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Ashry A, Khan S, Johns M, Moran D, Mohammed HM, Lotto R, Kutty R, Dhannapuneni R, Guerrero R, Lotto A. Ventricular Septal Defect Exposure by Tricuspid Valve Chordal Detachment-A Retrospective Matched Study. World J Pediatr Congenit Heart Surg 2023; 14:350-356. [PMID: 36862697 DOI: 10.1177/21501351221151042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Background: Transatrial approach is the standard method in repairing ventricular septal defects (VSD) in the pediatric population. However, the tricuspid valve (TV) apparatus might obscure the inferior border of the VSD risking the adequacy of repair by leaving residual VSD or heart block. Detachment of the TV chordae has been described as an alternative technique to TV leaflet detachment. The aim of this study is to investigate the safety of such a technique. Methods: Retrospective review of patients who underwent VSD repair between 2015 and 2018. Group A (n = 25) had VSD repair with TV chordae detachment were matched for age and weight to group B (n = 25) without tricuspid chordal or leaflet detachment. Electrocardiogram (ECG) and echocardiogram at discharge and at 3 years of follow-up were reviewed to identify new ECG changes, residual VSD, and TV regurgitation. Results: Median ages in groups A and B were 6.13 (IQR 4.33-7.91) and 6.33 (4.77-7.2) months. New onset right bundle branch block (RBBB) was diagnosed at discharge in 28% (n = 7) of group A versus 56% (n = 14) in group B (P = .044), while the incidence dropped to 16% (n = 4) in group A versus 40% (n = 10) in group B (P = .059) in the 3 years follow-up ECG. Echocardiogram at discharge showed moderate tricuspid regurgitation in 16% (n = 4) in group A and 12% (n = 3) in group B (P = .867). Three years of follow-up echocardiography revealed no moderate or severe tricuspid regurgitation and no significant residual VSD in either group. Conclusion: No significant difference in operative time was observed between the two techniques. TV chordal detachment technique reduces the incidence of postoperative RBBB without increasing the incidence of TV regurgitation at discharge.
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Affiliation(s)
- Amr Ashry
- Congenital Cardiac Surgery Service, Alder Hey Children's Hospital, Liverpool, UK.,Department of Cardiothoracic Surgery, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sophia Khan
- Paediatric Cardiology Service, Alder Hey Children's Hospital, Liverpool, UK
| | - Melonie Johns
- Paediatric Cardiology Service, Alder Hey Children's Hospital, Liverpool, UK
| | - Denise Moran
- Paediatric Cardiology Service, Alder Hey Children's Hospital, Liverpool, UK
| | - Heba M Mohammed
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Robyn Lotto
- Faculty of Health, 4589Liverpool John Moores University, Liverpool, UK
| | - Ramesh Kutty
- Congenital Cardiac Surgery Service, Alder Hey Children's Hospital, Liverpool, UK
| | - Ram Dhannapuneni
- Congenital Cardiac Surgery Service, Alder Hey Children's Hospital, Liverpool, UK
| | - Rafael Guerrero
- Congenital Cardiac Surgery Service, Alder Hey Children's Hospital, Liverpool, UK.,School of Medicine, University of Liverpool, Liverpool, UK
| | - Attilio Lotto
- Congenital Cardiac Surgery Service, Alder Hey Children's Hospital, Liverpool, UK.,Faculty of Health, 4589Liverpool John Moores University, Liverpool, UK
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Yuan D, Chen L, Zhang X, Qian Y. Tricuspid valve detachment for ventricular septal defect closure: A meta-analysis of existing evidence. J Card Surg 2022; 37:5395-5403. [PMID: 36378918 DOI: 10.1111/jocs.17214] [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: 08/27/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ventricular septal defect (VSD) is one of the most common congenital cardiac defects. However, in some cases, VSD sites are difficult to expose due to obstruction from chordal attachments and leaflets of the tricuspid valve (TV). To systematically review the efficacy and safety of tricuspid valve detachment, (TVD) versus conventional surgical repair (non-TVD) in the treatment of ventricular septal defect (VSD). This article is aimed to compare the many outcomes from existing studies and provide evidence regarding the necessity of performing TVD. METHODS We searched the following databases: PubMed via NCBI, the Cochrane Central Register of Controlled Trials (no date restriction), Medline via Ovid (from 1966 to May 2020); Embase via Ovid (no date restriction), and China National Knowledge Infrastructure for studies comparing the efficacy of TVD and other surgical techniques in VSD repair. Cardiopulmonary bypass time, Cross-clamp time; postoperative complications including residual defect, postoperative atrioventricular block, implantation of pacemakers, tricuspid regurgitation; length of stay (LOS), length of intensive care unit (ICU) stay were analyzed. RESULTS Only nine studies were included after selection, including seven retrospective cohort studies, one respective cohort study, and one prospective observational study, a patient pool of 1404 patients with 374 underwent TVD and 1030 underwent non-TVD procedures, met the inclusion criteria. Meta analysis has drawn to the following conclusions. First, TVD prolongs CPB time (MD = 7.75, 95% confidence interval [CI] = 2.60-12.89, p = .003) and cross-clamp time (MD = 7.77, 95% CI = 4.76-10.78, p < .001) compared with non-TVD techniques in VSD repair surgeries. Second, no significant difference exists in LOS, length of ICU stay, postoperative atrioventricular block, implantation of pacemakers, incidence of ≥mild tricuspid valve regurgitation (TR) postoperatively and at discharge, as well as the incidence of ≥small residual VSD after surgery and during follow-up (all p > .05). Third, application of TVD increases the risk of TR during follow-up (odds ratio [OR] = 2.42, 95% CI = 1.55-3.76, p < .001). CONCLUSION VSD closure using TVD technique results in longer CPB and cross-clamp time, and increases risk of TR during follow-up. TVD provides equally viable and safe alternative in treating VSD.
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Affiliation(s)
- Dou Yuan
- Department of Cardiovascular Surgery, Cheng Du Shang Jin Nan Fu Hospital, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Liping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoling Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yongjun Qian
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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3
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Ventricular Septal Defects. CONGENIT HEART DIS 2022. [DOI: 10.1016/b978-1-56053-368-9.00016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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4
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Ling Y, Bian X, Wang Y, Qian Y. Does tricuspid valve detachment improve outcomes compared with the non-tricuspid valve detachment approach in ventricular septal defect closure? Interact Cardiovasc Thorac Surg 2021; 32:483-488. [PMID: 33301568 DOI: 10.1093/icvts/ivaa289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 09/23/2020] [Accepted: 10/27/2020] [Indexed: 11/15/2022] Open
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the tricuspid valve detachment (TVD) approach to ventricular septal defect repair provides superior outcomes compared with the non-TVD approach. Altogether more than 54 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. A total of 2059 participants were enrolled in the 10 studies, including 2 prospective studies and 8 retrospective studies. Six studies demonstrated a longer cardiopulmonary bypass time or aortic clamp time in the TVD group, whereas 4 studies showed no difference. Only 1 study reported a lower incidence of trivial tricuspid regurgitation in the TVD group, whereas the other 9 studies showed no significant difference. One study showed that a higher incidence of residual shunting occurred in those patients who had indications for TVD but did not perform detachment during surgery. No difference in postoperative residual shunting was demonstrated in the other 9 studies. We conclude that surgeons should be reassured that if TVD is required to repair the ventricular septal defect, although it may lead to longer cardiopulmonary bypass time and cross-clamp times, outcomes are equivalent in terms of the degree of tricuspid regurgitation and incidence of the residual ventricular septal defect.
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Affiliation(s)
- Yunfei Ling
- Department of Cardiovascular Surgery, Sichuan University, Chengdu, Sichuan, China
| | - Xiaohui Bian
- Department of Cardiovascular Surgery, Sichuan University, Chengdu, Sichuan, China
| | - Yue Wang
- Department of Cardiovascular Surgery, Sichuan University, Chengdu, Sichuan, China
| | - Yongjun Qian
- Department of Cardiovascular Surgery, Sichuan University, Chengdu, Sichuan, China
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5
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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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6
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Zhou K, Yang L, He BC, Ke YJ, Yang YC, Yan Q, Chen ZR, Huang HL. Total thoracoscopic repair of ventricular septal defect: A single-center experience. J Card Surg 2021; 36:2213-2218. [PMID: 33783023 PMCID: PMC8252479 DOI: 10.1111/jocs.15504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/13/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
Objectives To explore the safety and efficacy of total thoracoscopic repair of ventricular septal defects (VSD). We compared clinical outcomes of VSD via a total thoracoscopic approach with those of mini‐sternotomy. Methods We retrospectively reviewed clinical data from patients with VSD from 2012 to January 2019. According to the surgical pattern, they were divided into two groups: the total thoracoscopic surgery group (36 patients, 27 females, aged 29 ± 9.52 years), and a mini‐sternotomy group (31 patients, 12 females, aged 28 ± 8.67 years). Results There were no deaths in either group. In the thoracoscopic group, cardiopulmonary bypass (CPB) time and aortic cross‐clamping (ACC) time were significantly longer than those of the mini‐sternotomy group (CPB time: 112 ± 23.16 min vs. 78 ± 37.90 min, respectively, p < .001; ACC time: 65 ± 19.94 min vs. 50 ± 24.90 min, respectively, p < .001). postoperative hospital stay time (5.11 ± 2.48 days vs. 5.90 ± 6.27 days, p = .488) and chest drainage (139.86 ± 111.71 ml vs. 196.13 ± 147.34 ml, p = .081) tended to be lower in the thoracoscopy group, although there was no significant difference. No residual shunt or tricuspid regurgitation was found at follow‐up. Conclusions Total thoracoscopic repair is safe and effective in patients with VSD, with or without tricuspid regurgitation.
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Affiliation(s)
- Kan Zhou
- Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, Guangdong Province, China
| | - Liang Yang
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Biao-Chuan He
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangzhou, China
| | - Ying-Jie Ke
- Nanhai Hospital of Guangdong Provincial People's Hospital, Guangdong, China
| | - Yan-Chen Yang
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangzhou, China
| | - Qian Yan
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangzhou, China
| | - Ze-Rui Chen
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangzhou, China
| | - Huan-Lei Huang
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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7
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Sanchez E, Rezaei K, Ramos B, Garcia-Borbolla M, Borrego JM. Septal and posterior sliding plasty in tricuspid valve endocarditis. J Card Surg 2020; 36:1123-1125. [PMID: 33124062 DOI: 10.1111/jocs.15139] [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: 09/19/2020] [Accepted: 10/10/2020] [Indexed: 11/27/2022]
Abstract
The tricuspid valve can be affected in left-sided infective endocarditis. We present a new technique to repair anteroseptal tricuspid valve commissure. It was employed in a patient with left-sided infective endocarditis with intervalvular fibrous body abscess. A sliding plasty of septal and posterior leaflets was performed, reaching the anteroseptal commissure with the aid of De-Vega like annuloplasty.
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Affiliation(s)
- Eladio Sanchez
- Department of Cardiac Surgery, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Kambiz Rezaei
- Department of Cardiac Surgery, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Belen Ramos
- Department of Cardiac Surgery, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | | | - Jose-Miguel Borrego
- Department of Cardiac Surgery, Hospital Universitario Virgen del Rocio, Sevilla, Spain
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8
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Bilen Ç, Akkaya G, Tuncer ON, Atay Y. Assessment of Tricuspid Valve Detachment Efficiency for Ventricular Septal Defect Closure: A Retrospective Comparative Study. ACTA CARDIOLOGICA SINICA 2020; 36:360-366. [PMID: 32675928 DOI: 10.6515/acs.202007_36(4).20191012a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The aim of this study was to investigate the efficiency of tricuspid valve detachment (TVD) during the surgical treatment of perimembranous ventricular septal defects (VSDs) and to compare the early and mid-term results to patients without TVD in terms of tricuspid insufficiency. Methods A total of 170 patients who had undergone surgical closure of perimembranous VSDs between November 2012 and January 2019 were included in this study, of whom 50 had an additional TVD procedure during the surgery. All patients were examined by transthoracic echocardiography before and after the operation with regular intervals, and the tricuspid valve function was then evaluated. Results There was no significant difference between subgroups with an unchanging degree of TVR, however, the result was also similar among those who had a decreased degree of TVR at any level (p = 0.271, p = 0.451). At the end of the study, all patients were in New York Heart Association class I. Conclusions We suggest that, in appropriate patients, VSD closure can be safely performed with an additional TVD application through an incision of the septal leaflet of the tricuspid valve without impairing the valve function or reducing the growth potential of the valve at midterm follow-up.
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Affiliation(s)
- Çağatay Bilen
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Gökmen Akkaya
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Osman Nuri Tuncer
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Yüksel Atay
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
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The Fate of the Tricuspid Valve After the Transatrial Closure of the Ventricular Septal Defect. Ann Thorac Surg 2018; 106:1229-1233. [DOI: 10.1016/j.athoracsur.2018.04.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 11/18/2022]
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10
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Pourmoghadam KK, Boron A, Ruzmetov M, Suguna Narasimhulu S, Kube A, O’Brien MC, DeCampli WM. Septal Leaflet Versus Chordal Detachment in Closure of Hard-to-Expose Ventricular Septal Defects. Ann Thorac Surg 2018; 106:814-821. [DOI: 10.1016/j.athoracsur.2018.02.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/07/2018] [Accepted: 02/26/2018] [Indexed: 11/27/2022]
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11
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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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12
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Mahgoub A, Kamel H, Simry W, Hosny H. Repair of very severe tricuspid regurgitation following detachment of the tricuspid valve. Glob Cardiol Sci Pract 2016; 2015:14. [PMID: 26779502 PMCID: PMC4448075 DOI: 10.5339/gcsp.2015.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/26/2015] [Indexed: 11/18/2022] Open
Abstract
We report on the case of 5-year-old girl with severe tricuspid regurgitation following previous repair of double outlet right ventricle with subaortic ventricular septal defect, performed through trans-atrial approach using detachment of tricuspid valve leaflet. The severe tricuspid regurgitation was found to be due to dehiscence at the site of the previous detachment and was repaired using a pericardial patch. In this report, we discuss the relative merits and risks of using this technique.
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Affiliation(s)
- Ahmed Mahgoub
- Aswan Heart Centre, Department of Cardiac Surgery, Aswan, Egypt
| | - Hassan Kamel
- Aswan Heart Centre, Department of Pediatric Cardiology, Aswan, Egypt
| | - Walid Simry
- Aswan Heart Centre, Department of Cardiac Surgery, Aswan, Egypt
| | - Hatem Hosny
- Aswan Heart Centre, Department of Cardiac Surgery, Aswan, Egypt
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13
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Weymann A, Georgiev S, Vogelsang C, Ivad A, Karck M, Gorenflo M, Loukanov T. Temporary Tricuspid Valve Detachment for Ventricular Septal Defect Closure: Is It Worth Doing It? Heart Surg Forum 2015; 16:E99-102. [DOI: 10.1532/hsf98.20121111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
<p><b>Background:</b> Tricuspid valve detachment (TVD) may improve the access for closing certain ventricular septal defects (VSDs), but it has some potential risks. We aimed to study the benefits and drawbacks of this technique.</p><p><b>Methods:</b> The midterm outcomes of all 20 patients who underwent a TVD closure for VSD were reviewed and compared with a control group of 15 patients with VSD closure without TVD.</p><p><b>Results:</b> There was no significant residual shunt in either group at the last actuarial follow-up. Tricuspid regurgitation occurred in both groups (45% in the TVD group and 27% in the control group, <i>P</i> = .48). These lesions were considered insignificant in all patients. There were no atrioventricular blocks, and all patients were in sinus rhythm. The cardiopulmonary bypass times were significantly higher in the TVD group than in the control group (91.6 � 17.2 minutes versus 68.3 � 15.7 minutes, <i>P</i> ? .01), as were the aortic cross-clamping times (50.7 � 12.1 minutes versus 35.9 � 14.4 minutes, <i>P</i> ? .01).</p><p><b>Conclusion:</b> Our results, along with results from other series, suggest that TVD can be used effectively and safely for closure of certain VSDs.</p>
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14
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Desinserción parcial de válvula tricúspide para cierre de comunicación interventricular. CIRUGIA CARDIOVASCULAR 2013. [DOI: 10.1016/j.circv.2013.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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15
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Permanent complete heart block following surgical closure of isolated ventricular septal defect. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tateishi A, Kawada M, Takeuchi M, Taga N, Otsuka Y, Kataoka K. Radial incision for ventricular septal defect with membranous septal aneurysm. Asian Cardiovasc Thorac Ann 2010; 18:250-2. [PMID: 20519293 DOI: 10.1177/0218492310368876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgical exposure and accurate closure of a ventricular septal defect with a membranous septal aneurysm beneath the septal tricuspid leaflet carries a risk of tricuspid valve dehiscence and conduction disturbances when the septal leaflet is detached along the tricuspid annulus. To avoid these problems, we use a radial incision to expose and close perimembranous ventricular septal defects. We reviewed recent cases to determine the risks and benefits of this technique. From January 2005 through September 2008, 30 patients underwent closure of a perimembranous ventricular septal defect through a right atrial approach at our institution. The operation included radial incision of the membranous septal aneurysm to improve visualization of the perimembranous ventricular septal defect in 9 patients. There was no perioperative or late death. The operative and postoperative courses were uneventful in all cases. A residual leak was detected in only one patient. No patient had more than mild postoperative tricuspid valve insufficiency, none underwent reoperation, and no new arrhythmia or conduction disturbance was detected during follow-up. The radial incision for closure of a ventricular septal defect with a membranous septal aneurysm provides satisfactory exposure of the defect through the right atriotomy, for safe and accurate closure.
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Affiliation(s)
- Atsushi Tateishi
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children's Medical Center Tochigi, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
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Häussler A, Prêtre R. Surgical closure of a perimembranous ventricular septum defect with a running suture. Multimed Man Cardiothorac Surg 2008; 2008:mmcts.2006.002410. [PMID: 24415545 DOI: 10.1510/mmcts.2006.002410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A ventricular septum defect (VSD) is a common defect in congenital surgery, either isolated or associated with other malformations. Most of the defects are located around the membranous septum and hence are called 'perimembranous'. The less damaging approach to close them is certainly through an incision in the right atrium. In some trunco-arterial malformation, an incision in the infundibulum is necessary to connect the right ventricle to the pulmonary arteries. A perimembranous VSD can then also be closed using the same incision. The videos show the closure of a perimembranous VSD using these two common approaches. Although many surgeons opt for interrupted stitches reinforced with pledgets to close these defects, a running suture can also be used and, in our opinion, is a reliable and rapid alternative technique.
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Affiliation(s)
- Achim Häussler
- Division of Pediatric and Congenital Cardiovascular Surgery, University and Children Hospital Zürich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
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18
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Sasson L, Katz MG, Ezri T, Tamir A, Herman A, Bove EL, Schachner A. Indications for Tricuspid Valve Detachment in Closure of Ventricular Septal Defect in Children. Ann Thorac Surg 2006; 82:958-63; discussion 963. [PMID: 16928516 DOI: 10.1016/j.athoracsur.2006.03.094] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 03/27/2006] [Accepted: 03/29/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Different techniques have been described for tricuspid valve detachment to improve visualization in ventricular septal defect repair. Our hypothesis was that preoperative echocardiographic criteria are important in deciding which patients should undergo ventricular septal defect repair by tricuspid valve detachment, and patients who undergo this procedure may have a better surgical outcome than those who fulfilled the criteria but were actually operated on with the standard surgical approach. METHODS Between January 2000 and December 2004 we prospectively studied 179 patients scheduled for ventricular septal defect repair and criteria for tricuspid valve detachment were established. Of these, 84 patients did not have any criteria for tricuspid valve detachment and were classified as the control group (group 1). Ninety-five patients with at least one criterion for tricuspid valve detachment were intraoperatively divided by patients who underwent tricuspid valve detachment into group 2 (n = 41), and those who did not undergo tricuspid valve detachment into group 3 (n = 53). RESULTS Surgical complications occurred more frequently in group 3 (26%) as opposed to group 2 (10%) and group 1 (7%). Residual ventricular septal defect and atrioventricular block occurred only in group 3. Tricuspid regurgitation occurred in 15% of group 3 versus 9.8% of group 2 and 7.1% of group 1. CONCLUSIONS Preoperative criteria for tricuspid valve detachment can be established before repair of ventricular septal defect. Patients who had indications for tricuspid valve detachment who actually had detachment performed during repair had fewer postoperative surgical complications as opposed to patients who fulfilled the criteria but did not undergo detachment.
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Affiliation(s)
- Lior Sasson
- Angela & Sami Shamoon Cardiothoracic Department, The Edith Wolfson Medical Center, Holon, Israel
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