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Schmitz C, Bennink G. Surgical closure of ventricular septal defects in small children in 2021: is it still the preferred therapeutical option? Eur J Cardiothorac Surg 2021; 60:552-553. [PMID: 33895834 DOI: 10.1093/ejcts/ezab188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/20/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christoph Schmitz
- Department of Cardiac Surgery, University of Munich, Germany.,Cardiovascular Research Unit, Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Gerardus Bennink
- Department of Cardiac and Thoracic Surgery, University of Cologne, Germany
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Li HY, Zhao YF, Dai L, Xu SJ, Zhang HJ, Jiang WJ. Ascending aortic dilation in adult patients with congenital ventricular septal defect: An observational study. Medicine (Baltimore) 2018; 97:e0383. [PMID: 29642196 PMCID: PMC5908605 DOI: 10.1097/md.0000000000010383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Many adult patients with congenital ventricular septal defect (VSD) also developed ascending aortic dilation, but few report the clinical features and surgical management of these patients. This study was designed to study ascending aortic dilation in adult patients with congenital VSD, and summarized the treatment experience and prognosis.To assess the clinical features and surgical management, we performed a retrospective analysis on preoperative data, intraoperative data, and postoperative data from the adult patients with congenital VSD who developed ascending aortic dilation in our institution from February 2010 to December 2016.From February 2010 to December 2016, we operated on 13 adult patients (12 males, 92.31%) with VSD who developed ascending aortic dilation. Median age was 37 (interquartile range 14) years. All patients suffered from perimembranous VSD and received surgical treatment. Their symptoms were all improved after surgery, no deaths occurred.Surgery is feasible for the ascending aortic dilation in adult patients with congenital VSD. Both proper perioperative treatment and close monitoring are required for the successful surgery.
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Affiliation(s)
- Hai-Yang Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases
- Beijing Lab for Cardiovascular Precision Medicine
- Beijing Aortic Disease Center, Cardiovascular Surgery Center
- Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Yuan-Fei Zhao
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Lu Dai
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases
- Beijing Lab for Cardiovascular Precision Medicine
- Beijing Aortic Disease Center, Cardiovascular Surgery Center
- Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Shi-Jun Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases
- Beijing Lab for Cardiovascular Precision Medicine
- Beijing Aortic Disease Center, Cardiovascular Surgery Center
- Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Hong-Jia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases
- Beijing Lab for Cardiovascular Precision Medicine
- Beijing Aortic Disease Center, Cardiovascular Surgery Center
- Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Wen-Jian Jiang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases
- Beijing Lab for Cardiovascular Precision Medicine
- Beijing Aortic Disease Center, Cardiovascular Surgery Center
- Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
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3
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Glovaci D, Naqvi A, Yu K, Patel P, Krishnam M. Utility of cardiac MRI in determining percutaneous versus surgical post-infarction ventricular septal defect repair. Future Cardiol 2018; 14:125-130. [PMID: 29355029 DOI: 10.2217/fca-2017-0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Postmyocardial infarction ventricular septal defect (VSD) is a rare complication that can lead to rapid hemodynamic patient decompensation. The type of VSD repair relies on several factors including: size, location, timing and surgical expertise. CASE A 63-year-old man with a ST-elevation myocardial infarction underwent percutaneous coronary intervention of the right coronary artery. A holosystolic murmur was notable postcatheterization, and transthoracic echocardiogram confirmed a VSD. To characterize the VSD, a cardiac MRI demonstrated a large, serpiginous VSD and longitudinal septal tear. Given the anatomic complexity and stable hemodynamics, a surgical trans-left ventricular patch repair was performed. CONCLUSION We emphasize the importance of cardiac magnetic resonance as a decision-making tool, utilizing imaging to ascertain the anatomy combined with hemodynamics to determine optimal individualized therapy.
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Affiliation(s)
- Diana Glovaci
- Department of Internal Medicine, University California Irvine Medical Center, Orange, CA 92868, USA
| | - Ali Naqvi
- Department of Internal Medicine, University California Irvine Medical Center, Orange, CA 92868, USA
| | - Katherine Yu
- Department of Cardiology, University California Irvine Medical Center, Orange, CA 92868, USA
| | - Pranav Patel
- Department of Cardiology, University California Irvine Medical Center, Orange, CA 92868, USA
| | - Mayil Krishnam
- Department of Radiology, University California Irvine Medical Center, Orange, CA 92868, USA
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Demirag MK, Keçeligil HT, Kolbakir F. Primary Surgical Repair of Ventricular Septal Defect. Asian Cardiovasc Thorac Ann 2016; 11:213-6. [PMID: 14514550 DOI: 10.1177/021849230301100307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Between January 1983 and December 2000, 78 patients underwent primary repair of a ventricular septal defect. There were 42 males (54%) and 36 females (46%) of whom 13 (17%) were under 1 year old, 50 (64%) were aged 1–10 years, 11 (14%) were aged 10–20 years, and 4 (5%) were over 20 years old. The ventricular septal defect was a perimembranous type in 60 patients (77%), subarterial (outlet) type in 10 (13%), and atrioventricular canal (inlet) type in 4 (5%). Operative repair was performed with a patch in all except 2 patients. Early postoperative complications included insignificant aortic regurgitation in 4 patients, persistent complete heart block in 1, and residual shunt in 4. There were 5 early deaths (6.4%) and 1 late death (1.8%) in 56 patients followed up. Early primary closure of ventricular septal defects, usually via a right atriotomy, can be performed with acceptable mortality and morbidity rates.
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Affiliation(s)
- M Kemal Demirag
- Department of Cardiovascular Surgery, Ondokuz Mayis University Medical School, Samsun, Turkey
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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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6
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Luo YK, Chen WH, Xiong C, Li CC, Chen LL. Comparison of effectiveness and cost between perventricular device occlusion and minimally invasive surgical repair for perimembranous ventricular septal defect. Pediatr Cardiol 2015; 36:308-13. [PMID: 25145293 DOI: 10.1007/s00246-014-1004-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 08/07/2014] [Indexed: 01/07/2023]
Abstract
Perventricular device occlusion and minimally invasive surgical repair for perimembranous ventricular septal defect (pmVSD) are two typical methods to reduce the invasiveness of the conventional operation through median sternotomy. However, few comparative studies have been made between them in terms of effectiveness and cost. A review was made of the inpatients with isolated pmVSD, who had undergone perventricular device occlusion or minimally invasive surgical repair from June 2011 and January 2013 for a comparative investigation between the two procedures. The two treatment groups had similar baseline characteristics. Procedural success was achieved in 163 (94.8%) of the perventricular and 137 (98.6%) of the surgical (P = 0.136). Major complications occurred in 2 (1.2%) of the perventricular and 4 (2.9 %) of the surgical (P = 0.497), and minor complications, in 57 (33%) of the percutaneous and 49 (35.2%) of the surgical (P = 0.696). In cost, the surgical repair was 30.5% cheaper than the device occlusion (Yuan 20139 ± 3760 vs. 28970 ± 3343, P < 0.001), where most of the cost was attributed to the occluder in the amount of Yuan 19,500. Compared with perventricular device closure, minimally invasive surgical repair can provide comparable efficacy and complication rates, without the potential for developing atrioventricular block at long-term follow-up. In addition, it is 30.5% cheaper than hybrid procedure. In the low-income countries where health-care resources are limited the medical resources must be judiciously allocated to the treatment that allows for effective treatment of the largest number of patients.
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Affiliation(s)
- Yu Kun Luo
- Department of Cardiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, China
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Charakida M, Pushparajah K, Anderson D, Simpson JM. Insights Gained From Three-Dimensional Imaging Modalities for Closure of Ventricular Septal Defects. Circ Cardiovasc Imaging 2014; 7:954-61. [DOI: 10.1161/circimaging.114.002502] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marietta Charakida
- From the Department of Congenital Heart Disease, Evelina London Children’s Hospital, London, United Kingdom
| | - Kuberan Pushparajah
- From the Department of Congenital Heart Disease, Evelina London Children’s Hospital, London, United Kingdom
| | - David Anderson
- From the Department of Congenital Heart Disease, Evelina London Children’s Hospital, London, United Kingdom
| | - John M. Simpson
- From the Department of Congenital Heart Disease, Evelina London Children’s Hospital, London, United Kingdom
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8
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Chen ZY, Lin BR, Chen WH, Chen Q, Guo XF, Chen LL, Ge JB. Percutaneous Device Occlusion and Minimally Invasive Surgical Repair for Perimembranous Ventricular Septal Defect. Ann Thorac Surg 2014; 97:1400-6. [DOI: 10.1016/j.athoracsur.2013.12.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/29/2013] [Accepted: 12/18/2013] [Indexed: 11/26/2022]
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9
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Desinserción parcial de válvula tricúspide para cierre de comunicación interventricular. CIRUGIA CARDIOVASCULAR 2013. [DOI: 10.1016/j.circv.2013.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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10
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Aydemir NA, Harmandar B, Karaci AR, Sasmazel A, Bolukcu A, Saritas T, Yucel IK, Coskun FI, Bilal MS, Yekeler I. Results for Surgical Closure of Isolated Ventricular Septal Defects in Patients Under One Year of Age. J Card Surg 2013; 28:174-9. [DOI: 10.1111/jocs.12073] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Numan Ali Aydemir
- Department of Pediatric Cardiac Surgery; Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | - Bugra Harmandar
- Department of Pediatric Cardiac Surgery; Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | - Ali Riza Karaci
- Department of Pediatric Cardiac Surgery; Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | - Ahmet Sasmazel
- Department of Pediatric Cardiac Surgery; Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | - Ahmet Bolukcu
- Department of Pediatric Cardiac Surgery; Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | | | | | | | - Mehmet Salih Bilal
- Department of Pediatric Cardiac Surgery; Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | - Ibrahim Yekeler
- Department of Pediatric Cardiac Surgery; Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
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11
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Current Expectations for Surgical Repair of Isolated Ventricular Septal Defects. Ann Thorac Surg 2010; 89:544-9; discussion 550-1. [DOI: 10.1016/j.athoracsur.2009.10.057] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2008] [Revised: 10/22/2009] [Accepted: 10/23/2009] [Indexed: 11/17/2022]
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12
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Häussler A, Prêtre R. Surgical closure of a perimembranous ventricular septum defect with a running suture. Multimed Man Cardiothorac Surg 2008; 2008:mmcts.2006.002410. [PMID: 24415545 DOI: 10.1510/mmcts.2006.002410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A ventricular septum defect (VSD) is a common defect in congenital surgery, either isolated or associated with other malformations. Most of the defects are located around the membranous septum and hence are called 'perimembranous'. The less damaging approach to close them is certainly through an incision in the right atrium. In some trunco-arterial malformation, an incision in the infundibulum is necessary to connect the right ventricle to the pulmonary arteries. A perimembranous VSD can then also be closed using the same incision. The videos show the closure of a perimembranous VSD using these two common approaches. Although many surgeons opt for interrupted stitches reinforced with pledgets to close these defects, a running suture can also be used and, in our opinion, is a reliable and rapid alternative technique.
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Affiliation(s)
- Achim Häussler
- Division of Pediatric and Congenital Cardiovascular Surgery, University and Children Hospital Zürich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
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13
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Andersen HØ, de Leval MR, Tsang VT, Elliott MJ, Anderson RH, Cook AC. Is complete heart block after surgical closure of ventricular septum defects still an issue? Ann Thorac Surg 2006; 82:948-56. [PMID: 16928514 DOI: 10.1016/j.athoracsur.2006.04.030] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Revised: 04/05/2006] [Accepted: 04/07/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND A serious complication after surgical closure of ventricular septal defect (VSD) is complete heart block. In this retrospective study, we reviewed the incidence of complete heart block after surgical closure of a VSD at Great Ormond Street Hospital from 1976 to 2001 to identify any particular anatomic features that still predisposed patients to surgically-induced complete heart block and to provide anatomic guidelines to avoid this in future. METHODS Data were extracted from our local database for patients having (1) isolated VSD or VSD in the setting of (2) tetralogy of Fallot with pulmonary stenosis or (3) tetralogy of Fallot with pulmonary atresia; (4) absent pulmonary valve syndrome; (5 and 6) coarctation or interruption of the aortic arch; and (7) subaortic fibrous shelf. We carefully reviewed the operative notes from all patients with postoperative complete heart block to discover any predisposing anatomical reasons to explain the complication. RESULTS Two thousand seventy-nine patients had a VSD closure. Permanent complete heart block developed in 7 of 996 patients (0.7%) with an isolated defect and in 1 of 847 patients (0.1%) with tetralogy of Fallot. Four more patients had postoperative complete heart block. CONCLUSIONS Instances of iatrogenic complete heart block continue to occur after surgical VSD closure, either because of unexpected biological variations or because of unawareness of the disposition of the atrioventricular conduction axis in particular circumstances. This report emphasizes the latter aspect in details and suggests a risk of iatrogenic complete heart block of less than 1%.
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Mahle WT, Parks WJ, Fyfe DA, Sallee D. Tricuspid regurgitation in patients with repaired Tetralogy of Fallot and its relation to right ventricular dilatation. Am J Cardiol 2003; 92:643-5. [PMID: 12943899 DOI: 10.1016/s0002-9149(03)00746-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In a cohort of 56 school-aged children with repaired tetralogy of Fallot, significant (moderate to severe) tricuspid regurgitation was common (32% of patients) and was related to both tricuspid annulus dilatation and structural valve abnormalities that were potentially related to previous surgery. Even after adjusting for pulmonary regurgitation, tricuspid regurgitation was significantly correlated with right ventricular volume (r= 0.39, p = 0.009), suggesting that tricuspid regurgitation as well as pulmonary regurgitation may contribute significantly to progressive right ventricular dilatation in this population.
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Affiliation(s)
- William T Mahle
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia 30329, USA.
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Maile S, Kadner A, Turina MI, Prêtre R. Detachment of the anterior leaflet of the tricuspid valve to expose perimembranous ventricular septal defects. Ann Thorac Surg 2003; 75:944-6. [PMID: 12645721 DOI: 10.1016/s0003-4975(02)04668-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Detachment of the septal leaflet of the tricuspid valve has been described for better access to perimembranous ventricular septal defects. Detachment confined to the anterior leaflet is less known, although it provides a better exposure of the subaortic area and puts less jeopardy on the conduction tissues. METHODS Data regarding 49 consecutive patients who had congenital perimembranous ventricular septal defect closure were retrospectively reviewed. Thirty-three patients (67%) underwent temporary detachment of the anterior leaflet of the tricuspid valve. The defect was closed with a Gore-Tex patch and a continuous suture. In 10 patients (29%), concomitant right ventricular outflow tract enlargement was performed. Follow-up was obtained in every patient (median time, 11 months; range, 2 to 26 months). RESULTS No early or late death occurred. Closure of the ventricular septal defect was complete, with no more than trivial residual jet leaks found in perioperative echocardiography. All patients were in sinus rhythm. The tricuspid valve never showed more than mild insufficiency after repair. No patient showed subaortic obstruction. CONCLUSIONS Detachment of the anterior leaflet of the tricuspid valve to expose the ventricular septal defect is a safe approach that allows rapid closure of the defect with a continuous suture and provides excellent results.
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Affiliation(s)
- Silke Maile
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
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16
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Nygren A, Sunnegårdh J, Berggren H. Preoperative evaluation and surgery in isolated ventricular septal defects: a 21 year perspective. Heart 2000; 83:198-204. [PMID: 10648497 PMCID: PMC1729305 DOI: 10.1136/heart.83.2.198] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To study short and long term results after surgical closure of isolated ventricular septal defects (VSDs) from 1976 to 1996, especially in relation to changes in preoperative evaluation during this period. DESIGN Retrospective study. SETTING Tertiary referral centre for paediatric cardiac care. PATIENTS All children under 18 years of age who had corrective surgery for VSD between 1976 and 1996. MAIN OUTCOME MEASURES Preoperative evaluation, indications for surgery, diagnostic errors, and early and late results. RESULTS A significant decrease in the use of invasive preoperative studies in favour of non-invasive methods was found; from 1976 to 1990, a total of 109/110 patients had preoperative invasive study as compared to 43/167 from 1991 to 1996 (p < 0.001). Pulmonary hypertension in small children, without detailed information on Qp:Qs ratio, as well as small or modest shunts without pulmonary hypertension, were more frequent indications for surgery in recent years. Early mortality after surgery occurred in 10 patients, with a significantly lower mortality rate found between 1991 and 1996 than between 1976 and 1990 (0.6% v 8.2%, p < 0.001). Children with large VSDs experienced perioperative complications significantly less often between 1991 and 1996 than between 1976 and 1990 (16/105 v 28/96, p < 0.05). Diagnostic errors showed a tendency to decrease between the two time periods. No late deaths occurred. CONCLUSIONS Significant reductions in early mortality, perioperative complications, and diagnostic mistakes were seen during the study period, even though less invasive diagnostic procedures were being performed.
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Affiliation(s)
- A Nygren
- Department of Paediatrics (Cardiology), The Queen Silva Children's Hospital, S-416 85, Göteborg, Sweden
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Kapoor L, Gan MD, Bandyhopadhyay A, Das MB, Chatterjee S. Improved exposure of isolated perimembranous ventricular septal defects. Ann Thorac Surg 2000; 69:291-2. [PMID: 10654544 DOI: 10.1016/s0003-4975(99)01224-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We describe an alternative step in the transatrial approach to the repair of ventricular septal defects. We temporarily detach the chorda of the obscuring tricuspid valve from its attachment to the septum to expose the ventricular septal defect.
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Affiliation(s)
- L Kapoor
- Department of Cardiac Surgery, B.M. Birla Heart Research Centre, Calcutta, India.
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18
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Yang YJ, Wu JM, Luo CY. Tetralogy of Fallot with an additional muscular inlet type ventricular septal defect--repair with split patch technique. J Card Surg 1995; 10:586-8. [PMID: 7488784 DOI: 10.1111/j.1540-8191.1995.tb00638.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
An 8-year-old girl with tetralogy of Fallot (TF) and double ventricular septal defects (VSDs) was reported. The additional VSD was a muscular inlet type. A split patch technique was used to cover both VSDs during the total correction. Follow-up echocardiogram demonstrated no residual shunt nor significant tricuspid valve regurgitation. The patient is doing well 2 years after operation.
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Affiliation(s)
- Y J Yang
- Department of Surgery, Medical College, National Cheng-Kung University, Tainan, Taiwan
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19
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Tatebe S, Miyamura H, Watanabe H, Sugawara M, Eguchi S. Closure of isolated ventricular septal defect with detachment of the tricuspid valve. J Card Surg 1995; 10:564-8. [PMID: 7488779 DOI: 10.1111/j.1540-8191.1995.tb00633.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Detachment of the septal leaflet of the tricuspid valve is an alternative technique for obtaining complete visualization of a perimembranous ventricular septal defect (VSD) in cases where the VSD is obscured by the chordae tendineae or a pouch formation of the septal leaflet. This method presents theoretical concerns because it has the potential for causing postoperative valvular insufficiency. We therefore evaluated valvular function in patients who underwent VSD closure with detachment of the tricuspid valve. In a consecutive series of 153 patients who underwent VSD closure using a transatrial approach, 13 had incision of the tricuspid valve. Follow-up echocardiographic studies were performed on these patients at least 1 year following operation. There were no operative deaths. Color Doppler echocardiography revealed no residual shunt in any of these patients. Ten patients had no evidence of tricuspid stenosis or regurgitation. One patient had trivial tricuspid regurgitation. Moderate tricuspid regurgitation was observed in two patients of these, one patient was a small infant who had a VSD complicated by pulmonary hypertension. The other patient had a VSD with a mitral cleft, pulmonary hypertension, and Down's syndrome. The incised tricuspid valve was resuspended by solely running sutures. In conclusion, detachment of the tricuspid valve is a safe and useful method for adequate exposure of a VSD. However, this method should be avoided in patients with Down's syndrome and in small infants. Furthermore, repair of the incised valve should not be performed using only running sutures.
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Affiliation(s)
- S Tatebe
- Department of Thoracic and Cardiovascular Surgery, Niigata University School of Medicine, Japan
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Graffigna A, Minzioni G, Ressia L, Vigano M. Surgical ablation of ventricular tachycardia secondary to congenital ventricular septal aneurysm. Ann Thorac Surg 1994; 57:921-4. [PMID: 8166541 DOI: 10.1016/0003-4975(94)90203-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Three patients underwent surgical ablation for ventricular tachycardia resulting from an aneurysm of the membranous portion of the ventricular septum. Two patients had a definite history of cardiac murmur during infancy, and one of them was found at the time of operation to have a left-to-right shunt through the apex of the aneurysm. The earliest ventricular activation sites were located around the neck of the aneurysm and were ablated in 1 patient by encircling the endocardial ventriculotomy and by cryoablation in the remaining 2. After focus resection had been completed, aneurysm resection and ventricular septal reconstruction were performed. All patients were alive and free of ventricular tachycardia and did not need medication as of 61, 66, and 88 months postoperatively. Spontaneous closure of a ventricular septal defect may lead to the formation of an aneurysm in the ventricular septum that may sustain ventricular tachycardias. Such arrhythmias can be effectively treated using electrically guided surgical techniques.
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Affiliation(s)
- A Graffigna
- Istituto di Cardiochirurgia, Università degli Studi di Pavia, Italy
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