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Wadile S, Kondgekar D, Banpurkar AM, Raeen SP, Kulkarni K, Kulkarni S. How do Age at the Surgery and Birth Weight Influence Post-Operative Anthropometric Parameters in Infants with Surgical Closure of Large Ventricular Septal Defects? A Prospective Cohort Study from a Lower-Middle-Income Country. Pediatr Cardiol 2024:10.1007/s00246-024-03486-w. [PMID: 38635040 DOI: 10.1007/s00246-024-03486-w] [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: 01/07/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
Closure of the large ventricular septal defects (VSD) in infancy can lead to normalization of growth, but data are limited. Our study is done to assess the growth pattern in different age groups of children and lower birth weight babies after shunt closure. This is a prospective observational study that included infants with isolated large VSD operated in infancy. Anthropometric data were collected at baseline and at follow-up, and growth patterns were analyzed. 99 infants were included in the study. The mean age and weight at the time of surgery were 6.97 ± 2.79 months and 5.07 ± 1.16 kg, respectively. The mean follow-up duration was 8.99 ± 2.31 months. The weight for age (W/A) was the most adversely affected parameter preoperatively, and there was significant improvement noted in the mean Z score for W/A after shunt closure (- 3.67 ± 1.18 vs. - 1.76 ± 1.14, p = 0.0012). There was improvement in Z-scores for length for age (L/A) and weight for length (W/L), although it was not statistically significant. The infants from all the age groups had statistically significant growth in the anthropometric parameters. The rate of weight gain was maximum in the infants operated below 8 months of age (2-4 months = 3588 g, 5-6 months = 3592 g, 7-8 months = 3606 g, 9-10 months = 2590 g, 11-12 months = 2250 g). Low birth weight and normal birth weight infants had similar Z-scores at the time of surgery and at follow-up in all 3 anthropometric parameters, and birth weight did not affect pre- as well as post-operative growth parameters. Suboptimal improvement in weight and length was seen in 40 and 20% of babies even after successful surgical repair, respectively. Growth failure in infants with a large VSD can be multifactorial. Early surgical closure of the shunt can lead to early normalization of growth parameters and faster catch-up growth. Few babies may fail to demonstrate a positive growth response even after timely surgical correction, and may be related to intrauterine and genetic factors or faulty feeding habits.
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Affiliation(s)
- Santosh Wadile
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, Maharashtra, 410210, India
| | - Divya Kondgekar
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, Maharashtra, 410210, India
| | - Ashishkumar Moreshwar Banpurkar
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, Maharashtra, 410210, India
| | - Shahena Parveen Raeen
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, Maharashtra, 410210, India
| | - Komal Kulkarni
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, Maharashtra, 410210, India
| | - Snehal Kulkarni
- Head of Department of Paediatric Cardiology and Mentor, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, Maharashtra, 410210, India.
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Ogdon TL, Loomba RS, Penk JS. Reduced length of stay after implementation of a clinical pathway following repair of ventricular septal defect. Cardiol Young 2024; 34:101-104. [PMID: 37226503 DOI: 10.1017/s1047951123001245] [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: 05/26/2023]
Abstract
BACKGROUND There is variation in care and hospital length of stay following surgical repair of ventricular septal defects. The use of clinical pathways in a variety of paediatric care settings has been shown to reduce practice variability and overall length of stay without increasing the rate of adverse events. METHODS A clinical pathway was created and used to guide care following surgical repair of ventricular septal defects. A retrospective review was done to compare patients two years prior and three years after the pathway was implemented. RESULTS There were 23 pre-pathway patients and 25 pathway patients. Demographic characteristics were similar between groups. Univariate analysis demonstrated a significantly shorter time to initiation of enteral intake in the pathway patients (median time to first enteral intake after cardiac ICU admission was 360 minutes in pre-pathway patients and 180 minutes in pathway patients, p < 0.01). Multivariate regression analyses demonstrated that the pathway use was independently associated with a decrease in time to first enteral intake (-203 minutes), hospital length of stay (-23.1 hours), and cardiac ICU length of stay (-20.5 hours). No adverse events were associated with the use of the pathway, including mortality, reintubation rate, acute kidney injury, increased bleeding from chest tube, or readmissions. CONCLUSIONS The use of the clinical pathway improved time to initiation of enteral intake and decreased length of hospital stay. Surgery-specific pathways may decrease variability in care while also improving quality metrics.
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Affiliation(s)
- Tracey L Ogdon
- Pediatric Cardiac Intensive Care Unit, Advocate Children's Hospital, Oak Lawn, IL 60453, USA
| | - Rohit S Loomba
- Pediatric Cardiac Intensive Care Unit, Advocate Children's Hospital, Oak Lawn, IL 60453, USA
| | - Jamie S Penk
- Cardiac Care Unit, Anne and Robert H., Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
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Danford DA, Yetman AT, Haynatzki G. Derivation and Validation of a General Predictive Model for Long Term Risks for Mortality and Invasive Interventions in Congenital and Acquired Cardiac Conditions Encountered in the Young. Pediatr Cardiol 2023; 44:1763-1777. [PMID: 37069273 DOI: 10.1007/s00246-023-03154-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
Accurate prognostic assessment is a key driver of clinical decision making in heart disease in the young (HDY). This investigation aims to derive, validate, and calibrate multivariable predictive models for time to surgical or catheter-mediated intervention (INT) and for time to death in HDY. 4108 unique subjects were prospectively and consecutively enrolled, and randomized to derivation and validation cohorts. Total follow-up was 26,578 patient-years, with 102 deaths and 868 INTs. Accelerated failure time multivariable predictive models for the outcomes, based on primary and secondary diagnoses, pathophysiologic severity, age, sex, genetic comorbidities, and prior interventional history, were derived using piecewise exponential methodology. Model predictions were validated, calibrated, and evaluated for sensitivity to changes in the independent variables. Model validity was excellent for predicting mortality and INT at 4 months, 1, 5, 10, and 22 years (areas under receiver operating characteristic curves 0.813-0.915). Model calibration was better for INT than for mortality. Age, sex, and genetic comorbidities were significant independent factors, but predicted outcomes were most sensitive to variations in composite predictors incorporating primary diagnosis, pathophysiologic severity, secondary diagnosis, and prior intervention. Despite 22 years of data acquisition, no significant cohort effects were identified in which predicted mortality and intervention varied by study entry date. A piecewise exponential model predicting survival and freedom from INT is derived which demonstrates excellent validity, and performs well on a clinical sample of HDY outpatients. Objective model-based predictions could educate both patient and provider, and inform clinical decision making in HDY.
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Affiliation(s)
- David A Danford
- University of Nebraska Medical Center, Omaha, NE, USA.
- Criss Heart Center at Children's Hospital and Medical Center, Omaha, NE, USA.
- , 804 S. 129th Ave, Omaha, NE, 68154, USA.
| | - Anji T Yetman
- University of Nebraska Medical Center, Omaha, NE, USA
- Criss Heart Center at Children's Hospital and Medical Center, Omaha, NE, USA
| | - Gleb Haynatzki
- School of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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Abdelrehim AR, Al-Muhaya M, Alkodami AA, Baangood LS, Al-Mutairi M, Quadeer A, Alabsi FA, Alashwal M, Morsy MMF, Alnajjar AA, Salem SS. Predictors of major adverse events and complications after ventricular septal defects surgical closure in children less than 10 kg. J Cardiothorac Surg 2022; 17:232. [PMID: 36071526 PMCID: PMC9450295 DOI: 10.1186/s13019-022-01985-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Ventricular septal defect (VSD) is the most common congenital cardiac defect for which outcomes are not uniform. There is a lack of consensus on the risk factors for the unfavorable outcomes following surgical VSD closure. Aim The aim of this study was to determine the risk factors and the predictors of major adverse events (MAEs) and complications following surgical closure of VSD in children weighing less than 10 kg. Methods This retrospective cohort study included children less than 10 kg who underwent surgical closure of congenital VSD of any type with or without associated congenital heart diseases. Patients with associated major cardiac anomalies were excluded. Preoperative, operative and postoperative data were collected from medical records. Results This study included 127 patients 52.8% were males, the median age was 8.0 months (IQR = 6.0–11.0 months), and their median weight was 5.7 kg (IQR = 4.8–7.0). Mortality was in one patient (0.8%) Multivariable logistic regression analysis revealed that male sex group (observational data), previous pulmonary artery banding (PAB), and significant intraoperative residual VSD were significant risk factors for the development of MAEs (odds ratios were 3.398, 14.282, and 8.634, respectively). Trisomy 21 syndrome (odds ratio: 5.678) contributed significantly to prolonged ventilation. Pulmonary artery banding (odds ratio: 14.415), significant intraoperative (3 mm) residual VSD (odds ratio: 11.262), and long cross-clamp time (odds ratio: 1.064) were significant predictors of prolonged ICU stay, whereas prolonged hospital stay was observed significantly in male sex group (odds ratio: 12.8281), PAB (odds ratio: 2.669), and significant intraoperative (3 mm) residual VSD (odds ratio: 19.551). Conclusions Surgical VSD repair is considered a safe procedure with very low mortality. Trisomy 21 was a significant risk factor for prolonged ventilation. Further, PAB, significant intraoperative residual of 3 mm or more that required a second pulmonary bypass, and a greater cross-clamp time were significant predictors of MAE and associated complications with prolonged ICU and hospital stay.
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Affiliation(s)
- Ayman R Abdelrehim
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia. .,Cardiothoracic Surgery Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt.
| | - Mustafa Al-Muhaya
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Alassal A Alkodami
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Luna S Baangood
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Mansour Al-Mutairi
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Abdul Quadeer
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Fath A Alabsi
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - M Alashwal
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Mohamed Mofeed F Morsy
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia.,Pediatric Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | | | - Sherif S Salem
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia.,Pediatric Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt
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Lotto AA. Children Presenting Late with Ventricular Septal Defect and Pulmonary Hypertension: "Prevention is better than cure" (Desiderius Erasmus 1500 Circa). Eur J Cardiothorac Surg 2022; 62:6687128. [PMID: 36053208 DOI: 10.1093/ejcts/ezac433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Attilio A Lotto
- Cardiac surgery Services, Alder Hey Children Hospital, Liverpool, UK.,Faculty of Health, Liverpool John Moores University, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
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Patel M, Patel K, Gajjar T. Subpulmonary pseudoaneurysm-a rare complication following surgical ventricular septal defect closure. Indian J Thorac Cardiovasc Surg 2022; 38:525-529. [PMID: 36050979 PMCID: PMC9424435 DOI: 10.1007/s12055-022-01366-7] [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: 03/10/2022] [Revised: 04/05/2022] [Accepted: 04/18/2022] [Indexed: 10/18/2022] Open
Abstract
In this report, we describe the surgical management of a subpulmonary pseudoaneurysm following surgical closure of ventricular septal defect in an infant. Diagnosis, pathogenesis, and surgical considerations for management of this complication are discussed.
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Affiliation(s)
- Mrinal Patel
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, (Affiliated to B. J. Medical College), New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Kartik Patel
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, (Affiliated to B. J. Medical College), New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Trushar Gajjar
- Department of Pediatric Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, (Affiliated to B. J. Medical College), New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
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Lin L, Liu J, Guo X, Chen H, Huang Y, Zheng H, Chen W, Chen L, Chen L, Chen Z. Risk factors for atrioventricular block after occlusion for perimembranous ventricular septal defect. Heart Rhythm 2021; 19:389-396. [PMID: 34843969 DOI: 10.1016/j.hrthm.2021.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The risk factors for complete atrioventricular block (CAVB) after device closure of perimembranous ventricular septal defect (pmVSD) remain unclear. OBJECTIVE The purpose of this study was to analyze the incidence and risk factors for CAVB after device closure for pmVSD. METHODS We reviewed 1884 patients with pmVSD who had undergone successful device occlusion between June 2005 and January 2020. Permanent CAVB was defined as CAVB requiring implantation of a permanent pacemaker (PPM) or extraction of the occluder. RESULTS In total, 14 patients (0.7%) developed permanent CAVB. Of these patients, 10 (0.5%) required PPM implantation. Four permanent CAVB occurred within 7 days after the procedure (acute), 2 between 7 and 30 days (subacute), 3 between 30 days and 1 year (late), and 5 more than 1 year (very late). None of the subacute, late, and very late CAVB recovered normal conduction with medication and eventually required device removal or PPM implantation. Four patients with acute CAVB and 1 with subacute CAVB underwent device removal, and 4 (80%) recovered normal conduction. Multivariate regression revealed that the ratio of device to defect size was the only independent risk factor for permanent CAVB (odds ratio 3.027; 95% confidence interval 1.476-6.209; P = .003). CONCLUSION The incidences of permanent CAVB after occlusion for pmVSD and PPM implantation were 0.7% and 0.5%, respectively. The ratio of device to defect size was the only independent risk factor for permanent CAVB. Device removal is an effective therapeutic modality for recovering normal conduction in acute and subacute CAVB patients.
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Affiliation(s)
- Li Lin
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Jianwen Liu
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Xiufen Guo
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Hang Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Yu Huang
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Huiying Zheng
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Wanhua Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Lianglong Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Liangwan Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Zhaoyang Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China.
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Long-term surgical outcomes after repair of multiple ventricular septal defects in pediatrics. THE CARDIOTHORACIC SURGEON 2021. [DOI: 10.1186/s43057-021-00058-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Surgical closure of multiple ventricular septal defects (VSDs) is challenging and associated with a high complication rate. Several factors may affect the outcomes after surgical repair of multiple VSDs. We aimed to report the outcomes after surgical repair of multiple VSDs before and after 1 year and identify the factors affecting the outcomes. We have studied forty-eight patients between 2016 and 2017 who had surgical repair of multiple VSDs. We grouped them according to the age at the time of repair. Study outcomes were hospital complications, prolonged hospital stay, and reoperation.
Results
There were 18 females (60%) in group 1 and 13 (72.22%) in group 2 (P = 0.39). There were no differences in the operative outcomes between the groups. Prolonged postoperative stay was associated with group 1 (OR 0.23 (0.055–0.96); P = 0.04) and lower body weight (OR 0.76 (0.59–0.97); P = 0.03). Hospital mortality occurred in 2 patients (6.67%) in group 1 and 1 patient (5.56%) in group 2 (P > 0.99). Five patients had reoperations: two for residual VSDs, two for subaortic membrane resection, and one for epicardial pacemaker implantation. All reoperations occurred in group 1 (log-rank P = 0.08). Two patients had transcatheter closure of the residual muscular VSDs; both were in group 2.
Conclusions
Surgical repair of multiple VSDs was associated with good hospital outcomes. The outcomes were comparable in patients younger or older than 1 year of age. Young age at repair could lead to prolonged postoperative stay and a higher reoperation rate.
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Pillai MN, Suneel PR, Menon S, Unnikrishnan KP, Baruah SD, Mathew T, Lovhale SP, Dharan BS. Intraoperative Three-dimensional Imaging of Ventricular Septal Defects in Children Using Epicardial Echocardiography: A Novel Approach. J Cardiothorac Vasc Anesth 2021; 35:2892-2899. [DOI: 10.1053/j.jvca.2020.10.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 11/11/2022]
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10
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Lee JH, Cho S, Kwak JG, Kwon HW, Kwak Y, Min J, Kim WH, Lee JR. Tricuspid valve detachment for ventricular septal defect closure in infants <5 kg: should we be hesitant? Eur J Cardiothorac Surg 2021; 60:544-551. [PMID: 33787866 DOI: 10.1093/ejcts/ezab113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES We compared the clinical outcomes between tricuspid valve detachment (TVD) and non-TVD for ventricular septal defect (VSD) closure in infants <5 kg. METHODS From January 2004 to April 2020, 462 infants <5 kg with VSD without more complex intracardiac lesions and who had undergone VSD closure through the trans-atrial approach were enrolled. Propensity score-matching analysis was performed. Clinical outcomes were compared between the paired TVD group (group D) and paired non-TVD group (group N). RESULTS The median age and body weight at operation were 1.9 months [interquartile range(IQR), 1.4-2.5] and 4.2 kg (IQR, 3.7-4.6). The median follow-up duration was 83.4 months (IQR, 43.5-130.4). After matching, 44 pairs were extracted from each group. There were no significant differences in all-cause mortality (P = 0.176), reoperation (P = 0.172), postoperative morbidities, including residual VSD, aortic regurgitation, atrioventricular block and significant tricuspid regurgitation (TR) (P = 0.346) between group D and group N. However, group D showed significantly less TR progression during follow-up (P = 0.019). CONCLUSIONS In infants <5 kg, TVD can be a reasonable and valid option for successful VSD closure without morbidities, including TR progression if the indication exists.
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Affiliation(s)
- Jae Hong Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Hye Won Kwon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Yujin Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Jooncheol Min
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Jeong Ryul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
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Ren C, Wu C, Pan Z, Li Y. Minimally invasive closure of transthoracic ventricular septal defect: postoperative complications and risk factors. J Cardiothorac Surg 2021; 16:30. [PMID: 33741014 PMCID: PMC7980643 DOI: 10.1186/s13019-021-01415-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives To summarize and analyze the clinical characteristics of postoperative complications after minimally invasive closure of transthoracic ventricular septal defect, and to explore the risk factors for its occurrence. Methods Retrospectively analyzed the clinical data of 209 patients underwent transthoracic ventricular septal defect closure performed in the Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University from January 2018 to January 2020, obtained relevant clinical data from the electronic medical record system and summarized their postoperative complications. And used univariate logistics regression and multivariate logistics regression to analyze the risk factors of its occurrence. Results The postoperative hospital stay of 27 patients was longer than 9 days. Residual shunt occurred in 33 patients recently after operation. One patient underwent surgical treatment again because of mechanical hemolysis after the operation. Two patients were re-operated 1 month and 10 months after surgery because of persistent moderate to severe aortic regurgitation. After surgery, 3 patients underwent pericardiocentesis due to a large amount of pericardial effusion, and 2 patients developed a new atrioventricular block after the operation. No other serious adverse events occurred. Multivariate logistic regression analysis showed that the size of VSD defect (OR: 1.494, 95% Cl: 1.108–2.013, P value: 0.008) was related to long postoperative hospitalization. The residual shunt is related to the size of the occluder (OR: 1.452, 95%Cl: 1.164–1.810, P value: 0.001). In the univariate logistics regression analysis, no risk factors related to serious adverse events were found. Conclusions The minimally invasive closure of transthoracic ventricular septal defect is very effective, with no mortality and low incidence of serious adverse events after surgery. The size of the defect is related to the long postoperative hospitalization, and the size of the occluder is related to the residual shunt in the early postoperative period. No risk factors related to the occurrence of serious adverse events after the operation were found.
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Affiliation(s)
- Chunnian Ren
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, No.136, Zhongshan 2nd Road, Yuzhong Dis, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, P. R. China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, No.136, Zhongshan 2nd Road, Yuzhong Dis, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, P. R. China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, No.136, Zhongshan 2nd Road, Yuzhong Dis, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, P. R. China
| | - Yonggang Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, No.136, Zhongshan 2nd Road, Yuzhong Dis, P.R. China. .,Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, P.R. China. .,Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, P. R. China.
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12
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Analysis of factors associated with prolonged post-operative course after surgical repair of aortic coarctation. Cardiol Young 2021; 31:191-198. [PMID: 33140711 DOI: 10.1017/s1047951120003637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We sought to describe patient characteristics associated with prolonged post-operative length of stay in a contemporary cohort of infants who underwent isolated repair of aortic coarctation. METHODS We reviewed patients less than 1 year of age who underwent isolated repair of aortic coarctation at our institution from 2009 to 2016. Prolonged post-operative length of stay was defined as length of stay within the upper tertile for the cohort. Bivariate and multi-variable analyses were performed to determine independent risk factors for prolonged length of stay. RESULTS We reviewed 95 consecutive patients who underwent isolated repair of aortic coarctation, of whom 71 were neonates at the time of diagnosis. The median post-operative length of stay was 6.5 days. The upper tertile for post-operative length of stay was greater than 10 days; 32 patients within this tertile and 1 patient who died at 8.5 days after surgery were analysed as having prolonged post-operative length of stay. In a multi-variable analysis, pre-maturity (odds ratio: 3.5, 95% confidence interval: 1.2, 10.7), genetic anomalies (odds ratio: 4.7, 95% confidence interval: 1.2, 18), absence of pre-operative oral feeding (odds ratio: 7.4, 95% confidence interval: 2.4, 22.3), and 12-hour vasoactive-ventilation-renal score greater than 25 (odds ratio: 7.4, 95% confidence interval: 1.9, 29) were independently associated with prolonged length of stay. CONCLUSIONS In neonates and infants who underwent isolated repair of aortic coarctation, pre-maturity, genetic anomalies, lack of pre-operative oral feedings, and 12-hour vasoactive-ventilation-renal score more than 25 were independent risk factors for prolonged post-operative length of stay. Further study on the relationship between pre-operative oral feedings and post-operative length of stay should be pursued.
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Sun KP, Xu N, Huang ST, Chen LW, Cao H, Chen Q. Comparison of Health-Related Quality of Life in Adults Undergoing Transthoracic and Transcatheter Device Closure for Ventricular Septal Defects. Int Heart J 2020; 61:1212-1219. [PMID: 33191342 DOI: 10.1536/ihj.20-102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aims to compare and analyze the health-related quality of life (HRQoL) of adult patients with ventricular septal defects (VSDs) who underwent transthoracic or transcatheter device closure.The HRQoL data of 30 patients who underwent transthoracic device closure for VSDs and 30 who underwent transcatheter device closure for VSDs were retrospectively evaluated before and one year after the procedure. The Medical Outcomes Study 36-Item Short-Form (SF-36), the Hospital Anxiety and Depression Scale (HADS), and a self-designed questionnaire were used as evaluation tools.After treatment, both groups showed significant improvements in SF-36 and HADS scores. After comparing the two groups regarding the SF-36, there was a significant difference in the two dimensions of vitality and mental health. There were no statistically significant differences in the HADS-A and HADS-D scores between these two groups. The results of the self-designed questionnaire also showed that the subjective feedback of the two groups was roughly the same. In the process of exploring the influential factors, we found that the scores of patients on most dimensions of the SF-36 in the two groups showed a significantly negative trend with increasing age. In terms of HADS scores, patients in both groups showed a tendency toward increasing scores with age.The HRQoL of adult patients undergoing transthoracic and transcatheter device closure for VSDs was similar, and the HRQoL was affected by the patient's own condition, so it is necessary to pay more attention to patients after device closure.
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Affiliation(s)
- Kai-Peng Sun
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University
| | - Ning Xu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University
| | - Shu-Ting Huang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University
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14
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Maagaard M, Eckerström F, Boutrup N, Hjortdal VE. Functional Capacity Past Age 40 in Patients With Congenital Ventricular Septal Defects. J Am Heart Assoc 2020; 9:e015956. [PMID: 32962479 PMCID: PMC7792429 DOI: 10.1161/jaha.120.015956] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Ventricular septal defects (VSD), when treated correctly in childhood, are considered to have great prognoses, and the majority of patients are discharged from follow‐up when entering their teens. Young adults were previously found to have poorer functional capacity than healthy peers, but the question remains whether functional capacity degenerates further with age. Methods and Results A group of 30 patients with surgically closed VSDs (51±8 years) with 30 matched, healthy control participants (52±9 years) and a group of 30 patients with small unrepaired VSDs (55±12 years) and 30 matched control participants (55±10 years) underwent cardiopulmonary exercise testing using an incremental workload protocol and noninvasive gas measurement. Peak oxygen uptake was lower in participants with closed VSDs than matched controls (24±7 versus 34±9 mL/min per kg, P<0.01) and with unrepaired VSDs than matched controls (26±5 versus 32±8 mL/min per kg, P<0.01). Patients demonstrated lower oxygen uptake from exercise levels at 20% of maximal workload compared with respective control groups (P<0.01). Peak ventilation was lower in patients with surgically closed VSDs than control participants (1.0±0.3 versus 1.4±0.4 L/min per kg, P<0.01) but similar in patients with unrepaired VSDs and control participants (P=0.14). Exercise capacity was 29% lower in older patients with surgically closed VSDs than healthy peers, whereas younger patients with surgically closed VSDs previously demonstrated 18% lower capacity compared with peers. Older patients with unrepaired VSDs reached 21% lower exercise capacity, whereas younger patients with unrepaired VSDs previously demonstrated 17% lower oxygen uptake than healthy peers. Conclusions Patients with VSDs demonstrate poorer exercise capacity than healthy peers. The difference between patients and control participants increased with advancing age—and increased most in patients with operated VSDs—compared with previous findings in younger patients. Results warrant continuous follow‐up for these simple defects.
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Affiliation(s)
- Marie Maagaard
- Department of Cardiothoracic and Vascular Surgery Aarhus University Hospital Aarhus N Denmark.,Department of Clinical Medicine Aarhus University Aarhus N Denmark
| | - Filip Eckerström
- Department of Cardiothoracic and Vascular Surgery Aarhus University Hospital Aarhus N Denmark.,Department of Clinical Medicine Aarhus University Aarhus N Denmark
| | - Nicolai Boutrup
- Department of Cardiothoracic and Vascular Surgery Aarhus University Hospital Aarhus N Denmark.,Department of Clinical Medicine Aarhus University Aarhus N Denmark
| | - Vibeke E Hjortdal
- Department of Clinical Medicine Aarhus University Aarhus N Denmark.,Department of Clinical Medicine Copenhagen University Copenhagen Denmark
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15
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Abstract
Left-to-right shunts represent a significant portion of congenital heart disease. Such lesions are common in isolation, but are frequently seen in conjunction with other, often more complex, congenital heart disease. This review covers basic anatomy, physiology, physical examination findings, diagnosis and management for atrial septal defects, ventricular septal defects, and patent ductus arteriosa.
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Affiliation(s)
- Dale A Burkett
- Division of Pediatric Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado, 13123 East 16th Avenue, Aurora, CO, USA.
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16
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Zhang QL, Xu N, Huang ST, Chen Q, Cao H. Effect of using the WeChat platform on the perioperative health education of parents of children who underwent transthoracic device closure of VSDs. J Cardiothorac Surg 2020; 15:256. [PMID: 32933575 PMCID: PMC7493314 DOI: 10.1186/s13019-020-01282-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/01/2020] [Indexed: 11/18/2022] Open
Abstract
Objective To explore the effects of using the WeChat platform on the perioperative health education of parents of children who underwent transthoracic device closure of ventricular septal defects (VSDs). Methods Participants were divided into a WeChat group and a leaflet group. Responses to relevant questionnaires and clinical data were recorded and analyzed. Results Before the operation, the scores of the Caretaker Knowledge Questionnaire in the WeChat group were significantly higher than those in the leaflet group. The scores of PSQ-18 in the WeChat group were significantly higher than those in the leaflet group. All the children in the WeChat group were followed up 1 month after discharge, while four children in the leaflet group were lost to follow-up. The rate of attrition in the leaflet group was significantly higher than that in the WeChat group. For the postoperative complications, there was no significant difference between the two groups. Conclusion Perioperative health education for parents of children who undergo transthoracic device closure of VSDs through the WeChat platform can effectively enhance parents’ knowledge of care, improve parent satisfaction, which is an effective method to ensure convenient operation and reduce loss to follow-up.
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Affiliation(s)
- Qi-Liang Zhang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ning Xu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Shu-Ting Huang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China. .,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.
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17
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Bibevski S, Ruzmetov M, Mendoza L, Decker J, Vandale B, Jayakumar KA, Chan KC, Bove E, Scholl FG. The Destiny of Postoperative Residual Ventricular Septal Defects After Surgical Repair in Infants and Children. World J Pediatr Congenit Heart Surg 2020; 11:438-443. [PMID: 32645789 DOI: 10.1177/2150135120918537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Residual ventricular septal defects (rVSDs) of small size are commonly seen on transesophageal echocardiography after surgical repair. This study aimed to determine the destiny of rVSD found on intraoperative echocardiogram. METHODS Patients undergoing surgical repair of VSD as the primary procedure with available intraoperative and discharge echocardiograms between 2007 and 2017 were reviewed. Presence of an rVSD on intraoperative echo triggered review of discharge echo and of subsequent follow-up echocardiograms. RESULTS One hundred four patients were analyzed. The mean age and weight for the entire cohort were 1.4 ± 2.9 years (median, 5.4 months; range, 29 days to 14 years) and 8.8 ± 9.9 kg (median, 5.1 kg; range, 2.7-58 kg), respectively. Sixty (57%) patients had rVSD at discharge, with mean size of residual VSD of 1.38 ± 0.92 mm (mode, 0.6; median, 2.2 mm; range, 0.5-3.9 mm). The mean follow-up time was 3.7 ± 3.1 years (range, 1 month to 9.3 years). Among those with rVSD at discharge, a residual shunt persisted in 73% at one-month follow-up. On follow-up at three years postdischarge, of the 60 patients with early rVSD, 6 had a persistent rVSD (10%) with a mean diameter of 3.0 ± 0.8 mm (range, 2.4-3.9 mm). CONCLUSIONS Residual VSD after surgical repair is detected frequently on postoperative echocardiogram. The presence of rVSD was not associated with any preoperative, intraoperative, or postoperative factors. By three years of follow-up, only six patients continued to demonstrate rVSD with a mean diameter of 3 mm, suggesting that defects 3 mm or greater may be less likely to close spontaneously after three years.
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Affiliation(s)
- Steve Bibevski
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Mark Ruzmetov
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Laura Mendoza
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | | | - Breanna Vandale
- Division of Pediatric Cardiology, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Kaimal A Jayakumar
- Division of Pediatric Cardiology, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Kak Chen Chan
- Division of Pediatric Cardiology, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Edward Bove
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Frank G Scholl
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
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18
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Outcomes of infants and children undergoing surgical repair of ventricular septal defect: a review of the literature and implications for research with an emphasis on pulmonary artery hypertension. Cardiol Young 2020; 30:799-806. [PMID: 32431266 DOI: 10.1017/s1047951120001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pulmonary vascular disease resulting from CHDs may be the most preventable cause of pulmonary artery hypertension worldwide. Many children in developing countries still do not have access to early closure of clinically significant defects, and the long-term outcomes after corrective surgery remain unclear. Focused on long-term results after isolated ventricular septal defect repair, our review sought to determine the most effective medical therapy for the pre-operative management of elevated left-to-right shunts in patients with an isolated ventricular septal defect. METHODS We identified articles specific to the surgical repair of isolated ventricular septal defects. Specific parameters included the pathophysiology and pre-operative medical management of pulmonary over-circulation and outcomes. RESULTS Studies most commonly focused on histologic changes to the pulmonary vasculature and levels of thromboxanes, prostaglandins, nitric oxide, endothelin, and matrix metalloproteinases. Only 2/44 studies mentioned targeted pharmacologic management to any of these systems related to ventricular septal defect repair; no study offered evidence-based guidelines to manage pulmonary over-circulation with ventricular septal defects. Most studies with long-term data indicated a measurable frequency of pulmonary artery hypertension or diminished exercise capacity late after ventricular septal defect repair. CONCLUSION Long-term pulmonary vascular and respiratory changes can occur in children after ventricular septal defect repair. Research should be directed at providing an evidenced-based approach to the medical management of infants and children with ventricular septal defects (and naturally all CHDs) to minimise consequences of pulmonary artery hypertension, particularly as defect repair may occur late in underprivileged societies.
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19
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Lin ZW, Huang ST, Xu N, Cao H, Chen Q. Parents' knowledge and attitudes regarding transthoracic device closure of VSD in children: a cross-sectional study. J Cardiothorac Surg 2020; 15:75. [PMID: 32381035 PMCID: PMC7206819 DOI: 10.1186/s13019-020-01124-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/28/2020] [Indexed: 12/04/2022] Open
Abstract
Objectives This study aimed to identify Chinese parents’ knowledge and attitudes toward transthoracic device closure of ventricular septal defect (VSD). Methods This cross-sectional study collected data on a total of 203 Chinese parents of patients with VSD were included, and an author-designed three-page questionnaire was used. Results A total of 73.9% of the parents had heard of transthoracic device closure of VSD; however, they lacked detailed knowledge. 88.2% parents expressed their willingness to undergo this procedure. Although there was no significant correlation between knowledge about the occluder material and acceptance of the method, knowledge of other information was significantly related to willingness to undergo the procedure. Some parents expressed some concerns and high expectations, but the postoperative risk reduced their desire for accepting the procedure. This study also found that most parents did not have a detailed understanding of such procedure. Conclusion Parents of patients with VSD in China need continued education regarding transthoracic device closure of VSD, especially in terms of its benefits and limited postoperative complications. In addition, it is essential to reduce the cost of this procedure to promote its development and application.
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Affiliation(s)
- Ze-Wei Lin
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Shu-Ting Huang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Ning Xu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China. .,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.
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20
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Dai XF, Chen Q, Zhang GC, Chen LW. A comparative study of minimal lower-sternal incision device closure, minimal right thoracic incision device closure, and midsternal open repair of isolated perimembranous VSD, a retrospective cohort study. Int J Cardiol 2020; 306:15-19. [PMID: 31785954 DOI: 10.1016/j.ijcard.2019.11.128] [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: 07/27/2019] [Revised: 11/07/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare transthoracic device closure via a minimal lower-sternal incision or minimal right thoracic incision and surgical repair via midsternal incision for perimembranous ventricular septal defect (VSD). METHODS We retrospectively analyzed the clinical data of 147 patients with isolated perimembranous VSD who were treated in our hospital from June 2017 to December 2017. According to the therapeutic approaches, the patients were divided into group A(transthoracic device closure via a minimal lower-sternal incision), group B((transthoracic device closure via a minimal right thoracic incision) and group C(surgical repair via midsternal incision). The clinical data of the three groups were statistically analyzed. RESULTS The three groups of patients had satisfactory outcomes for VSD closure. No complications, including third-degree atrioventricular block, large residual shunt requiring re-operation, newly moderate-severe aortic or tricuspid regurgitation, occluder detachment were reported. Compared with group C, the operative time, duration of mechanical ventilation, length of ICU stay, drainage volume, blood transfusion volume, length of the incision, and length of postoperative hospital stay were significantly lower in the device groups (A and B). CONCLUSION Transthoracic device closure via a minimal lower-sternal incision or minimal right thoracic incision and surgical repair via midsternal incision are sufficiently safe procedures for the treatment of isolated perimembranous VSD and can achieve satisfactory early clinical efficacy. Both device approaches have the advantages of a quick recovery and good cosmetic appearance of the incision.
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Affiliation(s)
- Xiao-Fu Dai
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, PR China
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, PR China.
| | - Gui-Can Zhang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, PR China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, PR China
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21
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Deng X, Huang P, Luo J, Chen R, Yang G, Chen W, Liu Q, He C. Residual Shunts Following Isolated Surgical Ventricular Septal Defect Closure: Risk Factors and Spontaneous Closure. Pediatr Cardiol 2020; 41:38-45. [PMID: 31650215 DOI: 10.1007/s00246-019-02218-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/29/2019] [Indexed: 11/29/2022]
Abstract
Although isolated congenital ventricular septal defects (VSD) can be repaired with a high degree of success, residual shunts (RS) are commonplace postoperatively. Small RS are relatively innocuous and tend to spontaneously close with time, despite the emotional burden it poses for the patient and family. A large RS, however, needs ongoing surveillance and may necessitate reintervention. Factors influencing the incidence of RS as well as the likelihood and expected timing of its spontaneous closure are discussed in this study. The patient records and relevant data of 362 consecutive patients undergoing cardiac operation with isolated congenital VSD closure as primary procedure between January 2017 and December 2017 were included in the study. Postoperative transthoracic echocardiograms were performed at hospital discharge, and during follow-up, at 1 month, 3 months, 6 months and 1 year postoperatively. Residual defects were measured under echocardiogram at every follow-up. Factors expected to be associated with RS occurrence and spontaneous closure were included for logistic and Cox regression statistical analysis. There were 113 cases where RS occurred according to the first postoperative echocardiograms that were performed at discharge, of which 80 were confirmed closed during subsequent follow-up, with a median follow-up of 96 days. A cutoff of 1.25 mm for the initial RS was found to be the best predictor of spontaneous closure at 6-month follow-up. Small shunts had higher closure rate than larger ones by a follow-up duration of 300 days, at which the two groups tended to reach a similar spontaneous closure rate. Longer surgical bypass time distinguished small from larger residual shunts measured upon discharge. Following repair of isolated congenital VSDs, the incidence of a residual shunt is high. The majority spontaneously close within 300 days following surgery. Longer bypass time predicted a larger residual shunt upon discharge. Larger than 1.25 mm shunts had lower short-term closure rate but seemed not to differ from smaller shunts beyond 300 days postoperatively.
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Affiliation(s)
- Xicheng Deng
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, No. 86 Ziyuan Road, Changsha, 410007, China.
| | - Peng Huang
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, No. 86 Ziyuan Road, Changsha, 410007, China
| | - Jinwen Luo
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, No. 86 Ziyuan Road, Changsha, 410007, China
| | - Renwei Chen
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, No. 86 Ziyuan Road, Changsha, 410007, China
| | - Guangxian Yang
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, No. 86 Ziyuan Road, Changsha, 410007, China
| | - Wenjuan Chen
- Department of Ultrasound, Hunan Children's Hospital, No. 86 Ziyuan Road, Changsha, 410007, China
| | - Qianjun Liu
- Department of Ultrasound, Hunan Children's Hospital, No. 86 Ziyuan Road, Changsha, 410007, China
| | - Cheng He
- Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, VIC, Australia
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22
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Sun KP, Chen Q, Hong ZN, Huang JS, Cao H. Health-related quality of life in adults undergoing transthoracic device closure of ventricular septal defect. J Cardiothorac Surg 2019; 14:176. [PMID: 31639022 PMCID: PMC6805436 DOI: 10.1186/s13019-019-1004-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023] Open
Abstract
Objective To evaluate the health-related quality of life (HRQoL) of adult patients who underwent transthoracic device closure of ventricular septal defect (VSD). Methods During the perioperative and postoperative period, a standard scale involving eight dimensions was used to analyze the HRQoL of 85 adult patients who underwent thoracic device closure of VSD and 80 healthy adults located locally were randomly selected as the control group in our center. Results A total of 80 patients’ and 80 healthy adults’ questionnaires were received with complete feedback. Out of all of the items that were investigated, postoperative patients experienced better feelings in some dimensions than the control group. Postoperative feedback was also better than preoperative feedback in some dimensions. In the comparison of the subgroups of these patients, the scores of the elderly were lower than those of the young in most dimensions. Males had more positive feedback in two aspects (“role-physical” (p = 0.01) and “vitality” (p = 0.003)), whereas unmarried people seemed to have poor emotional responses (“role-emotional” (p < 0.01) and “vitality” (p = 0.023)). There was no significant difference in any dimensions except “social functioning” (p < 0.01) between people with different levels of education. Conclusions Most of the adult patients who underwent thoracic closure of VSD felt that they could lead a normal life. They seemed to have reasonably normal psychosocial responses compared to healthy controls. Many patients even though their HRQoL was better than healthy individuals.
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Affiliation(s)
- Kai-Peng Sun
- Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, affiliated Hospital of Fujian Medical University, the Daoshan Road 18, Gulou District, Fuzhou, 350001, People's Republic of China
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Zhi-Nuan Hong
- Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, affiliated Hospital of Fujian Medical University, the Daoshan Road 18, Gulou District, Fuzhou, 350001, People's Republic of China
| | - Jiang-Shan Huang
- Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, affiliated Hospital of Fujian Medical University, the Daoshan Road 18, Gulou District, Fuzhou, 350001, People's Republic of China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, affiliated Hospital of Fujian Medical University, the Daoshan Road 18, Gulou District, Fuzhou, 350001, People's Republic of China.
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23
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Chen Q, Wu WX, Huang JS, Chen LW, Fang GH. Transthoracic Device Closure, Transcatheter Device Closure, and Surgical Repair via Right Submammary Thoracotomy for Restrictive Ventricular Septal Defect, a Respective Comparative Study. J INVEST SURG 2019; 34:467-472. [PMID: 31366250 DOI: 10.1080/08941939.2019.1645247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few comparative studies have focused on the advantages and disadvantages of transthoracic device closure, transcatheter device closure, and surgical repair via right submammary thoracotomy for restrictive ventricular septal defect (VSD). In this article, we compared the safety, efficacy, and clinical effects of these three treatments. Methods: The clinical data of 192 pediatric patients with a restrictive VSD in our hospital from January 2017 to May 2018 were retrospectively collected and analyzed. According to the different treatments, the patients were divided into three groups (the surgical and device groups). Results: There was no significant difference in the demographic characteristics, VSD size, mean pulmonary artery pressure, or cardiothoracic ratio. In addition, there were significant differences in the duration of mechanical ventilation, operation, hospitalization, and ICU stay between the two device groups and the surgical group, but there were no significant differences between the two device groups. Conclusions: Transthoracic device closure, transcatheter device closure, and surgical repair via right submammary thoracotomy for restrictive VSD repair are all safe and feasible. These three treatments have their own disadvantages and advantages and should be selected according to individual patients.
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Affiliation(s)
- Qin Chen
- Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, P. R. China
| | - Wei-Xiong Wu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P. R. China
| | - Jiang-Shan Huang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P. R. China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P. R. China
| | - Guan-Hua Fang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P. R. China
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24
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Ergün S, Genç SB, Yildiz O, Öztürk E, Kafalı HC, Ayyıldız P, Haydin S. Risk Factors for Major Adverse Events after Surgical Closure of Ventricular Septal Defect in Patients Less than 1 Year of Age: A Single-Center Retrospective. Braz J Cardiovasc Surg 2019; 34:335-343. [PMID: 31310473 PMCID: PMC6629230 DOI: 10.21470/1678-9741-2018-0299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To reveal the risk factors that can lead to a complicated course and an increased morbidity in patients < 1 year old after surgical ventricular septal defect (VSD) closure. METHODS We reviewed a consecutive series of patients who were admitted to our institution for surgical VSD closure who were under one year of age, between 2015 and 2018. Mechanical ventilation (MV) time > 24 hours, intensive care unit (ICU) stay longer than three days, and hospital stay longer than seven days were defined as "prolonged". Unplanned reoperation, complete heart block requiring a permanent pacemaker implantation, sudden circulatory arrest, and death were considered as significant major adverse events (MAE). RESULTS VSD closure was performed in 185 patients. The median age was five (1-12) months. There was prolonged MV time in 54 (29.2%) patients. Four patients (2.2%) required permanent pacemaker implantation. Hemodynamically significant residual VSD was observed in six (3.2%) patients. Extracorporeal membrane oxygenation-cardiopulmonary resuscitation was performed in one (0.5%) patient. Small age (< 4 months) (P-value<0.001) and prolonged cardiopulmonary bypass time (P=0.03) were found to delay extubation and to prolong MV time. Low birth weight at the operation was associated with MAE (P=0.03). CONCLUSION Higher body weight during operation had a reducing effect on the MAE frequency and shortened the MV duration, ICU stay, and hospital stay. As a conclusion, for patients who are scheduled to undergo VSD closure, body weight should be taken into consideration.
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Affiliation(s)
- Servet Ergün
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Saglik Bilimleri University Department of Pediatric Cardiovascular Surgery Istanbul Turkey Department of Pediatric Cardiovascular Surgery, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Serhat Bahadır Genç
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Saglik Bilimleri University Department of Pediatric Cardiovascular Surgery Istanbul Turkey Department of Pediatric Cardiovascular Surgery, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Okan Yildiz
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Saglik Bilimleri University Department of Pediatric Cardiovascular Surgery Istanbul Turkey Department of Pediatric Cardiovascular Surgery, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Erkut Öztürk
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Saglik Bilimleri University Department of Pediatric Cardiology Istanbul Turkey Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Hasan Candaş Kafalı
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Saglik Bilimleri University Department of Pediatric Cardiology Istanbul Turkey Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Pelin Ayyıldız
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Saglik Bilimleri University Department of Pediatric Cardiology Istanbul Turkey Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Sertaç Haydin
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Saglik Bilimleri University Department of Pediatric Cardiovascular Surgery Istanbul Turkey Department of Pediatric Cardiovascular Surgery, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
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Yu LS, Chen Q, Wang ZC, Cao H, Chen LW, Zhang GC. Comparison of Fast-Track and Conventional Anesthesia for Transthoracic Closure of Ventricular Septal Defects in Pediatric Patients. Ann Thorac Cardiovasc Surg 2019; 25:205-210. [PMID: 30867385 PMCID: PMC6698717 DOI: 10.5761/atcs.oa.18-00242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To compare and analyze the safety and efficacy of fast-track and conventional anesthesia for transthoracic closure of ventricular septal defects (VSDs) in pediatric patients. METHODS A total of 82 pediatric patients undergoing transthoracic closure of VSDs between September and December 2017 were retrospectively analyzed. The patients were divided into two groups, including 42 patients in group F (fast-track anesthesia) and 40 patients in group C (conventional anesthesia). The perioperative clinical data of both groups were collected and statistically analyzed. RESULTS There were no fatal complications in both groups. No complete atrioventricular block (AVB), new aortic valve regurgitation, and device closure failure were observed. No significant difference was found in preoperative general data or intraoperative hemodynamic changes between the two groups (P >0.05). However, the mechanical ventilation time, length of postoperative intensive care unit (ICU) stay, length of hospital stay, and hospitalization expenses of group F were significantly lower than those of group C (P <0.05). CONCLUSION It is safe and effective to use fast-track anesthesia for transthoracic closure of VSDs in pediatric patients.
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Affiliation(s)
- Ling-Shan Yu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Zeng-Chun Wang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Hua Cao
- 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
| | - Gui-Can Zhang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
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26
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The effect of body weight in infants undergoing ventricular septal defect closure: A report from the Nationwide Japanese Congenital Surgical Database. J Thorac Cardiovasc Surg 2019; 157:1132-1141.e7. [DOI: 10.1016/j.jtcvs.2018.11.111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/03/2018] [Accepted: 11/06/2018] [Indexed: 11/18/2022]
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Ayık MF, Şişli E, Dereli M, Şahan YÖ, Şahin H, Levent RE, Atay Y. A Retrospective Survey Comparing Suture Techniques Regarding the Risk of Permanent Epicardial Pacemaker Implantation After Ventricular Septal Defect Closure. Braz J Cardiovasc Surg 2019; 33:339-346. [PMID: 30184030 PMCID: PMC6122755 DOI: 10.21470/1678-9741-2018-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/13/2018] [Indexed: 12/04/2022] Open
Abstract
Objective The aim of this study is to compare the continuous and combined suturing
techniques in regards to the needing epicardial pacing at the time of
weaning from cardiopulmonary bypass (EP-CPB) and to evaluate permanent
epicardial pacemaker (PEP) implantation in patients who had undergone
surgical ventricular septal defect (VSD) closure. Methods This single-centre retrospective survey includes 365 patients who had
consecutively undergone VSD closure between January 2006 and October 2015.
Results The median age and weight of the patients were 15 months (range 27 days -
56.9 years) and 10 kg (range 3.5 - 100 kg), respectively. Continuous and
combined suturing techniques were utilised in 302 (82.7%) and 63 (17.3%)
patients, respectively. While 25 (6.8%) patients required EP-CPB, PEP was
implanted in eight (2.2%) patients. Comparison of the continuous and
combined suturing techniques regarding the need for EP-CPB (72%
vs. 28%, P=0.231) and PEP implantation
(87.5% vs. 12.5%, P=1.0) were not
statistically significant. The rate of PEP implantation in patients with
perimembraneous VSD without extension and perimembraneous VSD with inlet
extension did not reveal significant difference between the suture
techniques (P=1.0 and P=0.16,
respectively). In both univariate and multivariate analyses, large VSD
(P=0.001; OR 8.63; P=0.011) and
perimembraneous VSD with inlet extension (P<0.001; OR
9.02; P=0.005) had a significant influence on PEP
implantation. Conclusion Both suturing techniques were comparable regarding the need for EP-CPB or PEP
implantation. Caution should be exercised when closing a large
perimembraneous VSD with inlet extension.
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Affiliation(s)
- Mehmet Fatih Ayık
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Emrah Şişli
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Münevver Dereli
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | | | - Hatice Şahin
- Medical Education, Faculty of Medicine, Ege University, Izmir, Turkey
| | | | - Yüksel Atay
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
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Haddad RN, Daou L, Saliba Z. Device Closure of Perimembranous Ventricular Septal Defect: Choosing Between Amplatzer Occluders. Front Pediatr 2019; 7:300. [PMID: 31475122 PMCID: PMC6707042 DOI: 10.3389/fped.2019.00300] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/08/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Off-label device closure of perimembranous ventricular septal defect (pmVSD) is well reported in the literature with encouraging results. However, technical challenges may be encountered. Objectives: To evaluate and compare feasibility, technical aspects, procedural outcomes, and mid-term follow-up of pmVSD closure using Amplatzer™ occluders. Patients and Methods: From July 2015 to July 2018, patients in whom pmVSD closure was attempted using an Amplatzer occluder were retrospectively identified from our institution's database. Device selection was made according to the defect anatomy that was obtained via ventriculography and trans-esophageal echocardiography. Follow-up evaluations were done at discharge, then at 1, 3, 6, and 12 months and yearly thereafter with transthoracic echocardiography and electrocardiogram. Results: In total, 8 Amplatzer Duct Occluder (ADO), 27 ADO II, and 17 Amplatzer Muscular VSD Occluder (AMO) were used in 51 patients with a mean age of 7.4 ± 6.9 years and a mean weight of 25.4 ± 19.8 kg. Implantation was successful in 50/51 patients (98.0%). There was no procedure related mortality. One ADO accidentally embolized to the aorta after release and was surgically recaptured from the iliac artery. All ADO II were delivered retrogradely with the least amount of time (p = 0.002) and the lowest radiation exposure (p < 0.001). Minor valvular disturbances occurred in 8/49 patients (16.3%), including five tricuspid regurgitation (three with ADOII and two with AMO) and three trivial aortic regurgitations (two with ADO and one with ADOII). On a median follow-up of 194 days (range, 60-895 days), no surgical device removal was necessary. At 6 months of follow-up, trivial residual shunt was present in 5/49 patients (10.2%), among which none occurred with ADO. One complete atrioventricular block was detected 18 months after ADO implantation and required permanent pacing. Conclusions: Transcatheter closure of PmVSD using Amplatzer occluders is feasible, safe and efficacious in properly selected patients. The major key factor behind high procedural success rate is proper device selection. ADOII is remarkably superior in terms of device softness, flexibility and faster implantation process. Yet, its use is limited to small defects with particular anatomy.
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Affiliation(s)
- Raymond N Haddad
- Department of Pediatrics, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon
| | - Linda Daou
- Department of Pediatric Cardiology, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon
| | - Zakhia Saliba
- Department of Pediatric Cardiology, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon
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29
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Nguyen HL, Phan QT, Doan DD, Dinh LH, Tran HB, Sharmin S, Thottian JJ, Won H, Lee WS, Shin SY, Nguyen TQ, Kim SW. Percutaneous closure of perimembranous ventricular septal defect using patent ductus arteriosus occluders. PLoS One 2018; 13:e0206535. [PMID: 30439981 PMCID: PMC6237304 DOI: 10.1371/journal.pone.0206535] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 10/15/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To assess the safety and efficacy of percutaneous closure of perimembranous ventricular septal defect (PmVSD) using patent ductus arteriosus (PDA) occluders. BACKGROUND Widespread use of conventional PmVSD closure devices has been limited by unacceptable high rate of complete heart block (CHB). The elegant design of PDA occluders is supposed to ease implantation, increase closure rate and minimize damage to adjacent structures. Thus, PDA occluders may reduce complications, especially the CHB, and offer a good alternative for PmVSD closure. METHOD From September 2008 to October 2015, patients who underwent attempted percutaneous VSD closure using PDA occluders were included in the study. Patient demographics, echocardiography measurements, procedure details and follow-up data until October 2017 were collected. RESULTS In total, 321 patients with a mean age of 15.5±12.6 years and mean a weight of 33.3±20.5 kg were included in this study. The mean defect size was 4.8±2.1 mm. Implantation was successful in 307 (95.6%) patients. The median follow-up time was 63 months (24 to 108 months). The closure rates were 89.5%, 91.5%, and 99.3% after the procedure 24 hours, 6 months and 2 years, respectively. Major complications occurred in 5 (1.7%) patients during the procedure and follow-up, including persistent CHB in 2 (0.7%) patients and device embolization in 3 (1.0%) patients. No death, disability, or other major complication was detected. CONCLUSION Percutaneous closure of PmVSD using PDA occluders is feasible, safe and efficacious in selected patients.
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Affiliation(s)
- Hieu Lan Nguyen
- Intervention Center, Vietnam National Heart Institute, Ha Noi, Vietnam
- Intervention Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Quang Tan Phan
- Intervention Center, Quang Nam Central General Hospital, Quang Nam, Vietnam
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
- * E-mail:
| | - Dung Duc Doan
- Intervention Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Linh Huynh Dinh
- Intervention Center, Vietnam National Heart Institute, Ha Noi, Vietnam
| | - Hieu Ba Tran
- Intervention Center, Vietnam National Heart Institute, Ha Noi, Vietnam
| | - Saima Sharmin
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Julian Johny Thottian
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
- Intervention Center, Westfort Group Hospital, Kerala, India
| | - Hoyoun Won
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Wang Soo Lee
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Seung Yong Shin
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
| | | | - Sang Wook Kim
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
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30
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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.
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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
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31
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Fang GH, Chen Q, Hong ZN, Lin ZW, Zhang GC, Cao H, Chen LW. The Comparison of Perventricular Device Closure with Transcatheter Device Closure and the Surgical Repair via Median Sternotomy for Perimembranous Ventricular Septal Defect. Ann Thorac Cardiovasc Surg 2018; 24:308-314. [PMID: 30058611 PMCID: PMC6300419 DOI: 10.5761/atcs.oa.18-00085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Perventricular and transcatheter device closures are performed for perimembranous ventricular septal defect (pmVSD) to reduce the surgical trauma of conventional surgical repair via median sternotomy. Few comparative studies have been conducted among these three procedures. Methods: From June 2015 to May 2016, 247 patients with isolated pmVSD who had undergone perventricular or transcatheter device closure or conventional surgical repair were reviewed to compare these three procedures. Results: The procedure success rate was similar in these three groups. There were a statistically significant difference in operative time, aortic cross-clamping time, duration of cardiopulmonary bypass (CPB), blood transfusion amount, and medical cost in these three groups. Meanwhile, postoperative mechanical ventilation time, duration of intensive care, and length of hospital stay were longer in surgical group than the other two groups. The surgical group required the longest incision. No significant difference was noted in major adverse events. There were different advantages and disadvantages in these three kinds of procedures. Conclusions: Device closure may be alternative to conventional surgical repair for patients with isolated pmVSD. Perventricular device closure was the preferred procedure because it showed more maneuverable than transcatheter procedure with the same clinical result.
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Affiliation(s)
- Guan-Hua Fang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Zhi-Nuan Hong
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Ze-Wei Lin
- 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
| | - Hua Cao
- 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
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Narin N, Pamukcu O, Tuncay A, Baykan A, Sunkak S, Tasci O, Uzum K, Saltık L. Percutaneous Ventricular Septal Defect Closure in Patients Under 1 Year of Age. Pediatr Cardiol 2018. [PMID: 29541816 DOI: 10.1007/s00246-018-1852-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Untreated ventricular septal defect (VSD) is an important cause of congestive heart failure in early infancy. Growth is impaired in this population, and surgical closure is challenging because of congestion in the lungs, making infants prone to respiratory infection, and because of their poor nutritional status. The aim of this study is to share our experience with percutaneous VSD closure in patients under 1 year of age. Patients with hemodynamically significant left-to-right shunt, less than 1 year of age, and with VSD diameter ≤ 6 mm were retrospectively included in the study between December 2014 and January 2017. The median length of follow-up was 8.5 (4-14.2) months. Twelve patients from 2 to 12 months of age, with a median weight of 6.75 (5.4-8) kg, were included. The mean VSD diameter as measured by angiography from the left ventricle side was 4.7 ± 0.25 mm, and from the right ventricle side was 3.4 ± 1.1 mm. All were of a perimembranous type except three, which were muscular. All defects were closed with the Amplatzer Duct Occluder II (ADO II) or the ADO II-additional size. The mean fluoroscopy duration and total radiation dose were 22.6 ± 18.7 min and 1674 ± 851 cGy/min, respectively. No aortic regurgitation associated with device closure was seen in any of the patients. Complete atrioventricular block occurred in one patient 6 months after the procedure, and was treated with a permanent pacemaker. VSD closure is challenging, regardless of whether a surgical or percutaneous procedure is used. The risks are higher for children younger than 1 year with low body weight. Percutaneous closure, which carries similar risks but is less invasive than surgery, may be the preferred alternative in early infancy.
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Affiliation(s)
- Nazmi Narin
- Division of Pediatric Cardiology, Erciyes University School of Medicine, 38039, Kayseri, Turkey
| | - Ozge Pamukcu
- Division of Pediatric Cardiology, Erciyes University School of Medicine, 38039, Kayseri, Turkey.
| | - Aydin Tuncay
- Division of Cardiovascular Surgery, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ali Baykan
- Division of Pediatric Cardiology, Erciyes University School of Medicine, 38039, Kayseri, Turkey
| | - Suleyman Sunkak
- Division of Pediatric Cardiology, Erciyes University School of Medicine, 38039, Kayseri, Turkey
| | - Onur Tasci
- Division of Pediatric Cardiology, Erciyes University School of Medicine, 38039, Kayseri, Turkey
| | - Kazim Uzum
- Division of Pediatric Cardiology, Erciyes University School of Medicine, 38039, Kayseri, Turkey
| | - Levent Saltık
- Division of Pediatric Cardiology, Cerrahpasa University School of Medicine, Istanbul, Turkey
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Ou-Yang WB, Wang SZ, Hu SS, Zhang FW, Zhang DW, Liu Y, Meng H, Pang KJ, Meng LK, Pan XB. Perventricular device closure of perimembranous ventricular septal defect: effectiveness of symmetric and asymmetric occluders. Eur J Cardiothorac Surg 2017; 51:478-482. [PMID: 28082474 DOI: 10.1093/ejcts/ezw352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/19/2016] [Indexed: 12/17/2022] Open
Abstract
Objectives To assess safety and effectiveness of symmetric and asymmetric occluders in perventricular device closure without cardiopulmonary bypass of perimembranous ventricular septal defects (pmVSDs). Methods The present retrospective study enrolled 581 patients who underwent perventricular device closure of pmVSDs under transoesophageal echocardiography guidance from May 2011 to April 2016, and outpatient electrocardiography and transthoracic echocardiography assessments at 1, 3, 6 and 12 months, and yearly thereafter. Results The overall success rate of device implantation was 92.6% (43 surgical conversions immediately). Between patients receiving symmetric ( n = 353) and asymmetric ( n = 185) occluders, there were no significant differences in age, weight and defect diameter distributions; however, both before discharge and at mean 28.6 ± 21.2 (range, 1-60)-month follow-up, the symmetric group had lower rates of trivial residual shunt (5.7% vs 11.4%, P = 0.018; and 0.8% vs 5.9%, P = 0.001) and bundle branch block (0.8% vs 5.4%, P = 0.002; and 0.6% vs 3.8%, P = 0.009); and at follow-up, the asymmetric group had lower residual shunt (47.6% vs 85.0%, P = 0.020) and similar branch block (30.0% vs 33.3%, P = 1.000) disappearance rates. There were no severe complications, i.e. aortic regurgitation, malignant arrhythmias, haemolysis or device dislocation. Conclusions Perventricular device closure of pmVSDs appears safe and effective with symmetric and asymmetric occluders. However, the lower residual shunt disappearance and higher branch block incidence rates for asymmetric occluders would favour more proactive conversion to surgical repair immediately when residual shunt is present intraoperatively.
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Affiliation(s)
- Wen-Bin Ou-Yang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China.,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Shou-Zheng Wang
- Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Innovation Center of Major Infectious Diseases, Beijing, China
| | - Sheng-Shou Hu
- Department of Psychology, National Cheng Kung University, Tainan, Taiwan
| | - Feng-Wen Zhang
- Key Laboratory of Adaptation and Evolution of Plateau Biota, Northwest Institute of Plateau Biology, Chinese Academy of Sciences, Xining, China
| | - Da-Wei Zhang
- State Key Laboratory of ASIC and System, School of Microelectronics, Fudan University, Shanghai, China
| | - Yao Liu
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg, Netherlands
| | - Hong Meng
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Kun-Jing Pang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China.,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Liu-Kun Meng
- Gene Oasis Research and Innovation, Singapore Tianjin University, Tianjin, PR China
| | - Xiang-Bin Pan
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China.,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
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34
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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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Lawley CM, Lain SJ, Figtree GA, Sholler GF, Winlaw DS, Roberts CL. Mortality, rehospitalizations and costs in children undergoing a cardiac procedure in their first year of life in New South Wales, Australia. Int J Cardiol 2017; 241:156-162. [DOI: 10.1016/j.ijcard.2017.03.113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
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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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Schipper M, Slieker MG, Schoof PH, Breur JMPJ. Surgical Repair of Ventricular Septal Defect; Contemporary Results and Risk Factors for a Complicated Course. Pediatr Cardiol 2017; 38:264-270. [PMID: 27872996 PMCID: PMC5331080 DOI: 10.1007/s00246-016-1508-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/08/2016] [Indexed: 11/27/2022]
Abstract
Surgical closure of the ventricular septal defect is the most commonly performed procedure in pediatric cardiac surgery. There are conflicting data on weight at operation as risk factor for a complicated course. We performed a retrospective evaluation of mortality and morbidity in all patients undergoing surgical ventricular septal defect closure at our institution between 2004 and 2012 to identify risk factor for a complicated course. Multivariate logistic regression modeling was performed to identify risk factors for a complicated course. 243 patients who underwent surgical ventricular septal defect closure were included. Median age at operation was 168.0 days (range 17-6898), the median weight 6.0 kg (range 2.1-102.0). No deaths occurred. Two patients (0.8%) required a pacemaker for permanent heart block. Five patients (2.1%) underwent reoperation for a hemodynamically important residual ventricular septal defect. No other major adverse events occurred. No risk factors for major adverse events could be established. Multivariate analysis identified a genetic syndrome, long bypass time and low weight at operation as independent risk factors for a prolonged intensive care stay (>1 day) and prolonged ventilation time (>6 h). Contemporary results of surgical VSD closure are excellent with no mortality and low morbidity in this series. Although it is associated with increased ventilation time and a longer hospital stay, low bodyweight at operation is not associated with an increased risk of complications or major adverse events in our series.
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Affiliation(s)
- Maartje Schipper
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Martijn G. Slieker
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Paul H. Schoof
- Department of Pediatric Cardiothoracic Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Johannes M. P. J. Breur
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
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Variability of Myocardial Repolarization in Pediatric Patients with a Ventricular Septal Defect. Pediatr Cardiol 2016; 37:1458-1464. [PMID: 27554253 DOI: 10.1007/s00246-016-1457-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/16/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED In patients with a ventricular septal defect, left-to-right shunting increases the left ventricular preload. This pathological change affects myocardial depolarization and repolarization and has the potential to evoke arrhythmogenic substrates. We examined the effect of ventricular septal defects on myocardial repolarization by investigating the variability in the repolarization interval. This retrospective study included 19 patients (mean age, 1.8 ± 2.1 years) who underwent surgical closure (mean left-to-right shunt ratio, 2.60 ± 0.55) and 26 age-matched healthy controls from 2008 to 2015. Using preoperative electrocardiograms, we studied two electrocardiographic parameters (heart rate-corrected repolarization and variability of repolarization) and four repolarization intervals (QT, JT, J point to T peak [JTp], and T peak to T end [Tp-e] intervals). The variability index (VI) was calculated from the logarithm of the ratio of the repolarization parameter variance to heart rate variance. The various measures were compared between the patients and controls, and significant differences were found in the corrected QT, JTp, and Tp-e intervals (p < 0.05). The VI of the four intervals also showed significant differences (patients vs. CONTROLS QTVI, -0.55 ± 0.61 vs. -1.10 ± 0.53; JTVI, -0.33 ± 0.60 vs. -0.86 ± 0.57; JTpVI, -0.15 ± 0.78 vs. -0.73 ± 0.56; Tp-eVI, 0.75 ± 0.70 vs. 0.11 ± 0.73, respectively; p < 0.05). No correlation was found between the QTVI and corrected QT interval using linear regression analysis. These repolarization characteristics provide not only electrophysiological indices but also a new index with which to assess the pathophysiology of congenital heart disease.
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Varghese R, Saheed S, Ravi AK, Sherrif EA, Agarwal R, Kothandam S. The "excluding" suture technique for surgical closure of ventricular septal defects: A retrospective study comparing the standard technique. Ann Pediatr Cardiol 2016; 9:229-35. [PMID: 27625520 PMCID: PMC5007931 DOI: 10.4103/0974-2069.189116] [Citation(s) in RCA: 2] [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: 11/04/2022] Open
Abstract
BACKGROUND Conventional methods of closure of ventricular septal defects involve placement of sutures 4-5 mm from the posterior inferior margin. This study compares the conventional method with an alternative technique wherein sutures are placed along the edge of the defect thereby "excluding" the conduction system and the tensor apparatus of the tricuspid valve from the suture line. MATERIALS AND METHODS Between January 2013 and January 2016, 409 consecutive patients were retrospectively reviewed and divided into two matched groups. Group A (n = 174) underwent closure using the alternative technique and Group B (n = 235) with the conventional technique. Patients with isolated ventricular septal defects (VSDs) (n = 136) were separately analyzed as were infants within this subset. RESULTS Immediate postoperative results were similar with no statistically significant differences in either group in terms of incidence of residual defects or postoperative tricuspid regurgitation. There was however a significantly increased incidence of post operative complete heart block (CHB) among patients in the conventional group (P = 0.02). Incidence of temporary heart block that reverted to sinus rhythm was also more in the conventional method group (Group B) (P = 0.03) as was right bundle branch block (P ≤ 0.05) in all the subsets of patients analyzed. CONCLUSION Surgical closure of VSDs can be accomplished by placing sutures along the margins or away with comparable results. The incidence of CHB, however, seems to be less when the "excluding" technique is employed.
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Affiliation(s)
- Roy Varghese
- Department of Pediatric Cardiac Surgery, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Sanni Saheed
- Department of Pediatric Cardiac Surgery, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Amrutha K Ravi
- Department of Pediatric Cardiac Surgery, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Ejaz Ahmed Sherrif
- Department of Pediatric Cardiac Surgery, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Ravi Agarwal
- Department of Pediatric Cardiac Surgery, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Sivakumar Kothandam
- Department of Cardiology, Madras Medical Mission, Chennai, Tamil Nadu, India
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Detachment of the tricuspid valve for ventricular septal defect closure in infants younger than 3 months. J Thorac Cardiovasc Surg 2016; 152:491-6. [DOI: 10.1016/j.jtcvs.2016.03.067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/04/2016] [Accepted: 03/22/2016] [Indexed: 11/20/2022]
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Husain SA. Taking 1 step backward to go 2 forward? Managing the tricuspid valve in the surgical closure of a ventricular septal defect. J Thorac Cardiovasc Surg 2016; 152:496-7. [PMID: 27423838 DOI: 10.1016/j.jtcvs.2016.04.032] [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: 04/10/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
Affiliation(s)
- S Adil Husain
- Division of Pediatric and Congenital Cardiothoracic Surgery, University of Texas Health Sciences Center, San Antonio, Tex.
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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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Danford DA, Martin AB, Danford CJ, Kaul S, Marshall AM, Kutty S. Clinical Implications of a Multivariate Stratification Model for the Estimation of Prognosis in Ventricular Septal Defect. J Pediatr 2015; 167:103-7.e1-2. [PMID: 25935817 DOI: 10.1016/j.jpeds.2015.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/02/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To derive and validate a multivariate stratification model for prediction of survival free from intervention (SFFI) in ventricular septal defect (VSD). A secondary aim is for this model to serve as proof of concept for derivation of a more general congenital heart disease prognostic model, of which the VSD model will be the first component. STUDY DESIGN For 12 years, 2334 subjects with congenital heart disease were prospectively and consecutively enrolled. Of these, 675 had VSD and form the derivation cohort. One hundred seven other subjects with VSD followed in another practice formed the validation cohort. The derivation cohort was serially stratified based on clinical and demographic features correlating with SFFI. RESULTS Six strata were defined, the most favorable predicting nearly 100% SFFI at 10 years, and the least favorable, a high likelihood of event within weeks. Strata with best SFFI had many subjects with nearly normal physiology, muscular VSD location, or prior intervention. In the validation cohort, the relation between predicted and actual SFFI at 6 months, 1 year, 2 years, and 5 years follow-up had areas under the receiver operating characteristic curves 0.800 or greater. CONCLUSIONS A prediction model for SFFI in VSD has been derived and validated. It has potential for clinical application to the benefit of patients and families, medical trainees, and practicing physicians.
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Affiliation(s)
- David A Danford
- University of Nebraska Medical Center College of Medicine, Children's Hospital and Medical Center, Omaha, NE
| | - Ameeta B Martin
- Department of Cardiology, St. Elizabeth Hospital, Lincoln, NE
| | | | - Sheetal Kaul
- University of Nebraska Medical Center College of Medicine, Children's Hospital and Medical Center, Omaha, NE
| | - Amanda M Marshall
- University of Nebraska Medical Center College of Medicine, Children's Hospital and Medical Center, Omaha, NE
| | - Shelby Kutty
- University of Nebraska Medical Center College of Medicine, Children's Hospital and Medical Center, Omaha, NE.
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Hsu DT. Closure is not correction: late outcomes of ventricular septal defect surgery. J Am Coll Cardiol 2015; 65:1952-3. [PMID: 25953747 DOI: 10.1016/j.jacc.2015.02.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 02/24/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Daphne T Hsu
- Albert Einstein College of Medicine, Bronx, New York, and Pediatric Cardiology and Pediatric Heart Center, Children's Hospital at Montefiore, Bronx, New York.
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45
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Hu Y, Li Z, Chen J, Li F, Shen C, Song Y, Zhao S, Peng C, Chen M, Zhong Q. Results of comparing transthoracic device closure and surgical repair with right infra-axillary thoracotomy for perimembranous ventricular septal defects. Interact Cardiovasc Thorac Surg 2014; 20:493-8. [PMID: 25543179 DOI: 10.1093/icvts/ivu434] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Transthoracic device closure (TTDC) and surgical repair with right infra-axillary thoracotomy (SRRIAT) are two main alternative minimally invasive approaches for restrictive perimembranous ventricular septal defect (VSD); however, few studies have compared them with each other in terms of effectiveness and cost. METHODS Patients with perimembranous VSD undergoing TTDC or SRRIAT from January 2012 to July 2013 were reviewed in a comparative investigation between the two procedures. RESULTS Success from the procedures was achieved in 30 TTDC (30/33, 91%) and 96 SRRIAT patients (100%). Operation duration in the TTDC group was significantly shorter than that of the SRRIAT group (115.8 ± 43.8 vs 175.6 ± 41.3 min, P < 0.01). The total perioperative drainage, use of red blood cells, mechanical ventilation time, stay in the intensive care unit and hospital stay for the TTDC group were significantly less than those in the SRRIAT group. No deaths or complete atrioventricular block occurred in either group. One SRRIAT patient accepted a second surgery for residual shunt. TTDC costs slightly more than SRRIAT (40270.6 ± 2741.3 renmingbi [RMB] vs 32964.5 ± 8221.6 RMB, P < 0.01). CONCLUSIONS Both TTDC and SRRIAT showed excellent outcomes and cosmetic appearance for suitable VSD candidates. Although its costs were higher, TTDC had the advantages over SRRIAT of a short operation duration and intensive care unit stay and fewer days in the hospital.
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Affiliation(s)
- Yijie Hu
- Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Zhiping Li
- Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Jianming Chen
- Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Fuping Li
- Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Cheng Shen
- Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yi Song
- Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Shulin Zhao
- Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Caijing Peng
- Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Mingxiang Chen
- Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Qianjin Zhong
- Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
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