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Loomba RS, Rausa J, Villarreal E, Farias JS, Flores S. Postoperative Atrioventricular Block in Pediatric Patients: Impact of Congenital Cardiac Malformations and Medications. Pediatr Cardiol 2024; 45:759-769. [PMID: 38427091 DOI: 10.1007/s00246-024-03427-7] [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: 11/19/2023] [Accepted: 01/20/2024] [Indexed: 03/02/2024]
Abstract
Postoperative atrioventricular block may occur after pediatric cardiac surgery. A small proportion of those who develop atrioventricular block will require pacemaker placement. The primary aim of this study was to determine factors associated with postoperative atrioventricular block. Secondary aims included determining factors associated with pacemaker placement in those with atrioventricular block. Data from the PHIS data were utilized to identify patients under 18 years of age who underwent cardiac surgery. Those who did and did not develop atrioventricular block. Univariable analyses and regression analyses were conducted to determine factors associated with postoperative atrioventricular block. Similar analyses were conducted to determine factors associated with pacemaker placement in those with atrioventricular block. A total of 43,716 admissions were identified. Of these, 2093 (5%) developed atrioventricular block and 480 (1% of total admissions) underwent pacemaker placement. Approximately 70% of those with atrioventricular block received steroids but this was not associated with a decrease in pacemaker placement. Risk factors (congenital malformations of the heart, comorbidities, medications) associated with increased risk of atrioventricular block and pacemaker placement were identified. Postoperative atrioventricular block occurred in 5% of pediatric admissions for cardiac surgery. Of these admissions with postoperative atrioventricular block, 23% required pacemaker placement. Isoproterenol and steroids were not associated with a reduction in the likelihood of pacemaker placement.
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Affiliation(s)
- Rohit S Loomba
- Advocate Children's Hospital, Chicago, IL, USA.
- Chicago Medical School/Rosalind Franklin University of Medicine and Science, Chicago, IL, USA.
| | | | - Enrique Villarreal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | | | - Saul Flores
- Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
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Robinson JA, Leclair G, Escudero CA. Pacing in Pediatric Patients with Postoperative Atrioventricular Block. Card Electrophysiol Clin 2023; 15:401-411. [PMID: 37865514 DOI: 10.1016/j.ccep.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Surgery for congenital heart disease may compromise atrioventricular (AV) nodal conduction, potentially resulting in postoperative AV block. In the majority of cases, AV nodal function recovers during the early postoperative period and may only require short-term pacing support, typically provided via temporary epicardial wires. Permanent pacing is indicated when the postoperative AV block persists for more than 7 to 10 days due to the risk of mortality if a pacemaker is not implanted. Although there is a subset of patients who may have late recovery of AV nodal function, those with continued postoperative AV block will need lifelong pacing therapy.
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Affiliation(s)
- Jeffrey A Robinson
- Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Pediatric Cardiac Electrophysiology, The Criss Heart Center, Children's Hospital and Medical Center, 8200 Dodge Street, Omaha, NE 68114, USA
| | - Guillaume Leclair
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada; Stollery Children's Hospital, 4C1.19 WMC, 8440-112 Street, Edmonton, Alberta T6G 2B7, Canada
| | - Carolina A Escudero
- University of Alberta, Edmonton, Alberta, Canada; Pediatric Cardiology and Electrophysiology, Stollery Children's Hospital, Edmonton, Alberta, Canada.
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Ganea G, Cinteză EE, Filip C, Iancu MA, Balta MD, Vătășescu R, Vasile CM, Cîrstoveanu C, Bălgrădean M. Postoperative Cardiac Arrhythmias in Pediatric and Neonatal Patients with Congenital Heart Disease-A Narrative Review. Life (Basel) 2023; 13:2278. [PMID: 38137879 PMCID: PMC10744555 DOI: 10.3390/life13122278] [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: 10/06/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
Cardiac arrhythmias are a frequent complication in the evolution of patients with congenital heart disease. Corrective surgery for these malformations is an additional predisposition to the appearance of arrhythmias. Several factors related to the patient, as well as to the therapeutic management, are involved in the etiopathogenesis of cardiac arrhythmias occurring post-operatively. The risk of arrhythmias in the immediate postoperative period is correlated with the patient's young age and low weight at surgery. The change in heart geometry, hemodynamic stress, and post-surgical scars represent the main etiopathogenic factors that can contribute to the occurrence of cardiac arrhythmias in the population of patients with operated-on congenital heart malformations. Clinical manifestations differ depending on the duration of the arrhythmia, underlying structural defects, hemodynamic conditions, and comorbidities. The accurate diagnosis and the establishment of specific management options strongly influence the morbidity and mortality associated with arrhythmias. As such, identifying the risk factors for the occurrence of cardiac arrhythmias in the case of each patient is essential to establish a specific follow-up and management plan to improve the life expectancy and quality of life of children.
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Affiliation(s)
- Gabriela Ganea
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.G.); (E.E.C.); (C.F.); (M.B.)
- “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Eliza Elena Cinteză
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.G.); (E.E.C.); (C.F.); (M.B.)
- “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Cristina Filip
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.G.); (E.E.C.); (C.F.); (M.B.)
- “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Mihaela Adela Iancu
- Department of Internal Medicine, Family Medicine and Labor Medicine, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Alessandrescu-Rusescu” National Institute for Mother and Child Health, 20382 Bucharest, Romania
| | - Mihaela Daniela Balta
- Department of Internal Medicine, Family Medicine and Labor Medicine, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Alessandrescu-Rusescu” National Institute for Mother and Child Health, 20382 Bucharest, Romania
| | - Radu Vătășescu
- Emergency Clinical Hospital, 014461 Bucharest, Romania
- Cardio-Thoracic Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Corina Maria Vasile
- Pediatric and Adult Congenital Cardiology Department, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, France;
| | - Cătălin Cîrstoveanu
- Department of Neonatal Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Neonatal Intensive Care Unit, M.S. Curie Children’s Clinical Hospital, 041451 Bucharest, Romania
| | - Mihaela Bălgrădean
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.G.); (E.E.C.); (C.F.); (M.B.)
- “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
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Alshahrani D, Linnane N, McCrossan B, Oslizlok P, McMahon CJ, Walsh KP, Kenny DP. Transfemoral Perimembranous Ventricular Septal Defect Device Closure in Infants Weighing ≤ 10 kg. Pediatr Cardiol 2023; 44:1176-1182. [PMID: 36698044 PMCID: PMC10224829 DOI: 10.1007/s00246-023-03100-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Abstract
Transcatheter closure of Perimembranous VSDs (PMVSD) remains challenging particularly in infants. The aim of this study is to evaluate the efficacy and safety of transfemoral PMVSD device closure in infants weighing ≤ 10 kg in a single centre. Retrospective review of departmental databases and medical charts to define patient cohort and collect demographic, procedural and follow-up data. Between July 2014 and March 2021, 16 patients underwent attempted transfemoral PMVSD device closure (12 retrograde) at a median age of 11 months (interquartile range [IQR] 9-15.5) and a median weight of 8.3 kg (IQR 7.2-9.5). All patients were either symptomatic, had progressive left heart dilation or had VSD associated valve regurgitation. Median defect size on pre-procedural transoesophageal echocardiography was 6.8 mm (IQR 6-8.5). Median device waist size was 6 mm (IQR 4.5-8). Successful device placement was achieved in 14 patients (88%). One patient developed moderate aortic and tricuspid valve regurgitation upon retrograde and antegrade device deployment, respectively, and subsequently underwent surgical closure. The second patient developed progressive aortic regurgitation (AR) 2 days post procedure, and also underwent surgical removal with no residual AR. There was no cases of device embolization and no femoral arterial compromise. On median follow-up of 40.5 months (IQR 25-64), none of the patients developed complete heart block. Three patients (18.75%) had small residual shunts at latest follow-up which have not required any further intervention. Device closure of PMVSD's in children weighing ≤ 10 kg is feasible and safe with good procedural success rates. Use of both the antegrade and retrograde approaches may be necessary depending on anatomical variances.
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Affiliation(s)
- Dhafer Alshahrani
- Department of Pediatric Cardiology, Children's Health Ireland at Crumlin, Dublin 12, Republic of Ireland
- Section of Pediatric Cardiology, Department of Cardiac Sciences, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Niall Linnane
- Department of Pediatric Cardiology, Children's Health Ireland at Crumlin, Dublin 12, Republic of Ireland
| | - Brian McCrossan
- Department of Pediatric Cardiology, Children's Health Ireland at Crumlin, Dublin 12, Republic of Ireland
- Department of Pediatric Cardiology, Royal Belfast Hospital of Sick Children, Belfast, UK
| | - Paul Oslizlok
- Department of Pediatric Cardiology, Children's Health Ireland at Crumlin, Dublin 12, Republic of Ireland
| | - Colin J McMahon
- Department of Pediatric Cardiology, Children's Health Ireland at Crumlin, Dublin 12, Republic of Ireland
| | - Kevin P Walsh
- Department of Pediatric Cardiology, Children's Health Ireland at Crumlin, Dublin 12, Republic of Ireland
| | - Damien P Kenny
- Department of Pediatric Cardiology, Children's Health Ireland at Crumlin, Dublin 12, Republic of Ireland.
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Paediatrician's guide to post-operative care for biventricular CHD: a review. Cardiol Young 2022; 32:1721-1727. [PMID: 36165406 DOI: 10.1017/s1047951122002955] [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
IMPORTANCE Paediatricians play an integral role in the lifelong care of children with CHD, many of whom will undergo cardiac surgery. There is a paucity of literature for the paediatrician regarding the post-operative care of such patients. OBSERVATIONS The aim of this manuscript is to summarise essential principles and pertinent lesion-specific context for the care of patients who have undergone surgery or intervention resulting in a biventricular circulation. CONCLUSIONS AND RELEVANCE Familiarity with common issues following cardiac surgery or intervention, as well as key details regarding specific lesions and surgeries, will aid the paediatrician in providing optimal care for these patients.
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Li M, Wang S, Zhang H, Zhang H, Wu Y, Meng B. The predictive value of pressure recording analytical method for the duration of mechanical ventilation in children undergoing cardiac surgery with an XGBoost-based machine learning model. Front Cardiovasc Med 2022; 9:1036340. [PMID: 36386354 PMCID: PMC9649993 DOI: 10.3389/fcvm.2022.1036340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/05/2022] [Indexed: 12/05/2022] Open
Abstract
Objective Prolonged mechanical ventilation in children undergoing cardiac surgery is related to the decrease in cardiac output. The pressure recording analytical method (PRAM) is a minimally invasive system for continuous hemodynamic monitoring. To evaluate the postoperative prognosis, our study explored the predictive value of hemodynamic management for the duration of mechanical ventilation (DMV). Methods This retrospective study included 60 infants who underwent cardiac surgery. Cardiac index (CI), the maximal slope of systolic upstroke (dp/dtmax), and cardiac cycle efficiency (CCE) derived from PRAM were documented in each patient 0, 4, 8, and 12 h (T0, T1, T2, T3, and T4, respectively) after their admission to the intensive care unit (ICU). A linear mixed model was used to deal with the hemodynamic data. Correlation analysis, receiver operating characteristic (ROC), and a XGBoost machine learning model were used to find the key factors for prediction. Results Linear mixed model revealed time and group effect in CI and dp/dtmax. Prolonged DMV also have negative correlations with age, weight, CI at and dp/dtmax at T2. dp/dtmax outweighing CI was the strongest predictor (AUC of ROC: 0.978 vs. 0.811, p < 0.01). The machine learning model suggested that dp/dtmax at T2 ≤ 1.049 or < 1.049 in combination with CI at T0 ≤ 2.0 or >2.0 can predict whether prolonged DMV (AUC of ROC = 0.856). Conclusion Cardiac dysfunction is associated with a prolonged DMV with hemodynamic evidence. CI measured by PRAM immediately after ICU admission and dp/dtmax 8h later are two key factors in predicting prolonged DMV.
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Abdelrehim AR, Al-Muhaya M, Alkodami AA, Baangood LS, Al-Mutairi M, Quadeer A, Alabsi FA, Alashwal M, Morsy MMF, Alnajjar AA, Salem SS. Predictors of major adverse events and complications after ventricular septal defects surgical closure in children less than 10 kg. J Cardiothorac Surg 2022; 17:232. [PMID: 36071526 PMCID: PMC9450295 DOI: 10.1186/s13019-022-01985-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Ventricular septal defect (VSD) is the most common congenital cardiac defect for which outcomes are not uniform. There is a lack of consensus on the risk factors for the unfavorable outcomes following surgical VSD closure. Aim The aim of this study was to determine the risk factors and the predictors of major adverse events (MAEs) and complications following surgical closure of VSD in children weighing less than 10 kg. Methods This retrospective cohort study included children less than 10 kg who underwent surgical closure of congenital VSD of any type with or without associated congenital heart diseases. Patients with associated major cardiac anomalies were excluded. Preoperative, operative and postoperative data were collected from medical records. Results This study included 127 patients 52.8% were males, the median age was 8.0 months (IQR = 6.0–11.0 months), and their median weight was 5.7 kg (IQR = 4.8–7.0). Mortality was in one patient (0.8%) Multivariable logistic regression analysis revealed that male sex group (observational data), previous pulmonary artery banding (PAB), and significant intraoperative residual VSD were significant risk factors for the development of MAEs (odds ratios were 3.398, 14.282, and 8.634, respectively). Trisomy 21 syndrome (odds ratio: 5.678) contributed significantly to prolonged ventilation. Pulmonary artery banding (odds ratio: 14.415), significant intraoperative (3 mm) residual VSD (odds ratio: 11.262), and long cross-clamp time (odds ratio: 1.064) were significant predictors of prolonged ICU stay, whereas prolonged hospital stay was observed significantly in male sex group (odds ratio: 12.8281), PAB (odds ratio: 2.669), and significant intraoperative (3 mm) residual VSD (odds ratio: 19.551). Conclusions Surgical VSD repair is considered a safe procedure with very low mortality. Trisomy 21 was a significant risk factor for prolonged ventilation. Further, PAB, significant intraoperative residual of 3 mm or more that required a second pulmonary bypass, and a greater cross-clamp time were significant predictors of MAE and associated complications with prolonged ICU and hospital stay.
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Affiliation(s)
- Ayman R Abdelrehim
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia. .,Cardiothoracic Surgery Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt.
| | - Mustafa Al-Muhaya
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Alassal A Alkodami
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Luna S Baangood
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Mansour Al-Mutairi
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Abdul Quadeer
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Fath A Alabsi
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - M Alashwal
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Mohamed Mofeed F Morsy
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia.,Pediatric Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | | | - Sherif S Salem
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia.,Pediatric Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt
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Yoneyama F, Kato H, Matsubara M, Mathis BJ, Yoshimura Y, Abe M, Suetsugu F, Maruo K, Suzuki Y, Hiramatsu Y. Conduction disorders after perimembranous ventricular septal defect closure: continuous versus interrupted suturing techniques. Eur J Cardiothorac Surg 2022; 62:6373863. [PMID: 34549780 DOI: 10.1093/ejcts/ezab407] [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: 03/30/2021] [Revised: 07/30/2021] [Accepted: 08/12/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate postoperative conduction disorder differences between continuous and interrupted suturing techniques for the closure of perimembranous outlet-type ventricular septal defects (VSDs) in both tetralogy of Fallot (ToF) and isolated VSD cases. METHODS Patients aged 4 years or younger who underwent VSD closure for ToF (n = 112) or isolated perimembranous outlet-type VSD (n = 73) from April 2010 to December 2018 at 3 centres were reviewed. Patients either received continuous suturing for ToF (C-ToF, n = 58) or isolated VSD (C-VSD, n = 50), or interrupted suturing for ToF (I-ToF, n = 54) or isolated VSD (I-VSD, n = 23). Cohorts did not differ in preoperative characteristics. Postoperative conduction disorder differences upon discharge and postoperative year 1 (POY1) were evaluated by electrocardiography. RESULTS The C-ToF group showed significantly shorter PQ intervals (124.0 vs 133.5 ms; P = 0.042 upon discharge, 125.3 vs 133.5 ms; P = 0.045 at POY1) and QRS durations (98.0 vs 106.2 ms; P = 0.031 upon discharge, 97.3 vs 102.5 ms; P = 0.040 at POY1) than the I-ToF group. Right bundle branch block incidence was significantly lower in the C-ToF versus I-ToF groups (56.8 vs 75.9; P = 0.045 upon discharge, 56.8 vs 75.9; P = 0.045 at POY1). Heart rates were significantly lower in the C-ToF versus I-ToF groups at POY1 (109.2 vs 119.3 bpm; P < 0.001). No parameters significantly differed between C-VSD and I-VSD groups. Multivariable analyses confirmed the group (C-ToF versus I-ToF) as a significant covariate in postoperative heart rate, PQ interval, QRS duration and right bundle branch block outcomes at POY1 (P = 0.013, 0.027, 0.013 and 0.014, respectively). CONCLUSIONS A continuous suturing technique for the closure of outlet-type VSD in ToF could reduce the incidence of postoperative right bundle branch block, shorten the PQ interval and lower heart rate. SUBJECT COLLECTION 110, 138, 139.
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Affiliation(s)
- Fumiya Yoneyama
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Japan
| | - Hideyuki Kato
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Japan
| | - Muneaki Matsubara
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Japan
| | - Bryan J Mathis
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Japan
| | - Yukihiro Yoshimura
- Department of Cardiovascular Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Masakazu Abe
- Department of Cardiovascular Surgery, Ibaraki Children's Hospital, Mito, Japan
| | - Fuminaga Suetsugu
- Department of Cardiovascular Surgery, Suetsugu Clinic, Tsukuba, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasuyuki Suzuki
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Japan
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Japan
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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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Bergmann M, Germann CP, Nordmeyer J, Peters B, Berger F, Schubert S. Short- and Long-term Outcome After Interventional VSD Closure: A Single-Center Experience in Pediatric and Adult Patients. Pediatr Cardiol 2021; 42:78-88. [PMID: 33009919 PMCID: PMC7864847 DOI: 10.1007/s00246-020-02456-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022]
Abstract
Interventional closure of congenital ventricular septal defects (VSD) is recording a continuous rise in acceptance. Complete atrioventricular block (cAVB) and residual shunting are major concerns during follow-up, but long-term data for both are still limited. We retrospectively evaluated the outcome of patients with interventional VSD closure and focused on long-term results (> 1 year follow-up). Transcatheter VSD closures were performed between 1993 and 2015, in 149 patients requiring 155 procedures (104 perimembranous, 29 muscular, 19 residual post-surgical VSDs, and 3 with multiple defects). The following devices were used: 65 × Amplatzer™ Membranous VSD Occluder, 33 × Duct Occluder II, 27 × Muscular VSD Occluder, 3 × Duct Occluder I, 24 × PFM-Nit-Occlud®, and 3 × Rashkind-Occluder. The median age at time of implantation was 6.2 (0.01-66.1) years, median height 117 (49-188) cm, and median weight 20.9 (3.2-117) kg. Median follow-up time was 6.2 (1.1-21.3) years and closure rate was 86.2% at last follow-up. Complications resulting in device explantation include one case of cAVB with a Membranous VSD occluder 7 days after implantation and four cases due to residual shunt/malposition. Six (4%) deaths occurred during follow-up with only one procedural related death from a hybrid VSD closure. Overall, our reported results of interventional VSD closure show favorable outcomes with only one (0.7%) episode of cAVB. Interventional closure offers a good alternative to surgical closure and shows improved performance by using softer devices. However, prospective long-term data in the current era with different devices are still mandatory to assess the effectiveness and safety of this procedure.
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Affiliation(s)
- M. Bergmann
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - C. P. Germann
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - J. Nordmeyer
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - B. Peters
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - F. Berger
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - S. Schubert
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.418457.b0000 0001 0723 8327Clinic for Pediatric Cardiology and Congenital Heart Defects, Herz- Und Diabeteszentrum NRW, Ruhr University of Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
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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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12
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Commentary: Validation of our understanding of atrioventricular conduction anatomy using phase-contrast computed tomography. J Thorac Cardiovasc Surg 2020; 160:498-499. [PMID: 32359907 DOI: 10.1016/j.jtcvs.2020.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/09/2020] [Accepted: 03/09/2020] [Indexed: 11/20/2022]
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13
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Carrel T. Commentary: Advanced imaging technologies may help to eliminate the need for pacemaker implantation following repair of ventricular septal defect. J Thorac Cardiovasc Surg 2020; 160:497-498. [PMID: 32305188 DOI: 10.1016/j.jtcvs.2020.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Thierry Carrel
- Department for Cardiovascular Surgery, University Hospital and University of Bern, Bern, Switzerland.
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14
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Diagnostic and Therapeutic Approach to Arrhythmias in Adult Congenital Heart Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:44. [PMID: 31342289 DOI: 10.1007/s11936-019-0749-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Adult survivors of congenital heart disease (CHD) are at increased risk of arrhythmia. The goal of this review is to outline diagnostic and therapeutic approaches to arrhythmia in adult CHD patients. RECENT FINDINGS Macro-reentrant atrial tachyarrhythmia is the most common arrhythmia encountered in adults with CHD. Approximately 25% of hospitalizations associated with arrhythmia. The risk of ventricular arrhythmia is estimated as high as 25-100 times that for the general population and increased after two decades. Routine ambulatory monitoring is important for arrhythmia risk assessment in adults with CHD. There are limitations, potential adverse effects, and risk of recurrence with antiarrhythmic drugs, catheter ablation, and surgical approaches. Adults with CHD suffer various forms of arrhythmia, are at increased risk of sudden death, and require special consideration for medical and interventional therapy.
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15
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Ergün S, Genç SB, Yildiz O, Öztürk E, Kafalı HC, Ayyıldız P, Haydin S. Risk Factors for Major Adverse Events after Surgical Closure of Ventricular Septal Defect in Patients Less than 1 Year of Age: A Single-Center Retrospective. Braz J Cardiovasc Surg 2019; 34:335-343. [PMID: 31310473 PMCID: PMC6629230 DOI: 10.21470/1678-9741-2018-0299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To reveal the risk factors that can lead to a complicated course and an increased morbidity in patients < 1 year old after surgical ventricular septal defect (VSD) closure. METHODS We reviewed a consecutive series of patients who were admitted to our institution for surgical VSD closure who were under one year of age, between 2015 and 2018. Mechanical ventilation (MV) time > 24 hours, intensive care unit (ICU) stay longer than three days, and hospital stay longer than seven days were defined as "prolonged". Unplanned reoperation, complete heart block requiring a permanent pacemaker implantation, sudden circulatory arrest, and death were considered as significant major adverse events (MAE). RESULTS VSD closure was performed in 185 patients. The median age was five (1-12) months. There was prolonged MV time in 54 (29.2%) patients. Four patients (2.2%) required permanent pacemaker implantation. Hemodynamically significant residual VSD was observed in six (3.2%) patients. Extracorporeal membrane oxygenation-cardiopulmonary resuscitation was performed in one (0.5%) patient. Small age (< 4 months) (P-value<0.001) and prolonged cardiopulmonary bypass time (P=0.03) were found to delay extubation and to prolong MV time. Low birth weight at the operation was associated with MAE (P=0.03). CONCLUSION Higher body weight during operation had a reducing effect on the MAE frequency and shortened the MV duration, ICU stay, and hospital stay. As a conclusion, for patients who are scheduled to undergo VSD closure, body weight should be taken into consideration.
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Affiliation(s)
- Servet Ergün
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Saglik Bilimleri University Department of Pediatric Cardiovascular Surgery Istanbul Turkey Department of Pediatric Cardiovascular Surgery, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Serhat Bahadır Genç
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Saglik Bilimleri University Department of Pediatric Cardiovascular Surgery Istanbul Turkey Department of Pediatric Cardiovascular Surgery, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Okan Yildiz
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Saglik Bilimleri University Department of Pediatric Cardiovascular Surgery Istanbul Turkey Department of Pediatric Cardiovascular Surgery, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Erkut Öztürk
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Saglik Bilimleri University Department of Pediatric Cardiology Istanbul Turkey Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Hasan Candaş Kafalı
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Saglik Bilimleri University Department of Pediatric Cardiology Istanbul Turkey Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Pelin Ayyıldız
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Saglik Bilimleri University Department of Pediatric Cardiology Istanbul Turkey Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Sertaç Haydin
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Saglik Bilimleri University Department of Pediatric Cardiovascular Surgery Istanbul Turkey Department of Pediatric Cardiovascular Surgery, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
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16
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The effect of body weight in infants undergoing ventricular septal defect closure: A report from the Nationwide Japanese Congenital Surgical Database. J Thorac Cardiovasc Surg 2019; 157:1132-1141.e7. [DOI: 10.1016/j.jtcvs.2018.11.111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/03/2018] [Accepted: 11/06/2018] [Indexed: 11/18/2022]
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Ayık MF, Şişli E, Dereli M, Şahan YÖ, Şahin H, Levent RE, Atay Y. A Retrospective Survey Comparing Suture Techniques Regarding the Risk of Permanent Epicardial Pacemaker Implantation After Ventricular Septal Defect Closure. Braz J Cardiovasc Surg 2019; 33:339-346. [PMID: 30184030 PMCID: PMC6122755 DOI: 10.21470/1678-9741-2018-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/13/2018] [Indexed: 12/04/2022] Open
Abstract
Objective The aim of this study is to compare the continuous and combined suturing
techniques in regards to the needing epicardial pacing at the time of
weaning from cardiopulmonary bypass (EP-CPB) and to evaluate permanent
epicardial pacemaker (PEP) implantation in patients who had undergone
surgical ventricular septal defect (VSD) closure. Methods This single-centre retrospective survey includes 365 patients who had
consecutively undergone VSD closure between January 2006 and October 2015.
Results The median age and weight of the patients were 15 months (range 27 days -
56.9 years) and 10 kg (range 3.5 - 100 kg), respectively. Continuous and
combined suturing techniques were utilised in 302 (82.7%) and 63 (17.3%)
patients, respectively. While 25 (6.8%) patients required EP-CPB, PEP was
implanted in eight (2.2%) patients. Comparison of the continuous and
combined suturing techniques regarding the need for EP-CPB (72%
vs. 28%, P=0.231) and PEP implantation
(87.5% vs. 12.5%, P=1.0) were not
statistically significant. The rate of PEP implantation in patients with
perimembraneous VSD without extension and perimembraneous VSD with inlet
extension did not reveal significant difference between the suture
techniques (P=1.0 and P=0.16,
respectively). In both univariate and multivariate analyses, large VSD
(P=0.001; OR 8.63; P=0.011) and
perimembraneous VSD with inlet extension (P<0.001; OR
9.02; P=0.005) had a significant influence on PEP
implantation. Conclusion Both suturing techniques were comparable regarding the need for EP-CPB or PEP
implantation. Caution should be exercised when closing a large
perimembraneous VSD with inlet extension.
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Affiliation(s)
- Mehmet Fatih Ayık
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Emrah Şişli
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Münevver Dereli
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | | | - Hatice Şahin
- Medical Education, Faculty of Medicine, Ege University, Izmir, Turkey
| | | | - Yüksel Atay
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
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Haddad RN, Daou L, Saliba Z. Device Closure of Perimembranous Ventricular Septal Defect: Choosing Between Amplatzer Occluders. Front Pediatr 2019; 7:300. [PMID: 31475122 PMCID: PMC6707042 DOI: 10.3389/fped.2019.00300] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/08/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Off-label device closure of perimembranous ventricular septal defect (pmVSD) is well reported in the literature with encouraging results. However, technical challenges may be encountered. Objectives: To evaluate and compare feasibility, technical aspects, procedural outcomes, and mid-term follow-up of pmVSD closure using Amplatzer™ occluders. Patients and Methods: From July 2015 to July 2018, patients in whom pmVSD closure was attempted using an Amplatzer occluder were retrospectively identified from our institution's database. Device selection was made according to the defect anatomy that was obtained via ventriculography and trans-esophageal echocardiography. Follow-up evaluations were done at discharge, then at 1, 3, 6, and 12 months and yearly thereafter with transthoracic echocardiography and electrocardiogram. Results: In total, 8 Amplatzer Duct Occluder (ADO), 27 ADO II, and 17 Amplatzer Muscular VSD Occluder (AMO) were used in 51 patients with a mean age of 7.4 ± 6.9 years and a mean weight of 25.4 ± 19.8 kg. Implantation was successful in 50/51 patients (98.0%). There was no procedure related mortality. One ADO accidentally embolized to the aorta after release and was surgically recaptured from the iliac artery. All ADO II were delivered retrogradely with the least amount of time (p = 0.002) and the lowest radiation exposure (p < 0.001). Minor valvular disturbances occurred in 8/49 patients (16.3%), including five tricuspid regurgitation (three with ADOII and two with AMO) and three trivial aortic regurgitations (two with ADO and one with ADOII). On a median follow-up of 194 days (range, 60-895 days), no surgical device removal was necessary. At 6 months of follow-up, trivial residual shunt was present in 5/49 patients (10.2%), among which none occurred with ADO. One complete atrioventricular block was detected 18 months after ADO implantation and required permanent pacing. Conclusions: Transcatheter closure of PmVSD using Amplatzer occluders is feasible, safe and efficacious in properly selected patients. The major key factor behind high procedural success rate is proper device selection. ADOII is remarkably superior in terms of device softness, flexibility and faster implantation process. Yet, its use is limited to small defects with particular anatomy.
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Affiliation(s)
- Raymond N Haddad
- Department of Pediatrics, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon
| | - Linda Daou
- Department of Pediatric Cardiology, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon
| | - Zakhia Saliba
- Department of Pediatric Cardiology, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon
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19
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Nguyen HL, Phan QT, Doan DD, Dinh LH, Tran HB, Sharmin S, Thottian JJ, Won H, Lee WS, Shin SY, Nguyen TQ, Kim SW. Percutaneous closure of perimembranous ventricular septal defect using patent ductus arteriosus occluders. PLoS One 2018; 13:e0206535. [PMID: 30439981 PMCID: PMC6237304 DOI: 10.1371/journal.pone.0206535] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 10/15/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To assess the safety and efficacy of percutaneous closure of perimembranous ventricular septal defect (PmVSD) using patent ductus arteriosus (PDA) occluders. BACKGROUND Widespread use of conventional PmVSD closure devices has been limited by unacceptable high rate of complete heart block (CHB). The elegant design of PDA occluders is supposed to ease implantation, increase closure rate and minimize damage to adjacent structures. Thus, PDA occluders may reduce complications, especially the CHB, and offer a good alternative for PmVSD closure. METHOD From September 2008 to October 2015, patients who underwent attempted percutaneous VSD closure using PDA occluders were included in the study. Patient demographics, echocardiography measurements, procedure details and follow-up data until October 2017 were collected. RESULTS In total, 321 patients with a mean age of 15.5±12.6 years and mean a weight of 33.3±20.5 kg were included in this study. The mean defect size was 4.8±2.1 mm. Implantation was successful in 307 (95.6%) patients. The median follow-up time was 63 months (24 to 108 months). The closure rates were 89.5%, 91.5%, and 99.3% after the procedure 24 hours, 6 months and 2 years, respectively. Major complications occurred in 5 (1.7%) patients during the procedure and follow-up, including persistent CHB in 2 (0.7%) patients and device embolization in 3 (1.0%) patients. No death, disability, or other major complication was detected. CONCLUSION Percutaneous closure of PmVSD using PDA occluders is feasible, safe and efficacious in selected patients.
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Affiliation(s)
- Hieu Lan Nguyen
- Intervention Center, Vietnam National Heart Institute, Ha Noi, Vietnam
- Intervention Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Quang Tan Phan
- Intervention Center, Quang Nam Central General Hospital, Quang Nam, Vietnam
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
- * E-mail:
| | - Dung Duc Doan
- Intervention Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Linh Huynh Dinh
- Intervention Center, Vietnam National Heart Institute, Ha Noi, Vietnam
| | - Hieu Ba Tran
- Intervention Center, Vietnam National Heart Institute, Ha Noi, Vietnam
| | - Saima Sharmin
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Julian Johny Thottian
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
- Intervention Center, Westfort Group Hospital, Kerala, India
| | - Hoyoun Won
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Wang Soo Lee
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Seung Yong Shin
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
| | | | - Sang Wook Kim
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
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20
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Nguyen HL, Phan QT, Dinh LH, Tran HB, Won H, Thottian JJ, Duc DD, Quang TN, Kim SW. Nit-Occlud Lê VSD coil versus Duct Occluders for percutaneous perimembranous ventricular septal defect closure. CONGENIT HEART DIS 2018; 13:584-593. [PMID: 30019378 DOI: 10.1111/chd.12613] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/06/2018] [Accepted: 04/19/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of Nit-Occlud Lê VSD Coil versus Duct Occluders for percutaneous closure of perimembranous ventricular septal defect (pmVSD). INTRODUCTION VSD closure using conventional pmVSD occluders has been largely abandoned because of an unacceptable high rate of complete heart block (CHB). The advantages of Duct Occluders and VSD Coil are supposed to reduce the drawbacks of previous devices, especially CHB complications. METHOD Patients underwent percutaneous pmVSD closure were divided into Coil group (using VSD Coil, n = 71) and DO group (using Duct Occluders, n = 315). Patient demographics, clinical presentations, echocardiography measurements, procedure details and follow-up data were collected. RESULT The procedure success rate was high in both DO group (95.6%) and Coil group (97.2%, P = .53). The closure rate immediately after procedure in the DO group was higher than that in the Coil group (76.8% vs. 58.0%, P < .01). After 6 months, the closure rate was not significantly different between the 2 groups (DO group 91.3% vs. Coil group 84.1%, P = .07). The mean follow-up time was 61.4 ± 24.1 months. The major complication rate was low in both groups (DO group 1.9% vs. Coil group 1.4%, P = .78). Two patients (0.7%) in the DO group and one patient (1.4%) in the Coil group with CHB needed permanent pacemaker (P = .5). Device embolization (3 patients, 1.0%) and endocarditis (1 patient, 0.3%) occurred only in the DO group. There was no death, disability or other major complications detected in either group. CONCLUSION Percutaneous pmVSD closure using either Nit-Occlud Lê VSD Coil or Duct Occluders is feasible, safe and efficacious in selected patients. The main problems of Duct Occluders are unsuitable defect anatomy and device embolization while VSD Coil disadvantages are residual shunt and hemolysis.
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Affiliation(s)
- Hieu Lan Nguyen
- Intervention Center, Hanoi Medical University Hospital, Hanoi, Vietnam.,Intervention Center, Vietnam National Heart Institute, Hanoi, Vietnam
| | - Quang Tan Phan
- Intervention Center, Quang Nam Central General Hospital, Quang Nam, Vietnam.,Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Linh Huynh Dinh
- Intervention Center, Vietnam National Heart Institute, Hanoi, Vietnam
| | - Hieu Ba Tran
- Intervention Center, Vietnam National Heart Institute, Hanoi, Vietnam
| | - Hoyoun Won
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Julian Johny Thottian
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea.,Westfort Group Hospital, Intervention Center, Kerala, India
| | - Dung Doan Duc
- Intervention Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | | | - Sang Wook Kim
- Intervention Center, Chung-Ang University Hospital, Seoul, South Korea
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21
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Garcia RU, Safa R, Karpawich PP. Postoperative complete heart block among congenital heart disease patients: Contributing risk factors, therapies and long-term sequelae in the current era. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.04.003] [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: 10/17/2022]
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22
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Zhou Y, Liu LX, Zhao F, Tang SH, Peng HL, Jiang YH. Effects of transthoracic device closure on ventricular septal defects and reasons for conversion to open-heart surgery: A meta-analysis. Sci Rep 2017; 7:12219. [PMID: 28939836 PMCID: PMC5610181 DOI: 10.1038/s41598-017-12500-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/08/2017] [Indexed: 12/30/2022] Open
Abstract
Transthoracic device closure (TTDC) is thought to be a promising technology for the repair of ventricular septal defects (VSDs). However, there is considerable controversy regarding the efficacy and safety of TTDC. The present study aimed to compare the benefits and safety of TTDC with those of conventional open-heart surgery (COHS) and analyze the associated factors causing complications, conversion to COHS and reoperation. Electronic database searches were conducted in PubMed, EMBASE, Cochrane Library, Clinicaltrials.gov and several Chinese databases. A total of 5 randomized controlled trials (RCTs), 7 cohort studies, 13 case-control studies, 129 case series and 13 case reports were included. Compared to COHS, TTDC exhibited superior efficacy with a significantly lower risk of post-operative arrhythmia; however, no significant differences in other outcomes were identified. Meta-regression analysis showed that perimembranous VSDs (pmVSDs), a smaller VSD, a smaller occluder, and a median or subxiphoid approach lowered the relative risk of several post-operative complications, conversion to COHS and reoperation. The current evidence indicates that TTDC is associated with a lower risk of post-operative arrhythmia and is not associated with an increased risk of complications. PmVSDs, a smaller VSD and occluder, and a median or subxiphoid approach correlate with better outcomes when using TTDC.
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Affiliation(s)
- Yang Zhou
- Department of Cardiothoracic Surgery, the People's Hospital of Leshan, Leshan, Sichuan Province, 614000, P.R. China
| | - Ling-Xi Liu
- Department of Cardiothoracic Surgery, the People's Hospital of Leshan, Leshan, Sichuan Province, 614000, P.R. China
| | - Fei Zhao
- Department of Cardiothoracic Surgery, the People's Hospital of Leshan, Leshan, Sichuan Province, 614000, P.R. China
| | - Shi-Hai Tang
- Department of Cardiothoracic Surgery, the People's Hospital of Leshan, Leshan, Sichuan Province, 614000, P.R. China
| | - Hua-Li Peng
- Department of Cardiothoracic Surgery, the People's Hospital of Leshan, Leshan, Sichuan Province, 614000, P.R. China
| | - Yun-Han Jiang
- Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, Chongqing, 400030, P.R. China.
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23
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Marshall AM. A Review of Surgical Atrioventricular Block with Emphasis in Patients with Single Ventricle Physiology. CONGENIT HEART DIS 2016; 11:462-467. [PMID: 27139742 DOI: 10.1111/chd.12372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2016] [Indexed: 11/30/2022]
Abstract
We perceived an increased incidence of surgical atrioventricular (AV) block in patients with single ventricle physiology undergoing two ventricle rehabilitation for hypoplastic left heart syndrome compared to the overall incidence of surgical AV block for our institution. Retrospective investigation of our center's data revealed a statistically significant increase in the incidence of surgical AV block in the single ventricle population and two ventricle rehabilitation population compared to the two ventricle population. Here we review the literature with respect to historic definitions, incidence, risk factors, pre- and post-op management, current indications for pacemaker placement and added cost and comorbidity associated with surgical AV block. We then offer possible strategies for decreasing the incidence of surgical AV block within both the single and two ventricle populations.
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Affiliation(s)
- Amanda M Marshall
- Pediatric Cardiology, Children's Hospital & Medical Center, University of Nebraska Medical Center/Children's Hospital & Medical Center, Omaha, Neb, USA.
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24
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Gholampour-Dehaki M, Zareh A, Babaki S, Javadikasgari H. Conduction Disorders in Continuous Versus Interrupted Suturing Technique in Ventricular Septal Defect Surgical Repair. Res Cardiovasc Med 2016; 5:e28735. [PMID: 26889457 PMCID: PMC4752673 DOI: 10.5812/cardiovascmed.28735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 06/22/2015] [Accepted: 07/04/2015] [Indexed: 11/23/2022] Open
Abstract
Background: Ventricular septal defects (VSD) is one of the most frequent congenital cardiac malformations and cardiac conduction disorders are still one of the serious postoperative complications in this surgery. Objectives: This study aimed to compare the incidence of conduction disorders with the use of continuous compared to interrupted suturing techniques in VSD surgical repair. Patients and Methods: Previously recorded data of 231 patients who underwent surgical closure of VSD between January 2009 and January 2012 at the Rajaie cardiovascular medical and research center were retrospectively reviewed. VSD surgical repair was performed using continues suturing technique in group A patients (n = 163, 70.6%) and interrupted suturing technique in group B patients (n = 68, 29.4%). Results: The most common concomitant congenital anomaly was Tetralogy of Fallot (27.3%). Twenty-four (10.4%) patients had intraoperative cardiac arrhythmia, including 19 (8.2%) transient and 5 (2.2 %) permanent arrhythmia. During their ICU stay, ventricular arrhythmia and complete heart block were observed in 34 (14.7%) and 5 patients (2.2%), respectively. At the time of the last follow-up, incomplete right bundle branch block (RBBB), complete RBBB, RBBB with left anterior hemi-block, and complete heart block were identified in 84 (36.4%), 42 (18.2%), 29 (12.6%), and 5 patients (2.2%), respectively. The results revealed that group A patients were most likely to have had cardiac arrhythmias during their ICU stay and at the time of last follow-up (P < 0.001), while the intraoperative incidence of cardiac arrhythmia during surgery was not statistically significant between the two groups (P = 0.06). Conclusions: In the absence of any statistical differences in the other risk factors between the two groups, the difference in the incidence of conduction disorders can be attributed to the type of suturing used during the procedure.
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Affiliation(s)
- Maziar Gholampour-Dehaki
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Asghar Zareh
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Solmaz Babaki
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
- Department of Cardiology, Ludmillenstift Hospital, Ludmillenstraße, Meppen, Germany
| | - Hoda Javadikasgari
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Corresponding author: Hoda Javadikasgari, Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Vali-Asr St., Niayesh Blvd, P. O. Box: 1996911151, Tehran, IR Iran. Tel: +1-6822192494, E-mail:
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Complete atrioventricular block after percutaneous device closure of perimembranous ventricular septal defect: A single-center experience on 1046 cases. Heart Rhythm 2015; 12:2132-40. [PMID: 25981147 DOI: 10.1016/j.hrthm.2015.05.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Complete atrioventricular block (cAVB) has been deemed a rare complication after transcatheter closure for ventricular septal defect (VSD). However, this serious event appears to be underrecognized and is worth being investigated further. OBJECTIVES To determine the incidence and predisposing factors of cAVB associated with closure of VSD using a modified double-disk occluder (MDO). METHODS From December 21, 2001 to December 31, 2014, 1046 patients with perimembranous ventricular septal defect underwent percutaneous closure using the MDO. Electrocardiography was evaluated before the procedure, within 1 week after the procedure, and then at 1, 3, 6, and 12 months and every year thereafter. Other baseline and procedural parameters were also evaluated and a comparison between patients requiring pacemakers and those not suffering from cAVB was done. RESULTS cAVB occurred in 17 patients (1.63%) after the procedure. Of the 17 patients, 8 underwent permanent pacemaker (PPM) implantation. The cAVB occurred within 30 days after the procedure in 14 patients and after 1 year in 3 patients. In comparison patients aged ≤18 years, patients aged >18 years were more prone to cAVB (P = .025). Logistic regression revealed no significant parameter to predict later requirement for PPM. CONCLUSIONS The incidence of cAVB after transcatheter closure of VSD was acceptable, as part of the cAVB population recovered after administration of corticosteroid and application of a temporary pacemaker. Late cAVB (>1 year) appears to make it more difficult to restore normal conduction block. Because of the recurrence of cAVB, life-long follow-up with periodic electrocardiography examination may be mandatory.
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