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Xie L, Zhang G, He J, Shen Y, Liao D, Chen L, Xu F. Transthoracic device closure of perimembranous ventricular septal defect via a small left intercostal incision in children. Front Cardiovasc Med 2023; 10:1221136. [PMID: 37671138 PMCID: PMC10476519 DOI: 10.3389/fcvm.2023.1221136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/03/2023] [Indexed: 09/07/2023] Open
Abstract
Background In children with perimembranous ventricular septal defect, surgical repair requires sternotomy and leaves unsightly scars, which can trigger long-term physical and psychological distress. However, transcatheter device closure is limited by vascular diameter, radiographic exposure, and expensive DSA equipment. We used an ultra-small left intercostal incision for transthoracic device closure to avoid the above problems and investigated its safety and feasibility by comparing it with surgical repair. Methods This study enrolled 358 children with perimembranous ventricular septal defect. Among them, 152 patients were treated by surgical closure and 206 by transthoracic device closure via an ultra-small left intercostal incision. Perioperative clinical data and postoperative follow-up results were collected and analyzed retrospectively. Results The success rate was similar (P = 0.265) in the two groups: 203/206 patients in the device group vs. 152/152 patients in the surgical group. The operative time, intensive care unit time, mechanical ventilation time, and postoperative hospital stay were significantly shorter in the device group than in the surgical group. Although the incision length of the device group (1.1 ± 0.2 cm) was significant shorter (P < 0.001) than that of the surgical group (6.7 ± 1.5 cm), there was no difference in hospitalization costs between the two groups (P = 0.099). Except for small residual shunt (16/206 vs. 3/152, P = 0.017), the incidence of complications in the device group was lower or equal to that in the surgical group, and all small residual shunt disappeared during follow-up. There was no thoracic deformity in the device group, compared with 11 cases in the surgery group during follow-up (P < 0.001). Conclusions Transthoracic device closure via an ultra-small left intercostal incision under transesophageal echocardiography guidance is safe and feasible. With appropriate indications, it can be a suitable alternative to surgical closure for treating perimembranous ventricular septal defect in children.
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Affiliation(s)
- Linfeng Xie
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Medical University, Fuzhou, China
| | - Guican Zhang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, China
| | - Jian He
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Medical University, Fuzhou, China
| | - Yanming Shen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Medical University, Fuzhou, China
| | - Dongshan Liao
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, China
| | - Fan Xu
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, China
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Yu J, Shi Z, Qian J, Ma L, Zhang B, Ying L, Shu Q. Analysis and comparison of failure causes of minimally invasive surgical closure of ventricular septal defects in children. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000432. [PMID: 36817712 PMCID: PMC9933489 DOI: 10.1136/wjps-2022-000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 12/26/2022] [Indexed: 02/04/2023] Open
Abstract
Objectives The aims of the present study were to explore the causes of minimally invasive surgical ventricular septal defect (VSD) closure failure under transesophageal echocardiography guidance and thus to improve the success rate of surgical VSD closure. Methods From January 2015 to December 2019, 522 children with VSD underwent minimally invasive surgical closure. Nineteen procedures (3.64%) were unsuccessful. The failure causes, VSD locations and surgical incision approaches were retrospectively analyzed. Results Among the 19 patients (3.64%) with unsuccessful outcomes, 18 were switched to cardiopulmonary bypass (CPB) surgery, and 1 was closed successfully using an occlusion device a year later. The causes of failure included occlusion device shedding or shifting (n=6), failure of the guidewire (or the sheath) to pass through a small defect (n=5), device-related valve regurgitation (n=4), significant residual shunt (n=2), ventricular fibrillation (n=1), and continuous sharp blood pressure decreases (n=1). Patients with high VSD had a slightly higher failure rate than those with perimembranous VSD (p=0.049), and its key reason is the high proportion of occlusion device shedding or shifting (p=0.001). No significant difference in the failure rate was found between patients with different surgical incision approaches. Conclusions Minimally invasive surgery has a high success rate for perimembranous VSDs. Occlusion device shedding or shifting is the most common cause of failure. The shedding or shifting risk of eccentric occlusion devices being used only for high VSDs is much greater than that of concentric occlusion devices being used for perimembranous VSDs, which increases the risk of conversion to CPB surgery for high VSDs.
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Affiliation(s)
- Jin Yu
- Department of Ultrasound Diagnosis, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China,Department of Pediatric Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhuo Shi
- Department of Pediatric Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China,Department of Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jingjing Qian
- Department of Ultrasound Diagnosis, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China,Department of Pediatric Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lianglong Ma
- Department of Pediatric Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China,Department of Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Baofu Zhang
- Department of Ultrasound Diagnosis, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Liyang Ying
- Department of Pediatric Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China,Department of Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qiang Shu
- Department of Pediatric Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Healing the Broken Hearts: A Glimpse on Next Generation Therapeutics. HEARTS 2022. [DOI: 10.3390/hearts3040013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular diseases are the leading cause of death worldwide, accounting for 32% of deaths globally and thus representing almost 18 million people according to WHO. Myocardial infarction, the most prevalent adult cardiovascular pathology, affects over half a million people in the USA according to the last records of the AHA. However, not only adult cardiovascular diseases are the most frequent diseases in adulthood, but congenital heart diseases also affect 0.8–1.2% of all births, accounting for mild developmental defects such as atrial septal defects to life-threatening pathologies such as tetralogy of Fallot or permanent common trunk that, if not surgically corrected in early postnatal days, they are incompatible with life. Therefore, both congenital and adult cardiovascular diseases represent an enormous social and economic burden that invariably demands continuous efforts to understand the causes of such cardiovascular defects and develop innovative strategies to correct and/or palliate them. In the next paragraphs, we aim to briefly account for our current understanding of the cellular bases of both congenital and adult cardiovascular diseases, providing a perspective of the plausible lines of action that might eventually result in increasing our understanding of cardiovascular diseases. This analysis will come out with the building blocks for designing novel and innovative therapeutic approaches to healing the broken hearts.
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Yu J, Ye J, Zhang Z, Yang X, Ma L, Qian J, Zhao L, Qiang S. Value of transesophageal echocardiography in device closure of perimembranous ventricular septal defects in children via ultra‐minimal trans intercostal incision. J Card Surg 2022; 37:1171-1179. [PMID: 35188288 DOI: 10.1111/jocs.16311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/21/2021] [Accepted: 12/07/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Jin Yu
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Ultrasound Diagnosis, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Jingjing Ye
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Ultrasound Diagnosis, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Zewei Zhang
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Xiuzhen Yang
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Ultrasound Diagnosis, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Lianglong Ma
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Jingjing Qian
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Ultrasound Diagnosis, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Lei Zhao
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Ultrasound Diagnosis, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Shu Qiang
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
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