery. Heart Lung Circ 2018; 28:1121-1126. [PMID: 31178024 DOI: 10.1016/j.hlc.2018.06.1041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 04/09/2018] [Accepted: 06/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The placement of a temporary epicardial pacing wire is a challenge during a minimally invasive redo cardiac operation. The aim of this study is to assess the application of temporary endocardial pacing in patients who underwent minimally invasive redo tricuspid surgery. METHODS Perioperative data of consecutive patients who underwent thoracoscopic redo tricuspid surgery were collected. All the tricuspid surgeries and combined procedures were performed under peripheral cardiopulmonary bypass without aortic cross-clamping. A sheath was introduced into the right jugular vein beside the percutaneous superior vena cava cannula and a temporary endocardial pacing catheter was guided into the right ventricle via the sheath prior to the right atrial closure. The pacemaker was connected and run as needed during or after operation. RESULTS A total of 33 patients who underwent thoracoscopic redo tricuspid surgery were enrolled. Symptomatic tricuspid valve regurgitation (93.9%) and tricuspid valvular prosthesis obstruction (6.1%) after previous cardiac operations were noted as indications for a redo surgery. The mean time from previous cardiac operation to this time redo surgery was 13.3±6.4years. Isolated tricuspid valve replacement was performed in 18 patients (54.5%) and tricuspid valve plasty combined with or without mitral valve replacement was performed in 15 patients (45.5%). A temporary endocardial pacing catheter was successfully placed in the right ventricle for all patients with good sensing and pacing. No temporary pacing related complications occurred from insertion to removal of pacing catheter in the patients. CONCLUSIONS This application of temporary endocardial pacing provided a safe and effective substitute for epicardial pacing in patients who underwent minimally invasive redo tricuspid surgery.
Collapse
Affiliation(s)
- Qian Lei
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
| | - Xin-Chuan Wei
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Ke-Li Huang
- Department of Cardiac Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Tao Yu
- Department of Cardiac Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Xiao-Shen Zhang
- Department of Cardiac Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Huan-Lei Huang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Hui-Ming Guo
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| |
Collapse
|
12
|
Invited Commentary. Ann Thorac Surg 2016; 103:204-205. [PMID: 28007237 DOI: 10.1016/j.athoracsur.2016.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 07/12/2016] [Accepted: 07/15/2016] [Indexed: 10/20/2022]
|