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Yang Y, Xi L, Li H. A Retrospective Study in Occluding Sub-arterial Ventricular Septal Defect. Pediatr Cardiol 2024; 45:410-415. [PMID: 37803227 DOI: 10.1007/s00246-023-03309-4] [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: 05/18/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023]
Abstract
To assess the safety and effectiveness of utilizing eccentric occlusion for the treatment of sub-arterial ventricular septal defects, we performed a retrospective study on the classification and analysis of relevant cases. A total of 105 patients with a minimally invasive incision were enrolled in this study, from April 2018 to September 2022. All patients underwent treatment of transthoracic sub-arterial ventricular septal defect occlusion. We analyzed the causes of closure failure, indication, and complication. Briefly, the closure device was successfully implanted in 78 cases (74.2%) with a mean age of 31.4 ± 31.8 months, VSD size of 4.3 ± 0.9 mm, and device size of 6.0 ± 1.1 mm. However, 27 cases (25.8%) required cardiopulmonary bypass due to failure of occlusion. The reasons for failure included 13 cases with worsened aortic regurgitation, two cases with worsened aortic valve prolapse, one case with worsened mitral regurgitation, eight cases with significant residual shunt, and three cases with deviated occlusion morphology. During the 1-36-month follow-up visit, no cases experienced displacement of the eccentric umbrella, shedding, or arrhythmia. All residual shunts resolved during the visit. We concluded that occlusion for sub-arterial VSD has sufficient security and feasibility, under the strict control of surgical indications, appropriate choice of occluder and precise perioperative management.
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Affiliation(s)
- Yan Yang
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
| | - Linyun Xi
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China.
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China.
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Nguyen UH, Nguyen TLT, Kotani Y, Nguyen MT, Mai DD, Nguyen VAT, Nguyen NT. Doubly committed ventricular septal defect: Is it safe to perform surgical closure through the pulmonary trunk approached by right vertical axillary thoracotomy? JTCVS OPEN 2023; 15:368-373. [PMID: 37808014 PMCID: PMC10556957 DOI: 10.1016/j.xjon.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/22/2023] [Accepted: 06/20/2023] [Indexed: 10/10/2023]
Abstract
Objective This study investigated the safety of performing surgical repair for doubly committed ventricular septal defects by right vertical infra-axillary minithoracotomy (RVIAT). Methods A retrospective comparative study was performed to evaluate the outcomes of patients who underwent doubly committed ventricular septal defects closure from January 2019 to May 2022. Seventy-four patients were enrolled in the study and treated with either the median sternotomy approach (MSA: n = 37) or the RVIAT approach (RVIAT: n = 37). Results The median weight and age in the MSA group were significantly lower than those in the RVIAT group (MSA: 6.0 kg [interquartile range] (IQR), 5.2 to 8.7 kg] vs RVIAT: 7.5 kg [IQR, 5.6-14 kg]; P = .034 and MSA: 4.9 months [IQR, 3.6-9.4 month] vs 9.6 months [IQR, 5.0-60.4 months]; P = .0084). No patients died, and no patients in the RVIAT group required conversion to the MSA approach. The mean prebypass surgical time was longer in the RVIAT group (36.1 ± 8.2 minutes vs 31.8 ± 5.6 minutes; P = .03). There were no significant differences between the 2 groups in cardiopulmonary bypass time, aortic crossclamp time, or operation time. Significantly shorter ventilation times were observed in the RVIAT group (11.9 ± 8.2 hours vs 15.4 ± 6.3 hours; P = .006). Conclusions Closure of doubly committed ventricular septal defects through the pulmonary trunk by the RVIAT approach is feasible and safe, and does not increase the risk of bypass-related complications.
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Affiliation(s)
- Uoc Huu Nguyen
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Truong Ly Thinh Nguyen
- Department of Cardiovascular Surgery, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Yasuhiro Kotani
- Department of Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan
| | - Mai Tuan Nguyen
- Department of Cardiovascular Surgery, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Duyen Dinh Mai
- Department of Cardiovascular Surgery, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Van Anh Thi Nguyen
- Department of Cardiology, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Nam Trung Nguyen
- Department of Thoracic and Cardiovascular Surgery, Thanh Hoa Children Hospital, Thanh Hoa, Vietnam
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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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Sotodate G, Oyama K, Saiki H, Takahashi S. Early Ventricular Septal Defect Closure Prevents the Progression of Aortic Regurgitation: A Long-Term Follow-Up Study. Pediatr Cardiol 2021; 42:1607-1613. [PMID: 34059949 DOI: 10.1007/s00246-021-02647-5] [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: 03/22/2021] [Accepted: 05/19/2021] [Indexed: 12/01/2022]
Abstract
According to current short-term evidence, ventricular septal defect (VSD) closure should be performed as early as possible after aortic regurgitation (AR) diagnosis in pediatric patients to prevent AR progression. However, long-term follow-up data are lacking. Therefore, our aim was to evaluate the long-term follow-up (≥ 10 years) of patients who underwent VSD closure as early as possible after AR diagnosis and to evaluate whether early VSD closure prevents progression of AR. This was a retrospective cohort study of 42 patients with VSD and AR who had undergone VSD closure at a median age of 2.9 years, with a median waiting period from AR diagnosis to VSD closure of 3.4 months and follow-up of a median 13.1 years (interquartile range 10.0-15.8 years). The preoperative degree of AR was trivial in 25 patients, mild in 15, and moderate in 2. Of the 33 patients followed up for ≥ 10 years, none required aortic valve replacement and there was no incidence of mortality. The degree of AR improved or did not change, except in 1 patient. The size of the VSD (odds ratio [OR] 0.85; 95% confidence interval [CI] 0.62-1.18; p = 0.33), time from diagnosis to surgery (OR 1.00; 95% CI 1.000-1.001; p = 0.657), and age at the time of surgery (OR 1.00; 95% CI 0.998-1.004; p = 0.452) were not predictive of persistent postoperative AR. Therefore, VSD closure performed as early as possible after AR diagnosis could successfully prevent AR progression in patients with less than moderate preoperative AR, eliminating the need for aortic valve replacement and valvuloplasty.
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Affiliation(s)
- Genichiro Sotodate
- Department of Pediatrics, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Morioka, Iwate, 028-3694, Japan.
| | - Kotaro Oyama
- Department of Pediatrics, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Morioka, Iwate, 028-3694, Japan
| | - Hirofumi Saiki
- Department of Pediatrics, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Morioka, Iwate, 028-3694, Japan
| | - Shin Takahashi
- Department of Pediatrics, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Morioka, Iwate, 028-3694, Japan
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Giridhara P, Poonia A, Sasikumar D, Krishnamoorthy KM, Sivasubramonian S, Valaparambil A. Outflow Ventricular Septal Defect with Aortic Regurgitation: Optimal timing of Surgery? Ann Thorac Surg 2021; 114:873-880. [PMID: 34186092 DOI: 10.1016/j.athoracsur.2021.05.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 05/05/2021] [Accepted: 05/24/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ideal time of surgery still remains controversial in outflow ventricular septal defect (VSD) with aortic regurgitation (AR). We aimed to identify the prevalence and predictors of postoperative AR progression. METHODS 154 patients with outflow-VSD and AR who underwent VSD surgery between 2006 and 2012 were studied retrospectively. RESULTS Total 80 patients with subpulmonic-VSD and 74 with subaortic-VSD were followed-up for mean 6.32+/-2.27 years (range 3-12 years). Of them, 100 had trivial to mild (group-A) and 54 had moderate to severe preoperative-AR (group-B). At follow-up, There was no significant worsening of mean residual AR in group-A (p=0.16) and subpulmonic-VSD of group-B (p=0.083). However, it worsened significantly in subaortic-VSD (1.85+/-0.87 vs 2.21+/-1.08, p=0.005) of group-B. Only 2 (both had subaortic-VSD) patients of group-A developed moderate AR and none required aortic valve replacement (AVR), while 23 (42.60%) of group-B patients developed moderate or severe AR and 7 (30.4%) of them required AVR. Moreover, all who needed AVR had subaortic-VSD and had undergone valvuloplasty during VSD-closure. The 10 years freedom from moderate or severe-AR was significantly lower in group-B than group-A in both VSDs (subaortic-VSD 42.5+/-10.7% vs 89.3+/-8.1%, p<0.01; subpulmonic-VSD 66.7+/-10.3% vs 100%, p<0.01). On multiple regression analysis, postoperative residual-AR was the only predictor of AR-progression (standardized coefficients =0.48; p<0.001) at follow-up. CONCLUSIONS Mild preoperative-AR rarely progressed after VSD-repair. However, worsening of AR could not be prevented effectively, even with valvuloplasty, after the development of moderate or severe AR. Mild or more postoperative residual-AR need close follow-up, especially in subaortic-VSD.
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Affiliation(s)
- Priya Giridhara
- Department of Cardiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - Amitabh Poonia
- Department of Cardiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India.
| | - Deepa Sasikumar
- Department of Cardiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - Kavassery M Krishnamoorthy
- Department of Cardiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - Sivasankaran Sivasubramonian
- Department of Cardiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - Ajitkumar Valaparambil
- Department of Cardiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
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Liao Z, Chen H, Lin L, Chen Q, Chen L, Chen Z. Long-term outcomes after conventional surgical repair versus perventricular device occlusion for doubly committed subarterial ventricular septal defects: a propensity score matched study. Eur J Cardiothorac Surg 2020; 57:929-936. [PMID: 32163571 DOI: 10.1093/ejcts/ezaa020] [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: 07/31/2019] [Revised: 11/09/2019] [Accepted: 11/17/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the long-term outcomes of perventricular device occlusion and surgical repair for doubly committed subarterial ventricular septal defect using propensity score matched analysis because previous comparative studies were limited by differences in the baseline characteristics. METHODS We reviewed inpatients with isolated doubly committed subarterial ventricular septal defect aged <18 years who underwent surgical repair or device occlusion between January 2011 and December 2017. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics. RESULTS A total of 336 patients underwent surgical repair; 99 underwent device occlusion. After matching, the repair group included 164 patients, whereas the device group had 91 patients. There were no significant differences in the baseline characteristics. The median follow-up periods were 46 and 58 months for the device and repair groups, respectively. No significant difference was noted in the rates of cumulative adverse events in the 2 groups (7.9% vs 5.5%; P = 0.61). The repair group required longer periods of hospitalization (P = 0.002) and mechanical ventilation (P = 0.016). No grade 3 or higher valvular regurgitation or high-degree atrioventricular block events were observed. All patients were in sinus rhythm at the last follow-up examination. CONCLUSIONS In selected patients with doubly committed subarterial ventricular septal defect, compared with conventional repair, perventricular device occlusion has comparable efficacy and safety, less invasiveness in terms of time in the hospital and on mechanical ventilation and avoidance of cardiopulmonary bypass.
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Affiliation(s)
- ZhenMei Liao
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Hang Chen
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Li Lin
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
| | - LiangLong Chen
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
| | - ZhaoYang Chen
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
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Outcomes of closure of doubly committed subarterial ventricular septal defects in adults. Cardiol Young 2020; 30:599-606. [PMID: 32308178 DOI: 10.1017/s1047951120000530] [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 Outcome data of doubly committed subarterial ventricular septal defect closure in adults are limited. METHODS A review was made of the inpatients >18 years of age who underwent doubly committed subarterial ventricular septal defect closure between June 2010 and June 2017. RESULTS The patients were categorised into two groups: The valve intervention group consisted of 31 patients who underwent aortic valvuloplasty, aortic valve replacement, or repair of sinus Valsalva aneurysm in addition to doubly committed subarterial ventricular septal defect closure; non-valvular intervention group comprised 58 patients who underwent only doubly committed subarterial ventricular septal defect closure. The groups did not differ by sex and age. Patients in the valve intervention group, with a larger ventricular septal defect size, were shorter and tended to be lighter. The valve intervention group had more patients with pneumonia perioperatively. No infective endocarditis and reoperation were noted during the study period. At last follow-up, 91 and 96.6% of the studied patients were free from left ventricle dilation and pulmonary hypertension. In patients without pre-operative aortic regurgitation, 12 developed new mild aortic regurgitation during the follow-up. CONCLUSIONS About 34.8% of adult patients with doubly committed subarterial ventricular septal defect required concurrent intervention on aortic valve or sinus Valsalva aneurysm. The midterm results of doubly committed subarterial ventricular septal defect closure in adult patients were favourable. However, the incidence of new mild aortic regurgitation after ventricular septal defect closure was high (27.3%). Long-term follow-up of aortic regurgitation progression is needed.
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Kumari V, Shaikh AS, Zakai SB, Kumar N, Bangash SK, Patel N. Incidence of Aortic Regurgitation in Association with Type of Ventricular Septal Defects and its Immediate and Intermediate Outcome after Surgical Closure. Cureus 2019; 11:e5102. [PMID: 31523533 PMCID: PMC6728778 DOI: 10.7759/cureus.5102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction Ventricular septal defect (VSD) is one of the more common congenital heart defects, and aortic regurgitation (AR) is its major complication if it remains unrepaired. We aim to determine the AR incidence in various types of VSD, its immediate and intermediate six to 12-month post-VSD repair outcomes of AR. Methods We conducted a retrospective review of medical records of all children aged 18 years or younger who were diagnosed with single VSD at our institution from 2016 to 2018. VSD was classified according to its location and relation to the tricuspid annulus and semilunar valve. AR severity grading was done according to the American Society of Echocardiography, and vena contracta width (VC) was taken as the main parameter for severity. We defined trivial-to-mild AR as VC width less than 0.3 cm, moderate AR was 0.3-0.6 cm VC width, and severe AR was VC width of more than 0.6 cm. Immediate and intermediate outcomes of surgical closure, such as residual VSD and AR, were observed. Results One hundred ninety patients with isolated single VSD were included in the study. Of those, 114 patients had perimembranous VSD (60.0%), 64 patients had muscular VSD (33.7%), and 12 patients had supracristal VSD (6.3%). The median age of our study cohort was six months, with a male to female ratio of 1.3:1. Aortic valve prolapse (28.9%; n = 55) and AR (23.2%; n = 44) were the most common findings on echocardiographic evaluation of VSD patients. Most cases of VSD with AR had trivial-to-mild AR, (68.2%; n = 30). AR was most commonly seen in supracristal VSD (83.3%; n = 10) followed by perimembranous VSD (28.9%; n = 33). VSD closed spontaneously in 34 patients (17.9%) and 98 patients (51.6%) patients underwent surgery. Residual VSD after surgical closure was present in 57.1% (56) and 17.3% (17) of the patients immediate postoperatively and six- to 12-month postoperative follow-up, respectively. Similarly, residual AR after surgical closure of VSD was present in 32.7% (32) and 15.3% (15) of the patients immediate postoperatively and six- to 12-month postoperative follow-up, respectively. Conclusion The incidence of AR with VSD was very high in our study; AR was most commonly associated with supracristal VSD. After surgical repair, mild AR decreased with time. Early corrective surgery of VSD can prevent this complication and help improve outcomes.
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Affiliation(s)
- Veena Kumari
- Paediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Abdul S Shaikh
- Paediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Saad B Zakai
- Paediatric Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Naresh Kumar
- Paediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Sohail K Bangash
- Paediatric Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Najma Patel
- Paediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
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Huang C, Yu T, Zhang X. Doubly Committed Subarterial Ventricular Septal Defects Closure Using Minimal Mid-Partial Sternotomy. Ann Thorac Cardiovasc Surg 2019; 25:172-175. [PMID: 30541999 DOI: 10.5761/atcs.oa.18-00184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Chengfeng Huang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Tao Yu
- Department of Cardiovascular Surgery, Sichuan General Hospital, Sichuan Academy of Medical Sciences, Chengdu, China
| | - Xiaoshen Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Jinan University, Guangzhou, China
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Waqar T, Rizvi MFA, Baig AR. Doubly committed Subarterial Ventricular Septal defect repair: An experience of 51 cases. Pak J Med Sci 2017; 33:1112-1116. [PMID: 29142548 PMCID: PMC5673717 DOI: 10.12669/pjms.335.13429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To review the surgical outcome of doubly committed subarterial (DCSA) ventricular septal defect repair. Method: Data of 51 patients of doubly committed sub arterial Ventricular septal defect from January 2012 to June 2017 that were referred to Chaudhary Pervaiz Elahi institute of Cardiology Multan was retrospectively reviewed using electronic database. All patients were operated by first author. In our study, we segregated patients into four main groups depending on presence or absence of aortic structural defect and degree of aortic valve regurgitation. Group-A comprised of nineteen (37%) patients who neither had aortic structural nor functional abnormality while Group-B had six (11.7%) patients, having aortic valve cusp prolapse without aortic regurgitation. Group-C and Group-D consists of seventeen (33.3%) and nine (17.6%) patients respectively depending upon degree of aortic regurgitation. Furthermore, six (11.7%) patients among these 51 had associated defects as well. Results: Group-A patients had no aortic valve regurgitation post operatively and at follow up of 22.6 months (1.8 years) as well. In Group-B, aortic valve was not addressed and aortic regurgitation was also not present post operatively or on follow up of 33.6 months (2.8 years). Similarly, in Group-C aortic valve was not addressed, these patients also did not show progression of disease on regular follow up of 18 months (1.5 year). While, in Group-D, eight patients underwent aortic valve repair and one patient had aortic valve replacement. Aortic regurgitation improved significantly in all patients of this group and remained unchanged on follow up of 22.7 months (1.8 years). Conclusion: Early closure of doubly committed subarterial ventricular septal defect with appropriate management of aortic valve disease can halt the process of disease progression.
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Affiliation(s)
- Tariq Waqar
- Tariq Waqar, FCPS, FRCS. Associate Professor of Pediatric Cardiac Surgery, CPE Institute of Cardiology, Multan, Pakistan
| | - Muhammad Farhan Ali Rizvi
- Muhammad Farhan Ali Rizvi, FCPS. Senior Registrar Cardiac Surgery, CPE Institute of Cardiology, Multan, Pakistan
| | - Ahmad Raza Baig
- Ahmad Raza Baig, B.Sc. Hons. CPT. Clinical Perfusionist, CPE Institute of Cardiology, Multan, Pakistan
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Shamsuddin AM, Chen YC, Wong AR, Le TP, Anderson RH, Corno AF. Surgery for doubly committed ventricular septal defects. Interact Cardiovasc Thorac Surg 2016; 23:231-4. [PMID: 27170744 DOI: 10.1093/icvts/ivw129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/09/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Doubly committed ventricular septal defects (VSDs) account for up to almost one-third of isolated ventricular septal defects in Asian countries, compared with only 1/20th in western populations. In our surgical experience, this type of defect accounted for almost three-quarters of our practice. To date, patch closure has been considered the gold standard for surgical treatment of these lesions. Our objectives are to evaluate the indications and examine the outcomes of surgery for doubly committed VSDs. METHODS Between October 2013, when our service of paediatric cardiac surgery was opened, and December 2014, 24 patients were referred for surgical closure of VSDs. Among them, 17 patients (71%), with the median age of 6 years, ranging from 2 to 9 years, and with a median body weight of 19 kg, ranging from 11 to 56 kg, underwent surgical repair for doubly committed defects. In terms of size, the defect was considered moderate in 4 and large in 13. Aortic valvular regurgitation (AoVR) was present in 11 patients (65%) preoperatively, with associated malformations found in 14 (82%), with 5 patients (29%) having two or more associated defects. RESULTS After surgery, there was trivial residual shunting in 2 patients (12%). AoVR persisted in 6 (35%), reducing to trivial in 5 (29%) and mild in 1 (6%). Mean stays in the intensive care unit and hospital were 2.6 ± 1.2 days, ranging from 2 to 7 days, and 6.8 ± 0.8 days, ranging from 6 to 9 days, respectively. The mean follow-up was 14 ± 4 months, ranging from 6 to 20 months, with no early or late deaths and without clinical deterioration. CONCLUSIONS The incidence of doubly committed lesions is high in our experience, frequently associated with AoVR and other associated malformation. Early detection is crucial to prevent further progression of the disease. Patch closure remains the gold standard in management, not least since it allows simultaneous repair of associated intracardiac defects.
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Affiliation(s)
- Ahmad Mahir Shamsuddin
- Pediatric and Congenital Cardiac Surgery Unit, Department of Surgery, School of Medical Sciences, Health Campus, University of Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Yen Chuan Chen
- Pediatric and Congenital Cardiac Surgery Unit, Department of Surgery, School of Medical Sciences, Health Campus, University of Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Abdul Rahim Wong
- Pediatric Cardiology Unit, Department of Pediatrics, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia
| | - Trong-Phi Le
- Department for Structural and Congenital Heart Disease, Heart Center Bremen, Klinikum Links der Weser, Bremen, Germany
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, International Centre for Life, Newcastle upon Tyne, UK
| | - Antonio F Corno
- Pediatric and Congenital Cardiac Surgery, East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK
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Cao H, Chen Q, Zhang GC, Chen LW, Qiu ZH, Xu F. Transthoracic Subarterial Ventricular Septal Defect Occlusion Using a Minimally Invasive Incision. J Card Surg 2016; 31:398-402. [PMID: 27132625 DOI: 10.1111/jocs.12754] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study sought to investigate the feasibility of transthoracic occlusion of a subarterial ventricular septal defect using a minimally invasive incision. METHODS Between January 2009 and June 2014, we performed transthoracic subarterial ventricular septal defect occlusion for 81 patients via a minimally invasive incision. A special delivery sheath was used during surgery, and an eccentric occluder was implanted in the ventricular septal defect. RESULTS Successful defect closure was achieved in 74 cases, perioperative arrhythmia occurred in five cases, and a large pericardial effusion was observed in two cases. Open heart surgery was performed for two patients to repair postoperative dislocation of the occluder. Intraoperative conversion to surgical repair was required in seven cases. During one to five years of follow-up, there was no late occluder dislocation, residual leakage, or thrombus-related complications. CONCLUSIONS Transthoracic subarterial ventricular septal defect occlusion using a minimally invasive incision may be an alternative to open surgical repair in selected patients. doi: 10.1111/jocs.12754 (J Card Surg 2016;31:398-402).
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Affiliation(s)
- Hua Cao
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Gui-Can Zhang
- 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
| | - Zhi-Huang Qiu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Fan Xu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P.R. China
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Salih HG, Ismail SR, Kabbani MS, Abu-Sulaiman RM. Predictors for the Outcome of Aortic Regurgitation After Cardiac Surgery in Patients with Ventricular Septal Defect and Aortic Cusp Prolapse in Saudi Patients. Heart Views 2016; 17:83-87. [PMID: 27867454 PMCID: PMC5105228 DOI: 10.4103/1995-705x.192559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aim: Aortic valve (AV) prolapse and subsequent aortic regurgitation (AR) are two complications of ventricular septal defects (VSD) that are located close to or in direct contact with the AV. This finding is one of the indications for surgical VSD closure even in the absence of symptoms to protect the AV integrity. The goal of our study was to assess the outcome and to identify the predictors for improvement or progression of AR after surgical repair. Materials and Methods: A retrospective study of all children with VSD and AV prolapse who underwent cardiac surgery at King Abdulaziz Cardiac Centre in Riyadh between July 1999 and August 2013. Results: A total of 41 consecutive patients, operated for VSD with prolapsed AV, with or without AR, were reviewed. The incidence of AV prolapse in the study population was 6.8% out of 655 patients with VSD. Thirty-six (88%) patients had a perimembranous VSD, and four had doubly committed VSD. Only one patient had an outlet muscular VSD. Right coronary cusp prolapse was found in 38 (92.7%) patients. Preoperative AR was absent in five patients, mild or less in 25 patients, moderate in seven, and severe in four patients. Twenty-six patients showed improvement in the degree of AR after surgery (Group A), 14 patients showed no change in the degree of AR (Group B) while only one patient showed the progression of his AR after surgery. Those with absent AR before surgery remained with no AR after surgery. Improvement was found more in those with mild degree of AR preoperatively compared to those with moderate and severe AR. Female gender also showed a tendency to improve more as compared to male. Conclusion: Early surgical closure is advisable for patients with VSD and associated AV prolapse to achieve a better outcome after repair and to prevent progression of AR in future.
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Affiliation(s)
- Hiba Gaafar Salih
- Department of Cardiac Sciences, King Abdulaziz Cardiac Center, Section of Pediatric Cardiology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Sameh R Ismail
- Department of Cardiac Sciences, King Abdulaziz Cardiac Center, Section of Pediatric Cardiac ICU, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed S Kabbani
- Department of Cardiac Sciences, King Abdulaziz Cardiac Center, Section of Pediatric Cardiac ICU, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia; King Saud University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Riyadh M Abu-Sulaiman
- Department of Cardiac Sciences, King Abdulaziz Cardiac Center, Section of Pediatric Cardiology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia; King Saud University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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Transfemoral Device Occlusion and Minimally Invasive Surgical Repair for Doubly Committed Subarterial Ventricular Septal Defects. Pediatr Cardiol 2015; 36:1624-9. [PMID: 26033347 DOI: 10.1007/s00246-015-1207-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
Transfemoral device occlusion and minimally invasive surgical repair are performed for doubly committed subarterial ventricular septal defect (dcVSD) to reduce the invasiveness of the conventional surgical repair through a median sternotomy. However, few studies have compared them in terms of effectiveness and cost. Inpatients with isolated dcVSD who had undergone transfemoral device occlusion or minimally invasive surgical repair from January 2011 to June 2014 were reviewed for a comparative investigation between the two procedures. Procedure success was achieved in 36 transfemoral (75 %) and in 36 surgical (100 %) procedures (p = 0.001). Transfemoral patients were older, with a VSD size similar to that of surgical patients (14.5 ± 11.7 vs 4.4 ± 2.9 years, p < 0.001; 4.5 ± 1.5 vs 4.4 ± 1.3 mm, p = 0.577, respectively). No significant difference was observed in complication rates between the two treatment groups (p = 1). No large residual shunt was observed. Small residual shunt was noted in two transfemoral patients and four surgical patients (p = 0.674). All these small residual shunts closed spontaneously during follow-up. The surgical repair costs 26 % less than the device occlusion (Yuan 22063.2 ± 343.9 vs Yuan 29970.1 ± 1335.2, p < 0.001), where most of the cost was attributed to the occluder in the amount of Yuan 19,500. Compared with device occlusion, minimally invasive surgical repair can provide superior efficacy and comparable complication rates. In addition, it is 26 % cheaper than device occlusion. In low-income countries where healthcare resources are limited, medical resources must be judiciously allocated to the treatment that allows for effective treatment of the largest number of patients.
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Zhao Yang C, Hua C, Yuan Ji M, Qiang C, Wen Zhi P, Wan Hua C, Chang X, Lin F, Liang-Long C, Jun Bo G. Transfemoral and Perventricular Device Occlusions and Surgical Repair for Doubly Committed Subarterial Ventricular Septal Defects. Ann Thorac Surg 2015; 99:1664-70. [DOI: 10.1016/j.athoracsur.2015.01.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/30/2014] [Accepted: 01/06/2015] [Indexed: 10/23/2022]
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16
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Devlin PJ, Russell HM, Mongé MC, Patel A, Costello JM, Spicer DE, Anderson RH, Backer CL. Doubly Committed and Juxtaarterial Ventricular Septal Defect: Outcomes of the Aortic and Pulmonary Valves. Ann Thorac Surg 2014; 97:2134-40; discussion 2140-1. [DOI: 10.1016/j.athoracsur.2014.01.059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 12/26/2013] [Accepted: 01/06/2014] [Indexed: 11/26/2022]
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Li ZQ, Liu AJ, Li XF, Zhu YB, Liu YL. Progression of aortic regurgitation in Asian patients with congenital sinus of valsalva aneurysm. Heart Surg Forum 2013; 16:E219-24. [PMID: 23958536 DOI: 10.1532/hsf98.20131019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND We reviewed the experience of An Zhen and Fu Wai Hospital for congenital sinus of Valsalva aneurysm (SVA) to determine risk factors for aortic valve replacement (AVR) and postoperative progression of aortic regurgitation (AR). METHODS Over a 7-year period, 255 patients underwent surgical repair of an SVA. Aneurysms originated from the right sinus and the noncoronary sinus in 212 patients (83.1%) and 38 patients (14.9%), respectively, and protruded into the right ventricle and right atrium in 171 patients (67.1%) and 80 patients (31.4%), respectively. AR presented in 142 patients (55.7%), 60 patients underwent AVR, and 13 patients underwent aortic valvuloplasty (3 patients eventually received AVR for valvuloplasty failure). RESULTS All patients survived the operation. Late death occurred in 2 patients (0.8%), and 2 patients (0.8%) experienced anticoagulation-related complications. Logistic regression analysis revealed that infective endocarditis, the cardiothoracic ratio, and a nonruptured SVA were risk factors for AVR. Late follow-up of 150 patients by echocardiographic assessment revealed that AR improved in 17 patients and worsened in 20 patients. Cox regression analysis revealed AR at discharge to be an independent risk factor for AR aggravation at late follow-up. CONCLUSIONS SVA can be repaired with low mortality and excellent long-term results. AR at discharge is an important factor in determining AR aggravation at late follow-up after the operation. We recommend early diagnosis and aggressive treatment for SVA.
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Affiliation(s)
- Zhi-Qiang Li
- Department of Pediatric Cardiac Surgery Center, Anzhen Hospital, Capital Medical University, Beijing, China
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18
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Lin K, Zhu D, Tao K, Gan C, Tang H, Feng Y, An Q. Hybrid perventricular device closure of doubly committed subarterial ventricular septal defects: Mid-term results. Catheter Cardiovasc Interv 2013; 82:E225-32. [PMID: 23413226 DOI: 10.1002/ccd.24869] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 02/09/2013] [Indexed: 02/05/2023]
Affiliation(s)
- Ke Lin
- Department of Cardiovascular Surgery; West China Hospital; Sichuan University; Chengdu; Sichuan; People's Republic of China
| | - Da Zhu
- Department of Cardiovascular Surgery; West China Hospital; Sichuan University; Chengdu; Sichuan; People's Republic of China
| | - Kaiyu Tao
- Department of Cardiovascular Surgery; The Second Affiliated Hospital of Zhejiang University College of Medicine; Hangzhou; Zhejiang; People's Republic of China
| | - Changping Gan
- Department of Cardiovascular Surgery; West China Hospital; Sichuan University; Chengdu; Sichuan; People's Republic of China
| | - Hong Tang
- Department of Cardiology; West China Hospital; Sichuan University; Sichuan University; Chengdu; Sichuan; People's Republic of China
| | - Yuan Feng
- Department of Cardiology; West China Hospital; Sichuan University; Sichuan University; Chengdu; Sichuan; People's Republic of China
| | - Qi An
- Department of Cardiovascular Surgery; West China Hospital; Sichuan University; Chengdu; Sichuan; People's Republic of China
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Risk Factors for Preoperative and Postoperative Progression of Aortic Regurgitation in Congenital Ruptured Sinus of Valsalva Aneurysm. Ann Thorac Surg 2011; 91:542-8. [DOI: 10.1016/j.athoracsur.2010.07.076] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 07/20/2010] [Accepted: 07/21/2010] [Indexed: 11/22/2022]
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20
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Intraoperative Device Closure of Doubly Committed Subarterial Ventricular Septal Defects: Initial Experience. Ann Thorac Surg 2010; 90:869-73. [DOI: 10.1016/j.athoracsur.2010.06.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 06/01/2010] [Accepted: 06/07/2010] [Indexed: 11/20/2022]
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21
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Joshi P, Wong M, Londhe V, Sim KH. Impact of Surgical Closure of VSD With Prolapsed Aortic Valve on Aortic Cusp Deformity Indices Assessed By 2D-Trans-Thoracic Echocardiography. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.04.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Kale SB, Finucane K, Chan TL, Rumball E, Gentles T. Midterm Results of Repair of Perimembranous or Conal Ventricular Septal Defects Using the Transaortic Direct Suture Technique. Ann Thorac Surg 2010; 89:1244-9. [DOI: 10.1016/j.athoracsur.2009.12.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 12/13/2009] [Accepted: 12/15/2009] [Indexed: 11/25/2022]
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23
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Yip WCL. Paediatric Cardiology in Singapore – 1978 to 2008. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n3p181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This article marks Congenital Heart Defect Awareness Week, 7 to 14 February 2009 (http://tchin.org/aware/ index.htm). The title, “Paediatric Cardiology in Singapore – 1978 to 2008” reflects the most exciting phase in the development of paediatric cardiology in Singapore. Congenital heart defect (CHD), with an incidence of 1 in 100 live births, is the most important and frequent congenital malformation, causing much morbidity and mortality in infants, children, and even in adults.1,2 This article highlights some advances in the science, and the changing patterns in the practice, of paediatric cardiology in Singapore.
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Chiu SN, Wang JK, Lin MT, Chen CA, Chen HC, Chang CI, Chen YS, Chiu IS, Lue HC, Wu MH. Progression of aortic regurgitation after surgical repair of outlet-type ventricular septal defects. Am Heart J 2007; 153:336-42. [PMID: 17239699 DOI: 10.1016/j.ahj.2006.10.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Accepted: 10/31/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Progression of aortic regurgitation (AR) in repaired outlet ventricular septal defects (VSDs) remains unclear, especially for muscular outlet and perimembranous outlet VSDs. We tried to identify the risk factors for AR progression and aortic valve replacement (AVR) at long-term follow-up. METHODS Four hundred patients with complete follow-up after the repair of their outlet VSD between 1987 and 2002 were studied. RESULTS Juxta-arterial VSD, perimembranous outlet VSD, and muscular outlet VSD were noted in 190, 148, and 62 patients, respectively. There were 377 patients with none to mild AR (group I) and 23 with moderate to severe AR (group II) preoperatively. Aortic valve replacement was performed on 11 patients (all from group II), with 10 having received AVR concomitantly with VSD repair and 1 having received it 4 years later. Only severity of preoperative AR and older age (>15 years) at VSD repair were significant predictors of AVR. With a total follow-up of 2230 person-years, the 10-year freedom from AVR after VSD repair for group I was 100% and that for group II was 50.2%. In group I, AR progressed in 4 patients only (1.2%, 2 juxta-arterial and 2 perimembranous outlet) and aortic valvular (aortic valve prolapse or ruptured sinus Valsalva aneurysm) or subvalvular anomalies were present in all. The event-free (AR or AVR) survival rates among the 3 outlet-type VSDs however showed no difference. CONCLUSIONS Aortic regurgitation progression modes after surgical VSD repair were similar among the 3 outlet-type VSDs. Aortic valve replacement was rarely necessary for patients who were operated on when they were younger than 15 years. Aortic regurgitation of a less-than-moderate degree preoperatively rarely progressed after VSD repair.
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Affiliation(s)
- Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
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25
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Jian-Jun G, Xue-Gong S, Ru-Yuan Z, Min L, Sheng-Lin G, Shi-Bing Z, Qing-Yun G. Ventricular septal defect closure in right coronary cusp prolapse and aortic regurgitation complicating VSD in the outlet septum: which treatment is most appropriate? Heart Lung Circ 2006; 15:168-71. [PMID: 16697257 DOI: 10.1016/j.hlc.2005.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Revised: 06/02/2005] [Accepted: 10/10/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is currently not a standardized technique for the sizing and shaping of surgical closure of the ventricular septal defect (VSD) patch in patients with right coronary aortic cusp prolapse and aortic regurgitation (AR) complicating VSD in the outlet septum. METHODS Forty-six VSD patients who had aortic valve prolapse were divided into groups DC (direct closure, n=19), and SPC (small patch closure, n=27). Preoperative and postoperative echocardiography with Doppler color flow interrogation was performed on all patients. RESULTS In the DC group, among seven patients who had aortic valve prolapse but no AR preoperative, one patient developed AR during postoperative follow-up period. In the remaining 12 patients who had mild AR associated with aortic valve prolapse prior to the procedure, AR was diminished in four and unchanged in six patients. However, AR was aggravated in two patients who required further operations for AV repair or replacement. In the SPC group, among the eight patients who had no preoperative AR, AR progressed in one patient postoperatively. In the remaining 19 patients who had mild AR, AR was diminished in 15 and unchanged in four. The outcome from the operative procedure was significantly better in the SPC group than DC group with mild preoperative AR (chi(2)=7.82; P<0.05). CONCLUSIONS Small patch closure for this type of VSD is safer and more reliable in improving mild AR than that of direct closure, especially in patients with mild AR.
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Affiliation(s)
- Ge Jian-Jun
- Department of Cardiovascular Surgery, 1st Hospital of Anhui Medical University, Hefei, 218 Jixi Road, Hefei, Anhui 230022, China.
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Doll U, Herberg U, Tiemann K, Schirrmeister J, Bernhardt C, Köhler W, Schmitz C, Breuer J. Ruptured sinus of Valsalva aneurysm in two patients with subarterial ventricular septal defect. Clin Res Cardiol 2006; 95:127-31. [PMID: 16598524 DOI: 10.1007/s00392-006-0333-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Accepted: 10/10/2005] [Indexed: 11/30/2022]
Abstract
Rupture of a sinus of Valsalva aneurysm (SVA) is a rare, but life-threatening, event and requires immediate recognition and intervention. We present two previously healthy and physically active patients who were 12 and 33 years of age when rupture of a right coronary SVA into the right ventricle occurred. A subarterial ventricular septal defect (VSD) was detectable in both patients. Cardiac surgery involved VSD closure as well as reconstruction of the aortic valve. Considering complications of subarterial VSD, such as aortic cusp prolapse, aortic insufficiency or SVA, we suggest close follow-up and surgical closure of the VSD in case of any aortic valve deformity.
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Affiliation(s)
- Ulrike Doll
- Universitätsklinikum Bonn, Abteilung für Kinderkardiologie, Adenauerallee 119, 53113 Bonn, Germany.
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Tweddell JS, Pelech AN, Frommelt PC. Ventricular septal defect and aortic valve regurgitation: pathophysiology and indications for surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2006:147-52. [PMID: 16638560 DOI: 10.1053/j.pcsu.2006.02.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
As the velocity of a fluid increases a low-pressure zone is created, this is the Venturi effect and it explains the pathogenesis of aortic valve prolapse (AVP) and aortic insufficiency (AI) that is observed in a subset of patients with a ventricular septal defect (VSD). The VSDs complicated by AI are restrictive with high velocity shunting through the VSD, creating a low-pressure zone that impacts the adjacent aortic valve cusp resulting in AVP and subsequent AI. AVP and AI are therefore acquired lesions. AI is absent at birth because the forces necessary to create the low-pressure zone within the restrictive VSD do not exist in utero. The risk of development of AI increases during childhood, peaking at 5 to 10 years of age. VSD closure eliminates the low-pressure zone that is the cause of ongoing aortic valve cusp deformity and, if performed early, prevents development of AI. Patients with a subarterial VSD and AVP should undergo surgery to prevent the development of AI because this complicates about half of subarterial VSDs with AVP and spontaneous closure is rare. Patients with perimembranous VSDs with AVP should be followed with serial echocardiography and undergo VSD closure if more than trivial AI develops.
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Affiliation(s)
- James S Tweddell
- Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
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Tomita H, Arakaki Y, Ono Y, Yamada O, Yagihara T, Echigo S. Impact of noncoronary cusp prolapse in addition to right coronary cusp prolapse in patients with a perimembranous ventricular septal defect. Int J Cardiol 2005; 101:279-83. [PMID: 15882676 DOI: 10.1016/j.ijcard.2004.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2003] [Revised: 12/23/2003] [Accepted: 03/05/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Few data are available with regard to the impact of aortic cusp herniation on the evolution of aortic regurgitation (AR) in patients with a perimembranous ventricular septal defect (VSD). METHODS One hundred and two patients with a perimembranous ventricular septal defect with right coronary cusp prolapse were divided to two groups depending on the development of aortic regurgitation. The original defect diameter, the right coronary cusp deformity index (RCCD), and the right coronary cusp imbalance index were obtained as we reported previously. RESULTS Mild aortic regurgitation was detected in 35 patients, and moderate in three. No aortic regurgitation was observed in 64 patients. A significantly larger number of patients had noncoronary cusp prolapse and the right coronary cusp imbalance index >/=1.30 in the aortic regurgitation group than in the no regurgitation group. Relative risk and odds ratio of noncoronary cusp prolapse and the right coronary cusp imbalance index >/=1.30 for development of aortic regurgitation were 3.69 (95% CI, 0.91-15.03) and 27.90 (95.94-130.85), and 2.23 (0.83-5.98) and 4.70 (1.44-15.27), respectively. Surgical closure was performed in 29 patients. All patients with no noncoronary cusp prolapse underwent simple patch closure of the ventricular septal defect, while five patients with noncoronary cusp prolapse and aortic regurgitation underwent aortic valvuloplasty. Among these, one patient needed aortic valve replacement. CONCLUSIONS The additional complication of noncoronary cusp prolapse is a strong risk factor for the development of aortic regurgitation in patients with a perimembranous ventricular septal defect with right coronary cusp prolapse.
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Affiliation(s)
- Hideshi Tomita
- Department of Pediatrics, Sapporo Medical University, School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
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29
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Tomita H, Arakaki Y, Ono Y, Yamada O, Yagihara T, Echigo S. Severity Indices of Right Coronary Cusp Prolapse and Aortic Regurgitation Complicating Ventricular Septal Defect in the Outlet Septum-Which Defect Should Be Closed?-. Circ J 2004; 68:139-43. [PMID: 14745149 DOI: 10.1253/circj.68.139] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The factors that may determine the evolution of right coronary cusp prolapse (RCCP) and regurgitation (AR) associated with a ventricular septal defect in the outlet septum (outlet VSD) have not been clarified. METHODS AND RESULTS The Doppler echocardiograms of 316 patients were grouped according to both the development of RCCP, and the values of the right coronary cusp deformity index (RCCD) and the right coronary cusp imbalance index (R/L). All detected AR was </= slight, and not progressive in patients with both RCCD <0.30 and R/L <1.30. Moderate AR was detected in patients with either RCCD >/=0.30 or R/L >/=0.30. Rupture of the sinus of Valsalva was identified in patients with RCCD >/=0.30. A significantly large number of patients with both RCCD >/=0.30 and R/L >/=1.30 (p<0.01), and a few patients with either RCCD >/=0.30 or R/L >/=0.30 underwent aortic valvuloplasty or replacement. Operative outcome for AR </= slight was good. CONCLUSIONS There is no need to close an outlet VSD with RCCP when the RCCD <0.30 and R/L <1.30 as long as the AR remains trivial, but such defects should be closed when the RCCD is >/=0.30 or R/L >/=1.30.
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Affiliation(s)
- Hideshi Tomita
- Departments of Pediatrics, National Cardiovascular Center, Suita, Osaka, Japan.
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Tomita H, Yamada O, Kurosaki KI, Yagihara T, Echigo S. Eccentric aortic regurgitation in patients with right coronary cusp prolapse complicating a ventricular septal defect. Circ J 2003; 67:672-5. [PMID: 12890908 DOI: 10.1253/circj.67.672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To analyze the clinical significance of eccentric aortic regurgitation (AR) complicating the right coronary cusp prolapse associated with a ventricular septal defect (VSD), the Doppler echocardiograms of 129 patients were reviewed. In 102 patients, AR was classified as mild and in 27 patients it was classified as moderate. Eccentric AR was defined as the jet distributing in an eccentric direction. In 15 patients of the moderate group, AR was already moderate at the initial examination and of these, the AR was eccentric in 14 and central in 1. In 12 patients who initially had mild AR, it became moderate during follow-up. In 7 patients with mild, central AR, 6 worsened to central moderate AR and 1 evolved to eccentric moderate AR. Eccentric mild AR patients all developed eccentric moderate AR. Within the mild AR group, 5 of 9 patients with eccentric AR progressed from mild to moderate, whereas only 7 of 105 patients with central AR did so (p<0.01). In conclusion, eccentric AR may be an advanced finding of the AR associated with right coronary cusp prolapse in some patients, but in others eccentric AR is highly likely to progress and is malignant.
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Affiliation(s)
- Hideshi Tomita
- Department of Pediatrics, National Cardiovascular Center, Suita, Japan.
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31
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Cheung YF, Chiu CSW, Yung TC, Chau AKT. Impact of preoperative aortic cusp prolapse on long-term outcome after surgical closure of subarterial ventricular septal defect. Ann Thorac Surg 2002; 73:622-7. [PMID: 11848094 DOI: 10.1016/s0003-4975(01)03393-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Previous reports on the long-term outcome of surgical closure of subarterial ventricular septal defect were based on a relatively small number of patients. METHODS We reviewed the long-term outcome of 135 patients who underwent closure of their defect and, in light of the findings, assessed the impact of preoperative aortic cusp prolapse and surgical interventions on occurrence of aortic regurgitation (AR) in the long-term. The patients were categorized into three groups for comparison: group I consisted of 79 patients with no aortic cusp prolapse and underwent simple closure of ventricular septal defect, group II comprised 39 patients with mild to moderate cusp prolapse who similarly had only closure of the defect performed, whereas group III comprised 17 patients who had additional aortic valvoplasty for greater than moderate to severe cusp prolapse. RESULTS Group I patients had significantly higher pulmonary arterial pressure (p < 0.001) and ratio of pulmonary blood flow to systemic blood flow (p < 0.001). None of these patients had AR before their operation, and none experienced AR afterward at a median follow-up of 6.1 years. Of the 39 group II patients, 30 (77%) had trivial or mild AR preoperatively. The AR improved in 15 patients, remained trivial or mild in 14 and absent in 7, but progressed to trivial or mild in 3 at a median follow-up of 3.1 years. None required further interventions. In contrast, 14 (82%) of the 17 group III patients had moderate to severe AR before operation. The regurgitation improved in 10, but remained moderate or severe in 4 and worsened further in 3 at a median follow-up of 4.6 years. The freedom from failure of aortic valvoplasty was (mean +/- standard error of the mean) 71%+/-11%, 64%+/-12%, and 43%+/-19% at 1, 5, and 10 years, respectively. An older age at latest follow-up was the only identifiable significant risk factor (p = 0.03). CONCLUSIONS Our data do not support the need of aortic valvoplasty for mild to moderate aortic cusp prolapse. Close follow-up is warranted in those with greater than moderate to severe cusp prolapse despite valvoplasty as there is continued failure on follow-up. Nothing, however, is better than early closure of defects before development of aortic valve complications.
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Affiliation(s)
- Yiu-Fai Cheung
- Division of Paediatric Cardiology, Grantham Hospital, The University of Hong Kong, People's Republic of China.
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Tomita H, Arakaki Y, Ono Y, Yamada O, Tsukano S, Yagihara T, Echigo S. Evolution of aortic regurgitation following simple patch closure of doubly committed subarterial ventricular septal defect. Am J Cardiol 2000; 86:540-2. [PMID: 11009273 DOI: 10.1016/s0002-9149(00)01009-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We reviewed the Doppler echocardiographic findings of the aortic valve and associated aortic regurgitation (AR) in 55 patients who underwent patch closure of doubly committed subarterial ventricular septal defect (VSD). The maximal diameter of the VSD measured > or = 5 mm, whereas the postoperative follow-up interval was > or = 5 years. Twenty-three patients underwent closure before they developed aortic cusp prolapse or AR (group A). In 15 patients the VSD was closed when aortic cusp prolapse was recognized, but AR was absent (group B). Aortic cusp prolapse with AR was detected before closure in a further 15 patients (group C). Of 8 patients with no AR before closure, AR was detected during follow-up in 6 group A and in 2 group B patients. In group C, AR resolved after surgery in 4 patients, whereas AR grade improved in a further 8 patients and remained unchanged in 3. Although residual AR was more frequent in patients with aortic cusp prolapse and AR before closure, it was silent and asymptomatic.
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Affiliation(s)
- H Tomita
- Department of Pediatrics and Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan
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Sim EK, Grignani RT, Wong ML, Quek SC, Wong JC, Yip WC, Lee CN. Influence of surgery on aortic valve prolapse and aortic regurgitation in doubly committed subarterial ventricular septal defect. Am J Cardiol 1999; 84:1445-8, A8. [PMID: 10606121 DOI: 10.1016/s0002-9149(99)00594-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Doubly committed subarterial ventricular septal defects should be closed surgically once aortic valve deformity is present before the onset of aortic regurgitation.
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Affiliation(s)
- E K Sim
- Cardiac Department National University Hospital, Singapore, Singapore.
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