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Zampi JD, Sower CT, Lancaster TS, Sood V, Romano JC. Hybrid Interventions in Congenital Heart Disease: A Review of Current Practice and Rationale for Use. Ann Thorac Surg 2024; 118:329-337. [PMID: 38462049 DOI: 10.1016/j.athoracsur.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/14/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Hybrid interventions have become a common option in the management for a variety of patients with congenital heart disease. In this review, we discuss the data that have driven decision making about hybrid interventions to date. METHODS The existing literature on various hybrid approaches was reviewed and summarized. In addition, the key tenants to creating a successful hybrid program within a congenital heart center are elucidated. RESULTS Hybrid strategies for single-ventricle patients, pulmonary atresia with intact ventricular septum, branch pulmonary artery stenosis, and muscular ventricular septal defect closure have important benefits and limitations compared with traditional approaches. CONCLUSION A growing body of evidence supports the use of hybrid interventions in congenital heart disease. But important questions remain regarding improved survival and other long-term outcomes, such as neurocognition, that might impact widespread adoption as a primary treatment strategy.
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Affiliation(s)
- Jeffrey D Zampi
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
| | - C Todd Sower
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Timothy S Lancaster
- Section of Pediatric Cardiovascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Vikram Sood
- Section of Pediatric Cardiovascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jennifer C Romano
- Section of Pediatric Cardiovascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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2
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Adilbekova A, Marassulov S, Baigenzhin A, Kozhakhmetov S, Nurkeyev B, Kerimkulov A, Murzabayeva S, Maiorov R, Kenzhebayeva A. Hybrid versus traditional method closure of ventricular septal defects in children. JTCVS Tech 2024; 24:137-144. [PMID: 38835571 PMCID: PMC11145337 DOI: 10.1016/j.xjtc.2024.01.015] [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: 11/12/2023] [Revised: 12/23/2023] [Accepted: 01/12/2024] [Indexed: 06/06/2024] Open
Abstract
Objective The aim of our study was to evaluate the safety and effectiveness of the hybrid method off-pump for closure of isolated ventricular septal defect (VSD) compared with the traditional method of on-pump of children. Methods This research was a retrospective cohort study. Data were collected from 500 patients with isolated VSD (or residual VSD after a previous repair) who underwent surgery at the National Scientific Medical Center from May 2016 to December 2020. Patients were operated with 1 of 2 methods of surgery: the traditional method of on-pump or the hybrid method of off-pump. This study assessed the safety and efficacy of the hybrid method by comparing it with the traditional method for the treatment of patients with isolated VSD. Results The procedural success rate reached 93.2% in the hybrid method, with a 6.4% conversion rate to the traditional method and 0.4% hospital mortality. The mean operation time was 84 minutes (31; 160 minutes) in the hybrid group (n = 250) and 168 minutes (70; 300 minutes) in the traditional group (n = 250) (P = .000). Hospital mortality was 0.43% in the first group and 1.5% in the second group (P = .000). Conclusions The hybrid method of VSD closure is safe and effective in a selected group of patients. The advantages of the hybrid method are improved cosmetics and shorter operation time and overall hospital stay.
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Affiliation(s)
- Akkerbez Adilbekova
- Department of Pediatric Cardiac Surgery, National Scientific Medical Center, Astana City, Republic of Kazakhstan
- Department of Surgical Diseases Named Tsoi, Аstana Medical University, Astana City, Republic of Kazakhstan
| | - Shukhrat Marassulov
- Department of Pediatric Cardiac Surgery, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Abay Baigenzhin
- Department of Pediatric Cardiac Surgery, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Saken Kozhakhmetov
- Department of Surgical Diseases Named Tsoi, Аstana Medical University, Astana City, Republic of Kazakhstan
| | - Bakhytzhan Nurkeyev
- Department of Pediatric Cardiac Surgery, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Amangeldy Kerimkulov
- Department of Pediatric Anesthesiology, Reanimation and Intensive Care, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Saniya Murzabayeva
- Department of Pediatric Anesthesiology, Reanimation and Intensive Care, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Rinat Maiorov
- Department of Pediatric Interventional Cardiology, Endovascular X-ray Surgery and Functional Diagnostics, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Arailym Kenzhebayeva
- Department of Pediatric Cardiac Surgery, National Scientific Medical Center, Astana City, Republic of Kazakhstan
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Baspinar O, Kosger P, Aydin Sahin D. Percutaneous Closure of Hemodynamically Significant Postoperative Residual Ventricular Septal Defects. Pediatr Cardiol 2024; 45:272-281. [PMID: 38194099 DOI: 10.1007/s00246-023-03366-9] [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: 02/08/2023] [Accepted: 11/27/2023] [Indexed: 01/10/2024]
Abstract
The experience with percutaneous closure of postoperative residual ventricular septal defects (VSDs) is expanding with improved device technology and techniques. To report our experience with percutaneous closure of residual VSDs after cardiac surgeries. Retrospective clinical data review of patients who had percutaneous closure of postoperative residual VSDs at our institution between 2010 and 2022. Patients' demographics, procedural, and follow-up data were looked at. Twelve patients (50% males) with a median age of 9.2 years (range 0.9-22) were identified. Baseline surgeries were 8 tetralogy of Fallot corrections, 2 pulmonary bandings for large muscular VSD (mVSD) including 1 coarctation repair, 1 atrioventricular septal defect repair, 1 sub-aortic membrane resection-induced iatrogenic VSD, 1 isolated VSD closure, and 1 additional mVSD. Median duration between baseline surgery and percutaneous VSD closure was 2.2 years (range 0.2-8.3). Residual VSD shunting was secondary to surgical patch leakage in 8/12 patients. The median angiographic defect diameter was 6.8 mm (range 4.8-14). The defect was balloon-calibrated in 3/12 patients. Defects were tackled retrogradely in 3/9 patients. Amplatzer Membranous VSD occluder (n = 1), Lifetech Multifunctional (n = 5), Membranous (n = 1) and muscular VSD occluders (n = 2) and Occlutech Membranous (n = 1) and Muscular (n = 2) VSD occluders were used. The procedure was successful in 10/12 patients. Two devices embolized to the pulmonary artery and were snare-retrieved. Both patients were referred for surgery. The median follow-up was 1.3 years (range 0.1-12). Six-month ultrasound showed one trivial residual shunt and one mild right ventricular outflow obstruction. One patient is receiving targeted therapy for pulmonary hypertension at 2 years of follow-up. Transcatheter closure of postoperative residual VSDs is a feasible yet challenging intervention. Procedural complications can be encountered.
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Affiliation(s)
- Osman Baspinar
- Department of Pediatric Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Pelin Kosger
- Department of Pediatric Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Derya Aydin Sahin
- Department of Pediatric Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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Odemis E, Kizilkaya MH. Early and mid-term outcomes of transcatheter closure of perimembranous ventricular septal defects using the Lifetech™ Konar-MF Occluder device (MFO). Cardiol Young 2023; 33:2021-2026. [PMID: 36380499 DOI: 10.1017/s1047951122003547] [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] [Indexed: 11/18/2022]
Abstract
BACKGROUND Transcatheter closure of perimembranous ventricular septal defects is challenging. Double disk-designed devices have high adverse event rates; therefore, research into new devices persists. One such devise is the LifetechTM Konar-MF Occluder device (MFO), which is increasingly used. The purpose of this study is to present mid-term results of MFO for transcatheter closure of patients with perimembraneous ventricular septal defect. PATIENTS AND METHODS Records of the 52 patients with perimembraneous ventricular septal defect who had undergone transcatheter closure with MFO were reviewed. Demographic, echocardiographic, and procedure details were investigated. Three years follow-up results were recorded. RESULTS We closed the perimembraneous ventricular septal defect in 51 of 52 patients (98%). The femoral venous approach was used in 27 patients (53 %) whilst no arteriovenous loop was established in the remaining patients. No significant procedure-related complication occurred. On day 1 echocardiography, the residual ventricular septal defect rate was 31%. Mean±SD (range) follow-up duration was 36 ± 7,9 (18-54) months. In the follow-up, at 6th months, only four patients had hemodynamically insignificant residual defects. No severe dysrhythmia was detected including complete heart block. A right bundle branch block pattern was seen in one patient. CONCLUSION This study showed that MFO is a safe and effective device in the transcatheter treatment of perimembraneous ventricular septal defect's with mid-term follow-up.
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Affiliation(s)
- Ender Odemis
- Faculty of Medicine, Department of Pediatric Cardiology, Koc University, Turkey
| | - Mete Han Kizilkaya
- Faculty of Medicine, Department of Pediatric Cardiology, Koc University, Turkey
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Elmarsafawy H, Hafez M, Alsawah GA, Bakr A, Rakha S. Long-term outcomes of percutaneous closure of ventricular septal defects in children using different devices: A single centre experience from Egypt. BMC Pediatr 2023; 23:381. [PMID: 37525132 PMCID: PMC10392015 DOI: 10.1186/s12887-023-04194-9] [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: 03/06/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND The feasibility of percutaneous closure ventricular septal defects (VSD) in children has been previously proven. However, data on long-term outcomes are limited. We aim to evaluate the long-term outcome of our experience with percutaneous closure of VSD using various occluders. METHODS Retrospective institutional analysis of children who underwent transcatheter closure of perimembranous and muscular VSDs between September 2012 and February 2020. Patient demographics, procedural, and long-term follow-up data were comprehensively analyzed. Patients who lost to follow-up within two years post-procedure were excluded. RESULTS We identified 75 patients (54.7% males) with a median of 66 months (IQR, 46-96). The closure success rate at one year was 95.7%. Complete heart block was detected in two patients early post-procedure and resolved with steroids. The VSDs were perimembranous (52%), muscular (33.33%), and residual (14.67%). Implanted devices were Pfm Nit-Occlud LeˆVSD Coil (42.7%), HyperionTM VSD Muscular Occluder (28%), Amplatzer VSD muscular occluder (10.7%), Amplatzer Duct Occluder (14.7%), Occlutech Muscular VSD Occluder (2.7%), and Amplatzer Duct Occluder II (1.3%). No new arrhythmia or valve regurgitation was detected after two years post-procedure. Persisted complications on long-term follow-up included: residual shunting in 3(4%), mild tricuspid regurgitation in 2(2.7%), and aortic regurgitation in 2(2.7%), with one immediate post-catheterization mild aortic regurgitation worsened during follow-up, requiring surgical repair of VSD three years after device implantation. No deaths were reported. CONCLUSION Long-term outcomes of pediatric transcatheter VSD closure using different devices are satisfactory. Post-procedural adverse events are limited, but long-term surveillance is necessary to monitor their progression.
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Affiliation(s)
- Hala Elmarsafawy
- Pediatric Cardiology Unit, Pediatrics Department, Mansoura University Faculty of Medicine, El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
- Faculty of Medicine, New Mansoura University, New Mansoura City, Egypt
| | - Mona Hafez
- Pediatric Cardiology Unit, Pediatrics Department, Mansoura University Faculty of Medicine, El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
| | - Gehan A Alsawah
- Pediatric Cardiology Unit, Pediatrics Department, Mansoura University Faculty of Medicine, El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
| | - Asmaa Bakr
- Pediatric Cardiology Unit, Pediatrics Department, Mansoura University Faculty of Medicine, El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
| | - Shaimaa Rakha
- Pediatric Cardiology Unit, Pediatrics Department, Mansoura University Faculty of Medicine, El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt.
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Song J. Percutaneous Transcatheter Closure of Congenital Ventricular Septal Defects. Korean Circ J 2023; 53:134-150. [PMID: 36914603 PMCID: PMC10011220 DOI: 10.4070/kcj.2022.0336] [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: 12/13/2022] [Accepted: 12/27/2022] [Indexed: 02/17/2023] Open
Abstract
Ventricular septal defects (VSDs) are the most common kind of congenital heart disease and, if indicated, surgical closure has been accepted as a gold-standard treatment. However, as less-invasive methods are preferred, percutaneous device closure has been developed. After the first VSD closure was performed percutaneously by Lock in 1988, both techniques and devices have developed consistently. A perventricular approach for closure of muscular VSD in small patients and the closure of perimembranous VSD using off-label devices are key remarkable developments. Even though the Amplatzer membranous VSD occluder (Abbott) could not be approved for use due to the high complete atrioventricular conduction block rate, other new devices have shown good results for closure of perimembranous VSDs. However, the transcatheter technique is slightly complicated to perform, and concerns about conduction problems after VSD closure with devices remain. There have been a few reports demonstrating successful closure of subarterial-type VSDs with Amplatzer devices, but long-term issues involving aortic valve damage have not been explored yet. In conclusion, transcatheter VSD closure should be accepted as being as effective and safe as surgery but should only be performed by experienced persons and in specialized institutes because the procedure is complex and requires different techniques. To avoid serious complications, identifying appropriate patient candidates for device closure before the procedure is very important.
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Affiliation(s)
- Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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7
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Percutaneous closure of ventricular septal defect using LifeTech TM Konar-MF VSD Occluder: initial and short-term multi-institutional results. Cardiol Young 2022; 32:755-761. [PMID: 34318740 DOI: 10.1017/s1047951121002985] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Transcatheter ventricular septal defect closure remains a complex procedure with potential complications like complete heart block and aortic regurgitation. The ideal device design for such intervention is still evolving. AIM To assess the safety, efficacy, and short-term outcome of ventricular septal defect closure using LifeTechTM multifunctional (KONAR-MFTM) VSD Occluder. PATIENTS AND METHODS In a multicenre study, 44 patients with haemodynamically significant, restrictive ventricular septal defects underwent closure with the KONAR-MFTM device from April, 2019 to March, 2020. Clinical, echocardiographic, and angiographic data were collected and reviewed. Patients were followed up at 1, 3, 6, and 12 months. RESULTS The median age and weight were 8 (1.7-36) years and 20 (11-79) kg. Of 44 patients, 8 (18%) had a high muscular and 36 (82%) had a perimembranous defect, of which 6 had mild prolapse of the right coronary cusp. The median ventricular septal defect size was 8.8 (3.9-13.4) mm. A retrograde approach was adopted in 39 (88.6%) patients. Nine patients (20.5%) had a small residual leak and there was a slight increase in aortic regurgitation in one patient. One device, which embolised to pulmonary artery was retrieved, and the defect was closed with a larger device. At a median follow-up of 13 (5-18) months, the residual leak persisted in 1 (2.3%) patient. Mild aortic regurgitation in one patient remained unchanged. There were no major complications. CONCLUSION Percutaneous closure of ventricular septal defect using KONAR-MFTM device is safe and effective in short and midterm follow-up including selected patients with perimembranous defect and mild prolapse of the right coronary cusp.
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8
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Ventricular Septal Defects. CONGENIT HEART DIS 2022. [DOI: 10.1016/b978-1-56053-368-9.00016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Diab KA, Boujemline Y, Hijazi ZM. Update on shunt closure in neonates and infants. Expert Rev Cardiovasc Ther 2021; 19:475-492. [PMID: 33899641 DOI: 10.1080/14779072.2021.1922079] [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: 10/21/2022]
Abstract
Introduction: Cardiac defects that result in shunting are the most common types of congenital heart anomalies. Although these lesions can be simple, they can cause significant hemodynamic changes and can be challenging to manage in neonates and infants. Over the recent decades, the development of new transcatheter techniques and devices has made it safe and feasible to manage such defects when indicated, even in the smallest of patients. Understanding these interventional procedures is essential in order to manage those patients.Areas covered: In this article, we review the techniques and experience for closure of atrial septal defects, ventricular septal defects, patent ductus aarteriosus,as well as coronary arteriovenous malformations and fistulas in neonates and infants. Literature review of PubMed articles was performed through January 2021, with focus on the latest data and results of the usage of interventional techniques in treating these lesions specifically in this age-group.Expert opinion: Significant shunting lesions can be particularly challenging to manage in neonates and infants. Newer lower profile devices will likely continue to be developed in the future, allowing their use for transcatheter interventions in even smaller patients and those with more complex anatomy.
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Affiliation(s)
- Karim A Diab
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar
| | - Younes Boujemline
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar
| | - Ziyad M Hijazi
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar.,Weill Cornell Medical College, Doha, Qatar.,Weill Cornell Medical College, New York, NY, USA
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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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Tang L, Zhan X, Zhang C, Fang X, Liao H, Liu F, Lin W, Huang Y, Huang T, Fei H, Wu S, Xue Y. Novel Strategy for Predicting Conduction Abnormalities During Transcatheter Closure of Perimembranous Ventricular Septal Defect in Adults. Circ J 2020; 84:776-785. [PMID: 32201412 DOI: 10.1253/circj.cj-19-0664] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND In this study we evaluated the feasibility and efficacy of predicting conduction system abnormalities under 3-dimensional (3D) electroanatomic mapping guidance during transcatheter closure of perimembranous ventricular septal defects (pmVSDs) in adults.Methods and Results:The distribution of the His-Purkinje system (HPS) close to the margins of pmVSDs in the left ventricle was identified using 3D electroanatomic mapping and near-field HPS was further confirmed by different pacing protocols. Of the 20 patients in the study, 17 (85%) were successfully treated by transcatheter intervention. The minimum distance between the margins of the pmVSD and near-field HPS, as measured by 3D electroanatomic mapping, ranged from 1.3 to 3.9 mm (mean [± SD] 2.5±0.7 mm). Five patients with a minimum distance <2 mm had a higher risk (3/5; 60%) for adverse arrhythmic events, whereas patients with a distance >2 mm were at a much lower risk (1/15; 6.7%) of procedure-related conduction block (P=0.032). No other adverse events were recorded during the follow-up period (median 30 months). CONCLUSIONS A minimum distance between the pmVSD and near-field HPS <2 mm was associated with a relatively high risk of closure-related conduction block. 3D electroanatomic mapping may be helpful in guiding decision making for transcatheter closure and reduce the incidence of adverse arrhythmic events.
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Affiliation(s)
- Lihong Tang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
| | - Xianzhang Zhan
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
| | - Caojin Zhang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
| | - Xianhong Fang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
| | - Hongtao Liao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
| | - Fangzhou Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
| | - Weidong Lin
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
| | - Yigao Huang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
| | - Tao Huang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
| | - Hongwen Fei
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
| | - Shulin Wu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
| | - Yumei Xue
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
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12
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Parsons C, Zhao CB, Huang J. Closure of an iatrogenic ventricular septal defect using a hybrid approach and echocardiographic guidance. Ann Card Anaesth 2020; 23:212-215. [PMID: 32275038 PMCID: PMC7336984 DOI: 10.4103/aca.aca_150_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Treatment of postsurgical iatrogenic ventricular septal defects (VSDs) remains a challenge. Surgical closure is associated with significant morbidity and mortality. A peripheral accessed percutaneous approach is faced with difficulties of gaining adequate access and complex positioning in a beating heart. We report a case of using a hybrid approach to treat iatrogenic VSD with surgical right atriotomy and delivery of an Amplatzer system under direct visualization and transesophageal echocardiography guidance.
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Affiliation(s)
- Christopher Parsons
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA
| | - Chen B Zhao
- Department of Anesthesiology, Jewish Hospital, Louisville, KY, USA
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville; Department of Anesthesiology, Jewish Hospital, Louisville, KY, USA
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Bu H, Yang Y, Wu Q, Zhao T. Percutaneous Puncture Closure of Postoperative Residual Ventricular Septal Defects Without Radiation. Ann Thorac Surg 2020; 109:e457-e459. [PMID: 32035048 DOI: 10.1016/j.athoracsur.2019.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/13/2019] [Accepted: 12/14/2019] [Indexed: 11/19/2022]
Abstract
A redo surgical approach to residual ventricular septal defect (VSD) is technically demanding. Sternum reentry has to be performed very carefully to avoid any uncontrolled bleeding, and preparation of the adhesions must be made to expose the most important structures (ascending aorta, caval veins). However, percutaneous transcatheter device closure of the residual VSD with radiation exposure can cause arrhythmia, valve injury, and vascular complications. This report presents a less invasive technique to treat residual VSD, without arterial access, radiation exposure, or cardiopulmonary bypass.
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Affiliation(s)
- Haisong Bu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yifeng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qin Wu
- Department of Echocardiography, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tianli Zhao
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
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14
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Shah JH, Saraiya SP, Nikam TS, Jha MJ. Transcatheter Device Closure of Perimembranous Ventricular Septal Defect in Pediatric Patients: Long-Term Outcomes. Heart Views 2020; 21:17-21. [PMID: 32082495 PMCID: PMC7006324 DOI: 10.4103/heartviews.heartviews_13_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/25/2019] [Indexed: 11/04/2022] Open
Abstract
Aims The aim of this study is to evaluate the safety and efficacy of transcatheter device closure of perimembranous ventricular septal defects in pediatric patients at long-term follow-up. Materials and Methods We prospectively studied 376 patients with perimembranous VSDs between September 2008 and December 2015 who underwent percutaneous closure at our center. Transthoracic echocardiography (TTE) and electrocardiogram were done before and after the procedure in all the patients. All patients were subjected to follow-up evaluation at 1, 3, 6, 12 months, and annually thereafter with TTE and electrocardiogram. Results A total of 376 patients (210 males and 166 females) underwent transcatheter closure of perimembranous VSD. Mean age of patients was 8.67 ± 3.02 (range 3-18 years) and mean weight was 21.15 ± 8.31 (range 8-65 kg). The procedure was carried out successfully in 98.93% of patients with no reported mortality. Rhythm disturbances occurred in 8.5% of patients after the procedure which included three cases of complete atrioventricular block. Conclusion This study shows that in experienced hands transcatheter closure of perimembrnous VSD is safe and effective at long-term follow-up. With minimal morbidity and no mortality, the transcatheter is an effective alternative to surgical closure in selected patients.
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Affiliation(s)
- Jayal Hasmukhbhai Shah
- Department of Cardiology, U N Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Ahmedabad, Gujarat, India
| | - Sanket Pravinchandra Saraiya
- Department of Cardiology, U N Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Ahmedabad, Gujarat, India
| | - Tushar Sudhakarrao Nikam
- Department of Cardiology, U N Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Ahmedabad, Gujarat, India
| | - Mukesh Jitendra Jha
- Department of Cardiology, U N Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Ahmedabad, Gujarat, India
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Esmaeili A, Behnke-Hall K, Schrewe R, Schranz D. Percutaneous closure of perimembranous ventricular septal defects utilizing almost ideal Amplatzer Duct Occluder II: Why limitation in sizes? CONGENIT HEART DIS 2018; 14:389-395. [PMID: 30561883 DOI: 10.1111/chd.12731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/27/2018] [Accepted: 11/26/2018] [Indexed: 11/28/2022]
Abstract
AIM The purpose of this study is to describe the special aspects of perimembranous ventricular septal defects (pmVSD) closure by utilizing Amplatzer Duct Occluder II (ADO II) devices with a rational request for bigger ADO-II sizes, based on our experience in transcatheter device closure of pmVSD. METHODS AND RESULTS At our institution, placement of an ADO II device was used in 15 patients with pmVSD; the patients' age ranged between 6 months and 20 years. The indications for closure were CHF (n = 4), hemodynamically significant shunt (n = 7), tricuspid regurgitation (n = 3), and high risk for infective endocarditis (n = 2), respectively. The location of the VSD was infracristal in 13 patients, supracristal in 1, and a postsurgical Gerbode VSD in another one. Implantation of the device was successfully performed without embolization, any evidence of an AV block, or other conductance abnormalities during implantation and follow-up in the mean of 2.5 years (range 2 months-6.5 years). CONCLUSIONS Transcatheter closure of a pmVSD with ADO II is feasible in all pediatric and young adult age groups, by considering the device diameter limitations. The off-label use of ADO II implantation seems to be safe for VSDs closure up to 6 mm of size and feasible for various locations including unusual morphology such as postsurgical Gerbode defect.
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Affiliation(s)
- Anoosh Esmaeili
- Pediatric Heart Center of Hessen, Goethe University, Frankfurt am Main, Germany
| | - Kachina Behnke-Hall
- Pediatric Heart Center of Hessen, Goethe University, Frankfurt am Main, Germany
| | - Roland Schrewe
- Pediatric Heart Center of Hessen, Goethe University, Frankfurt am Main, Germany
| | - Dietmar Schranz
- Pediatric Heart Center of Hessen, Goethe University, Frankfurt am Main, Germany
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16
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He L, Cheng GS, Zhang YS, He XM, Wang XY, Du YJ. Transcatheter Closure of Perimembranous Ventricular Septal Defects in Children using a Wire-Drifting Technique. Clinics (Sao Paulo) 2018; 73:e371. [PMID: 30517278 PMCID: PMC6238823 DOI: 10.6061/clinics/2018/e371] [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] [Received: 10/12/2017] [Accepted: 07/04/2018] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Explore the feasibility and safety of transcatheter closure of perimembranous ventricular septal defects using a wire-drifting technique (WT) in children. METHODS We retrospectively analyzed 121 pediatric patients diagnosed with perimembranous ventricular septal defects who underwent interventional treatment at the First Affiliated Hospital of Xi'an Jiaotong University from Dec 2011 to Dec 2014. Based on the method used for arteriovenous loop establishment during the procedure, the patients were divided into a conventional technique (CT) group and a WT group. RESULTS In total, 51 of the 53 patients (96.2%) in the CT group and 66 of the 68 patients (97.1%) in the WT group achieved procedural success, with no significant difference between the two groups (p>0.05). The CT group showed a nonsignificantly higher one-time success rate of arteriovenous loop establishment (94.3% vs. 91.2%, p>0.05). The procedure time was 46.0 (14.0) min and 46.5 (10.0) min in the CT and WT groups, respectively. The CT procedure was discontinued in the 2 cases (3.8%) of intraprocedural atrioventricular block in the CT group. In the one case (1.9%) of postprocedural atrioventricular block in the CT group, a permanent pacemaker was implanted to resolve third-degree atrioventricular block three months after the procedure. In the WT group, no cases of intraprocedural atrioventricular block occurred, and one case (1.5%) of postprocedural atrioventricular block occurred. In this case, intravenous dexamethasone injection for three days returned the sinus rhythm to normal. Aggravated mild to moderate tricuspid regurgitation was observed in 2 patients (3.8%) in the CT group during the 2-year follow-up period; aggravated tricuspid regurgitation was not observed in the WT group. During the 2-year follow-up period, there was no evidence of residual shunting in either group. CONCLUSION Transcatheter closure of perimembranous ventricular septal defects with the WT is safe and effective in children.
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Affiliation(s)
- Lu He
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China
| | - Ge-Sheng Cheng
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China
| | - Yu-Shun Zhang
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China
- *Corresponding author. E-mail:
| | - Xu-Mei He
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China
| | - Xing-Ye Wang
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China
| | - Ya-Juan Du
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China
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17
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Abstract
Transcatheter closure of ventricular septal defects (VSDs) was first documented in 1988. The early studies of VSD closure were successful but there were high complication rates, particularly early and late-onset complete heart block. However, the development and use of new vascular occlusion devices in an off-label fashion has improved the range of patients who can be treated and reduced the complication rates. In particular, the rate of complete heart block documented in contemporary studies of VSD closure has fallen to levels at or below those documented in the surgical VSD closure literature.
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Affiliation(s)
- Brian H Morray
- Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way Northeast, RC.2.820, Seattle, WA 98105, USA.
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18
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Agarwal S, Sharma GK, Ratanapo S, Odo N, Javaheri SP. Percutaneous Closure of Complex Membranous Ventricular Septal Defect Under Transesophageal Echocardiographic Guidance. A A Pract 2018; 10:87-90. [DOI: 10.1213/xaa.0000000000000703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gu X, Zhang Q, Sun H, Fei J, Zhang X, Kutryk MJ. Transcatheter Closure Versus Repeat Surgery for the Treatment of Postoperative Left-to-Right Shunts: A Single Center 15-Year Experience. Cardiol Res 2018; 8:286-292. [PMID: 29317971 PMCID: PMC5755660 DOI: 10.14740/cr629e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/05/2017] [Indexed: 11/28/2022] Open
Abstract
Background Repeat surgery and the percutaneous approach (transcatheter closure (TCC)) have been used for the management of postoperative left-to-right shunts. In this study, we described our 15 years of experience in treating postoperative left-to-right shunts with these two approaches. Methods From February 2002 to February 2017, 50 patients with residual left-to-right shunts, following cardiac surgery, were treated using TCC or repeat surgery. Clinical examination, standard 12-lead electrocardiography, chest X-ray, and a transthoracic echocardiogram were performed before hospital discharge and at all follow-ups. Results The closure rate was 100% in both groups and there was no procedure-related mortality. Patients with TCC had few complications. The procedure time and duration of hospital stay for TCC patients were 58.9 ± 27.7 min and 6.1 ± 0.8 days, respectively. Eleven out of 19 patients receiving reoperation suffered serious complications after surgery, e.g., bleeding and nosocomial infections. The operation time and duration of hospital stay for reoperation patients were 256.7 ± 60.5 min and 17.0 ± 4.0 days, respectively. No other serious complications were seen at all follow-up visits for both groups. Conclusions In conclusions, TCC is safe and effective for the management of postoperative left-to-right shunts, and is associated with few complications, which can be the favored closure strategy over repeat surgery for the management of postoperative left-to-right shunts.
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Affiliation(s)
- Xinghua Gu
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan 250012, China
| | - Qiuwang Zhang
- Division of Cardiology, Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Hourong Sun
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan 250012, China
| | - Jianchun Fei
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan 250012, China
| | - Xiquan Zhang
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan 250012, China
| | - Michael J Kutryk
- Division of Cardiology, Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Cecchin F, Halpern DG. Cardiac Arrhythmias in Adults with Congenital Heart Disease: Pacemakers, Implantable Cardiac Defibrillators, and Cardiac Resynchronization Therapy Devices. Card Electrophysiol Clin 2017; 9:319-328. [PMID: 28457245 DOI: 10.1016/j.ccep.2017.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Implanting cardiac rhythm medical devices in adults with congenital heart disease requires training in congenital heart disease. The techniques and indications for device implantation are specific to the anatomic diagnosis and state of disease progression. It often requires a team of physicians and is best performed at a specialized adult congenital heart center.
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Affiliation(s)
- Frank Cecchin
- NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA.
| | - Daniel G Halpern
- NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
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21
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Gupta A, Amin Z. Popular Hybrid Congenital Heart Procedures without Cardiopulmonary Bypass. Front Surg 2017; 4:9. [PMID: 28321396 PMCID: PMC5337498 DOI: 10.3389/fsurg.2017.00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/26/2017] [Indexed: 12/16/2022] Open
Abstract
As surgical and catheter interventions advance, patients with congenital heart disease are now offered alternative treatment options that cater to their individual needs. Furthermore, collaboration between interventional cardiologists and cardiac surgeons have led to the development of hybrid procedures, using the best techniques of each respective field to treat these complex cardiac entities from initial treatment in the pediatric patient to repeat intervention in the adult. We present a review of the increased popularity and trend in hybrid procedures in congenital heart disease without the use of cardiopulmonary bypass.
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Affiliation(s)
- Aamisha Gupta
- Division of Pediatric Cardiology, Children's Hospital of Georgia, Augusta University , Augusta, GA , USA
| | - Zahid Amin
- Division of Pediatric Cardiology, Children's Hospital of Georgia, Augusta University , Augusta, GA , USA
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22
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Simpson J, Lopez L, Acar P, Friedberg MK, Khoo NS, Ko HH, Marek J, Marx G, McGhie JS, Meijboom F, Roberson D, Van den Bosch A, Miller O, Shirali G. Three-dimensional Echocardiography in Congenital Heart Disease: An Expert Consensus Document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2016; 30:1-27. [PMID: 27838227 DOI: 10.1016/j.echo.2016.08.022] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Three-dimensional echocardiography (3DE) has become important in the management of patients with congenital heart disease (CHD), particularly with pre-surgical planning, guidance of catheter intervention, and functional assessment of the heart. 3DE is increasingly used in children because of good acoustic windows and the non-invasive nature of the technique. The aim of this paper is to provide a review of the optimal application of 3DE in CHD including technical considerations, image orientation, application to different lesions, procedural guidance, and functional assessment.
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Affiliation(s)
- John Simpson
- Evelina London Children's Hospital, London, United Kingdom.
| | - Leo Lopez
- Nicklaus Children's Hospital, Miami, Florida
| | | | | | - Nee S Khoo
- Stollery Children's Hospital & University of Alberta, Edmonton, Alberta, Canada
| | - H Helen Ko
- Mt. Sinai Medical Center, New York, New York
| | - Jan Marek
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - Gerald Marx
- Boston Children's Hospital and Harvard School of Medicine, Boston, Massachusetts
| | - Jackie S McGhie
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - David Roberson
- Advocate Children's Hospital, Chicago Medical School, Chicago, Illinois
| | | | - Owen Miller
- Evelina London Children's Hospital, London, United Kingdom
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23
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Simpson J, Lopez L, Acar P, Friedberg M, Khoo N, Ko H, Marek J, Marx G, McGhie J, Meijboom F, Roberson D, Van den Bosch A, Miller O, Shirali G. Three-dimensional echocardiography in congenital heart disease: an expert consensus document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2016; 17:1071-97. [DOI: 10.1093/ehjci/jew172] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/28/2016] [Indexed: 01/02/2023] Open
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Hadeed K, Hascoet S, Amadieu R, Karsenty C, Cuttone F, Leobon B, Dulac Y, Acar P. Assessment of Ventricular Septal Defect Size and Morphology by Three-Dimensional Transthoracic Echocardiography. J Am Soc Echocardiogr 2016; 29:777-785. [DOI: 10.1016/j.echo.2016.04.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Indexed: 12/01/2022]
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25
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Shunt Lesions Part I: Patent Ductus Arteriosus, Atrial Septal Defect, Ventricular Septal Defect, and Atrioventricular Septal Defect. Pediatr Crit Care Med 2016; 17:S302-9. [PMID: 27490614 DOI: 10.1097/pcc.0000000000000786] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This review summarizes the current understanding of the pathophysiology and perioperative management of patent ductus arteriosus, atrial septal defect, ventricular septal defect, and atrioventricular septal defect. DATA SOURCE MEDLINE and PubMed. CONCLUSIONS The four congenital cardiac lesions that are the subject of this review, patent ductus arteriosus, atrial septal defect, ventricular septal defect, and atrioventricular septal defect, are the most commonly found defects causing a left-to-right shunt. These defects frequently warrant transcatheter or surgical intervention. Although the perioperative care is relatively straightforward for many of these patients, there are a number of management strategies and complications associated with each intervention. The treatment outcomes for all of these lesions are very good in the current era.
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Percutaneous Punctured Transcatheter Device Closure of Residual Shunt after Ventricular Septal Defect Repair. Case Rep Cardiol 2016; 2016:8124731. [PMID: 27293910 PMCID: PMC4886074 DOI: 10.1155/2016/8124731] [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: 03/10/2016] [Accepted: 05/04/2016] [Indexed: 11/18/2022] Open
Abstract
Ventricular septal defects (VSDs) are estimated to account for 20 to 30% of all congenital heart defects (CHDs). Although a residual shunt is the most common complication of VSD surgery, a second operation that applies the surgical repair method is very difficult because it can increase the possibility of uncontrolled bleeding and the severity of tissue adhesion. Here, we present the first case of percutaneous punctured transcatheter device closure of a residual shunt after VSD repair as a novel method to further develop for the treatment of children with congenital heart disease.
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Cossor W, Cui VW, Roberson DA. Three-Dimensional Echocardiographic En Face Views of Ventricular Septal Defects: Feasibility, Accuracy, Imaging Protocols and Reference Image Collection. J Am Soc Echocardiogr 2015; 28:1020-9. [PMID: 26141981 DOI: 10.1016/j.echo.2015.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ventricular septal defect (VSD) is the most common congenital cardiac anomaly. Accurate assessment is critical for planning treatment. Recent advances in three-dimensional (3D) echocardiography have improved image quality and ease of use. METHODS The feasibility and accuracy of three specific 3D echocardiographic protocols to demonstrate en face views of VSDs were analyzed in a retrospective review of 100 consecutive patients. Sixty-four patients underwent transthoracic echocardiography and 36 transesophageal echocardiography. Types of VSDs included 34 muscular, 32 perimembranous, 18 malaligned, 11 inlet, four outlet, and one acquired. Ages ranged from 1 day to 77 years, and body weights from 3 to 92 kg. Three-dimensional echocardiographic full-volume mode with standard XYZ and adjustable plane cropping, 3D full-volume mode with iCrop, and narrow-sector live 3D protocols were compared for feasibility and accuracy to obtain a diagnostic-quality en face view of a VSD. RESULTS The success rate for obtaining a high-quality en face image for the three protocols was 100% for full-volume mode with iCrop, 97% for full-volume standard mode, and 94% for narrow-sector live 3D mode. The ability of both full-volume mode with iCrop and full-volume standard mode to demonstrate a VSD was slightly better than that of narrow-sector live 3D mode (P < .001 for both vs narrow-sector live 3D mode). In all patients, the type, size, and location of the VSD were demonstrated accurately by two or more of the protocols. CONCLUSIONS Three-dimensional echocardiography of VSDs is feasible and accurate in most patients using defined protocols. The protocols are described and illustrated in detail, and a reference 3D image collection is presented.
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Affiliation(s)
- Waseem Cossor
- Advocate Children's Hospital Heart Institute, Chicago Medical School, Oak Lawn, Illinois
| | - Vivian Wei Cui
- Advocate Children's Hospital Heart Institute, Chicago Medical School, Oak Lawn, Illinois
| | - David A Roberson
- Advocate Children's Hospital Heart Institute, Chicago Medical School, Oak Lawn, Illinois.
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Bhatt AB, Foster E, Kuehl K, Alpert J, Brabeck S, Crumb S, Davidson WR, Earing MG, Ghoshhajra BB, Karamlou T, Mital S, Ting J, Tseng ZH. Congenital Heart Disease in the Older Adult. Circulation 2015; 131:1884-931. [DOI: 10.1161/cir.0000000000000204] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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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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Du RZ, Qian J, Wu J, Liang Y, Chen GH, Sun T, Zhou Y, Zhao Y, Yan JC. Cardiac resynchronization therapy for heart failure induced by left bundle branch block after transcatheter closure of ventricular septal defect. J Geriatr Cardiol 2014; 11:357-62. [PMID: 25593586 PMCID: PMC4294153 DOI: 10.11909/j.issn.1671-5411.2014.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 10/27/2014] [Accepted: 12/06/2014] [Indexed: 11/21/2022] Open
Abstract
A 54-year-old female patient with congenital heart disease had a persistent complete left bundle branch block three months after closure by an Amplatzer ventricular septal defect occluder. Nine months later, the patient suffered from chest distress, palpitation, and sweating at daily activities, and her 6-min walk distance decreased significantly (155 m). Her echocardiography showed increased left ventricular end-diastolic diameter with left ventricular ejection fraction of 37%. Her symptoms reduced significantly one week after received cardiac resynchronization therapy. She had no symptoms at daily activities, and her echo showed left ventricular ejection fraction of 46% and 53%. Moreover, left ventricular end-diastolic diameter decreased 6 and 10 months after cardiac resynchronization therapy, and 6-min walk distance remarkably increased. This case demonstrated that persistent complete left bundle branch block for nine months after transcatheter closure with ventricular septal defect Amplatzer occluder could lead to left ventricular enlargement and a significant decrease in left ventricular systolic function. Cardiac resynchronization therapy decreased left ventricular end-diastolic diameter and increased left ventricular ejection fraction, thereby improving the patient's heart functions.
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Affiliation(s)
- Rong-Zeng Du
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Jun Qian
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Jun Wu
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Yi Liang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Guang-Hua Chen
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Tao Sun
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Ye Zhou
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Yang Zhao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Jin-Chuan Yan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
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Xu XD, Bai Y, Chen XL, Liu SX, Zhao XX, Qin YW. Simultaneous transcatheter treatment of perimembranous ventricular septal defect and other congenital cardiopathies. Heart Lung Circ 2014; 23:1169-74. [PMID: 24998101 DOI: 10.1016/j.hlc.2014.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/17/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of simultaneous transcatheter corrections of perimembranous ventricular septal defect (VSD) and other congenital cardiopathies. PATIENTS/METHODS From 2004 to 2012, 56 patients (25 male, 31 female), aged 14.2±10.1, with compound congenital cardiovascular abnormalities underwent simultaneous transcatheter interventional procedure. Of the 56 patients, 32 had VSD and atrial septal defects (ASD); 17 had VSD and patent ductus arteriosus (PDA); and seven had VSD and pulmonary valve stenosis (PS). Percutaneous balloon pulmonary valvuloplasty (PBPV) was performed before the closure of VSD, PDA, or ASD. RESULTS The combined transcatheter interventional procedure was successfully performed in all patients. Among these, two occluders were implanted in each of 49 patients, seven patients with VSD combined with PS underwent successfully balloon valvuloplasty and VSD closure. The size of VSD, ASD and PDA detected by TTE was 4.8±1.7 mm, 9.0±5.0 mm and 4.5±2.5 mm, respectively. The occluder diameter of VSD, ASD and PDA was 7.6±2.2 mm, 14.3±6.2 mm and 7.9±3.2 mm, respectively. The peak-to-peak transpulmonary gradient decreased from 60.4±19.7 mmHg to 15.0±5.0 mmHg (p<0.001) in seven patients with VSD combined with PS. One patient with VSD and ASD had a permanent pacemaker implanted because of third-degree atrioventricular block two months after the procedure. There were not serious adverse events in relation to the combined procedures during the 23.8±20.7 months of follow-up in other 55 patients. CONCLUSION The simultaneous treatment of VSD and other congenital cardiopathies using transcatheter-based procedures is safe and effective, which can provide satisfactory results.
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Affiliation(s)
- Xu-Dong Xu
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, PR China
| | - Yuan Bai
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, PR China
| | - Xiao-Li Chen
- Department of Cardiology, First People's Hospital of Nantong, Nantong 226001, Jiangsu Province, PR China
| | - Su-Xuan Liu
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, PR China
| | - Xian-Xian Zhao
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, PR China.
| | - Yong-Wen Qin
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, PR China.
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YANG LINQI, TAI BEECHOO, KHIN LAYWAI, QUEK SWEECHYE. A Systematic Review on the Efficacy and Safety of Transcatheter Device Closure of Ventricular Septal Defects (VSD). J Interv Cardiol 2014; 27:260-72. [DOI: 10.1111/joic.12121] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- LINQI YANG
- Department of Paediatrics; National University Health System; National University of Singapore; Singapore
| | - BEE-CHOO TAI
- Saw Swee Hock School of Public Health; National University of Singapore; Singapore Singapore
| | - LAY WAI KHIN
- Saw Swee Hock School of Public Health; National University of Singapore; Singapore Singapore
| | - SWEE CHYE QUEK
- Department of Paediatrics; National University Health System; National University of Singapore; Singapore
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Yin S, Zhu D, Lin K, An Q. Perventricular Device Closure of Congenital Ventricular Septal Defects. J Card Surg 2014; 29:390-400. [PMID: 24762039 DOI: 10.1111/jocs.12334] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Senlin Yin
- Department of Cardiovascular Surgery; Pediatric Heart Center of West China Hospital, Sichuan University; Chengdu Sichuan China
| | - Da Zhu
- Department of Cardiovascular Surgery; Pediatric Heart Center of West China Hospital, Sichuan University; Chengdu Sichuan China
| | - Ke Lin
- Department of Cardiovascular Surgery; Pediatric Heart Center of West China Hospital, Sichuan University; Chengdu Sichuan China
| | - Qi An
- Department of Cardiovascular Surgery; Pediatric Heart Center of West China Hospital, Sichuan University; Chengdu Sichuan China
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Yang J, Yang L, Yu S, Liu J, Zuo J, Chen W, Duan W, Zheng Q, Xu X, Li J, Zhang J, Xu J, Sun L, Yang X, Xiong L, Yi D, Wang L, Liu Q, Ge S, Ren J. Transcatheter versus surgical closure of perimembranous ventricular septal defects in children: a randomized controlled trial. J Am Coll Cardiol 2014; 63:1159-1168. [PMID: 24509270 DOI: 10.1016/j.jacc.2014.01.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 12/28/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the safety and efficacy of the surgical versus transcatheter approach to correct perimembranous ventricular septal defects (pmVSDs) in a prospective, randomized, controlled clinical trial. BACKGROUND pmVSD is a common congenital heart disease in children. Surgical closure of pmVSD is a well-established therapy but requires open-heart surgery with cardiopulmonary bypass. Although the transcatheter approach is associated with significant incidence of complete atrioventricular block, it may provide a less invasive alternative. Critical comparison of the safety and efficacy of the 2 interventions necessitates a prospective, randomized, controlled trial. METHODS Between January 2009 and July 2010, 229 children with pmVSD were randomly assigned to surgical or transcatheter intervention. Clinical, laboratory, procedural, and follow-up data over a 2-year period were compared. RESULTS Neither group had mortality or major complications. However, statistical analysis of the 2 groups demonstrated significant differences (p < 0.001) in minor adverse events (32 vs. 7), quantity of blood transfused, duration of the procedure, median hospital stay, median intensive care unit stay, median hospitalization cost, and median blood loss. During a median follow-up of 2 years, the left ventricular end-diastolic dimension of both groups returned to normal and there was no difference in closure rate, adverse events, and complications between groups. CONCLUSIONS Transcatheter device closure and surgical repair are effective interventions with excellent midterm results for treating pmVSD in children. Transcatheter device closure has a lower incidence of myocardial injury, less blood transfused, faster recovery, shorter hospital stay, and lower medical expenses. (Transcatheter Closure Versus Surgery of Perimembranous Ventricular Septal Defects; NCT00890799).
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Affiliation(s)
- Jian Yang
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Lifang Yang
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shiqiang Yu
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jincheng Liu
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jian Zuo
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wensheng Chen
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Weixun Duan
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Qijun Zheng
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xuezeng Xu
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jun Li
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jun Zhang
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jian Xu
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lijun Sun
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiuling Yang
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lize Xiong
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Dinghua Yi
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lei Wang
- Department of Cardiology, Xi'an Children Hospital, Xi'an, China
| | - Qingchun Liu
- Department of Cardiovascular Surgery, Hanzhong Central Hospital, Hanzhong, China
| | - Shuping Ge
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China; Heart Center at St. Christopher's Hospital for Children and Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Jun Ren
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China; College of Health Sciences, University of Wyoming, Laramie, Wyoming
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Khairy P, Dore A, Talajic M, Dubuc M, Poirier N, Roy D, Mercier LA. Arrhythmias in adult congenital heart disease. Expert Rev Cardiovasc Ther 2014; 4:83-95. [PMID: 16375631 DOI: 10.1586/14779072.4.1.83] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent advances in pediatric cardiology and cardiac surgery have allowed a rapidly expanding population of patients with congenital heart disease to thrive well into their adult years. Often after prolonged uneventful clinical courses as children and adolescents, arrhythmias may surface later in life. These arrhythmias are a major source of morbidity. In addition, sudden death is the leading cause of mortality in adult patients with congenital heart disease. This review highlights the various types of brady- and tachyarrhythmias encountered in the more common forms of adult congenital heart disease and explores prognostic implications and therapeutic options.
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Affiliation(s)
- Paul Khairy
- Electrophysiology and Adult Congenital Heart Disease, Montreal Heart Institute, Montreal, QC H1T 1C8, Canada.
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MacDonald ST, Carminati M, Chessa M. Managing adults with congenital heart disease in the catheterization laboratory: state of the art. Expert Rev Cardiovasc Ther 2014; 8:1741-52. [DOI: 10.1586/erc.10.165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Giglia TM, Massicotte MP, Tweddell JS, Barst RJ, Bauman M, Erickson CC, Feltes TF, Foster E, Hinoki K, Ichord RN, Kreutzer J, McCrindle BW, Newburger JW, Tabbutt S, Todd JL, Webb CL. Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease. Circulation 2013; 128:2622-703. [DOI: 10.1161/01.cir.0000436140.77832.7a] [Citation(s) in RCA: 202] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Mylotte D, Martucci G, Piazza N, McElhinney D. Percutaneous options for heart failure in adults with congenital heart disease. Heart Fail Clin 2013; 10:179-96. [PMID: 24275303 DOI: 10.1016/j.hfc.2013.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the context of congenital heart disease (CHD), the complex biochemical and physiologic response to the pressure- or volume-loaded ventricle can be induced by stenotic and shunt/regurgitant lesions, respectively. A range of transcatheter therapies have recently emerged to expand the therapeutic potential of the more traditional surgical and medical interventions for heart failure in patients with CHD. Together, these complementary interventions aim to treat the growing patient population with adult CHD (ACHD). In this article, the most commonly used transcatheter interventions for heart failure in patients with ACHD are reviewed.
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Affiliation(s)
- Darren Mylotte
- Department of Interventional Cardiology, McGill University Health Centre, Royal Victoria Hospital, 687, Pine Avenue West, Montréal H3A-1A1, Québec, Canada
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Evolving trends in interventional cardiology: endovascular options for congenital disease in adults. Can J Cardiol 2013; 30:75-86. [PMID: 24365192 DOI: 10.1016/j.cjca.2013.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/06/2013] [Accepted: 11/06/2013] [Indexed: 02/06/2023] Open
Abstract
As increasing numbers of patients with congenital heart disease enter adulthood, there is a growing need for minimally invasive percutaneous interventions, primarily to minimize the number of repeated surgeries required by these patients. The use of percutaneous devices is commonplace for the treatment of simple lesions, such as atrial septal defect, patent foramen ovale, patent duct arteriosus, and abnormal vascular connections. There is also substantial experience with device closure of membranous and muscular ventricular septal defects, as well as more complex shunts such as baffle leaks after atrial switch repair and ventricular pseudoaneurysms. An increasing use of covered stents has improved the safety of aortic coarctation, conduit, and branch pulmonary stenosis interventions. Percutaneous pulmonary valve implantation now has an established role in the setting of dysfunctional right ventricle-pulmonary artery conduits or failing bioprosthetic pulmonary valves. Many patients remain unsuitable for percutaneous pulmonary valve implantation because of large diameter "native" outflow tracts, however, various techniques have emerged and multiple devices are in development to provide solutions for these unique anatomic challenges. Hybrid approaches involving use of surgical and transcatheter techniques are increasingly common, serving to optimize efficacy and safety of certain procedures; they depend on a collaborative and collegial relationship between cardiac surgeons and interventionalists that is primarily patient-centred.
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Zartner P, Christians C, Stelter JC, Hraška V, Schneider MB. Transvascular closure of single and multiple muscular ventricular septal defects in neonates and infants < 20 kg. Catheter Cardiovasc Interv 2013; 83:564-70. [DOI: 10.1002/ccd.25177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/10/2013] [Accepted: 08/25/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Peter Zartner
- Department of Cardioldogy; German Paediatric Heart Centre; Sankt Augustin Germany
| | - Claus Christians
- Department of Cardioldogy; German Paediatric Heart Centre; Sankt Augustin Germany
| | | | - Viktor Hraška
- Department of Cardiothoracic Surgery; Sankt Augustin Germany
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Fouilloux V, Bonello B, Gran C, Fraisse A, Macé L, Kreitmann B. Perventricular closure of muscular ventricular septal defects in infants with echocardiographic guidance only. World J Pediatr Congenit Heart Surg 2013; 3:446-51. [PMID: 23804906 DOI: 10.1177/2150135112447958] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report our experience with perventricular closure of muscular (apical) ventricular septal defects (VSDs) in small infants, with echocardiographic guidance only, in a nonhybrid suite. METHODS Eight infants with nine large muscular (apical) VSDs underwent perventricular device closure in a nonhybrid operating room, with transesophageal and epicardial echocardiography guidance, at a mean age and weight of 3.07 (0.3-7.28) months and 3.7 (2.5-6.2) kg, respectively. Five patients had multiple VSDs. Four had associated cardiac defects. RESULTS Nine Amplatzer muscular VSD devices with a mean size of 10 (4-14) mm were deployed. Seven patients were discharged from the intensive care unit with a mean length of stay of 8.6 days. Four patients had minimal postprocedural residual shunt; no one had a residual shunt at six-month follow-up. Mid-term results are excellent. CONCLUSION Perventricular closure is feasible under echocardiographic guidance only in small patients, even without hybrid suite. This may be a good approach for very symptomatic low-weight infants with apical VSD and may also be useful, in any center, at any time, and in any operating room, to treat an associated apical VSD, even unexpected.
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Affiliation(s)
- Virginie Fouilloux
- Department of Thoracic and Cardio-Vascular Surgery, Hôpital d'enfants de la Timone, Marseille, France
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Butera G, Piazza L, Saracino A, Chessa M, Carminati M. Transcatheter Closure of Membranous Ventricular Septal Defects-Old Problems and New Solutions. Interv Cardiol Clin 2013; 2:85-91. [PMID: 28581989 DOI: 10.1016/j.iccl.2012.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Isolated perimembranous ventricular septal defect (VSD) is the most common congenital heart defect (after bicuspid aortic valve). Surgery is considered the gold standard for the treatment of these VSDs. However, it is associated with morbidity and mortality. Less invasive techniques have been developed, and percutaneous closure of perimembranous VSDs is now considered a possible alternative to the standard surgical approach. The main problem associated with transcatheter closure of VSD is the occurrence of complete atrioventricular block and need for pacemaker implantation. Improvements in technology and design will help to reduce the occurrence of this problem in the near future.
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Affiliation(s)
- Gianfranco Butera
- Pediatric Cardiology and GUCH Unit, Policlinico San Donato IRCCS, Via Morandi 30, San Donato Milanese 20097, Italy.
| | - Luciane Piazza
- Pediatric Cardiology and GUCH Unit, Policlinico San Donato IRCCS, Via Morandi 30, San Donato Milanese 20097, Italy
| | - Antonio Saracino
- Pediatric Cardiology and GUCH Unit, Policlinico San Donato IRCCS, Via Morandi 30, San Donato Milanese 20097, Italy
| | - Massimo Chessa
- Pediatric Cardiology and GUCH Unit, Policlinico San Donato IRCCS, Via Morandi 30, San Donato Milanese 20097, Italy
| | - Mario Carminati
- Pediatric Cardiology and GUCH Unit, Policlinico San Donato IRCCS, Via Morandi 30, San Donato Milanese 20097, Italy
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Dilawar M, Ahmad Z. Safety and efficacy of amplatzer duct occluder for percutaneous closure of ventricular septal defects with tunnel shape aneurysm: Medium term follow up. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wjcd.2013.32035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wang L, Cao S, Li J, Yang L, Liu Y, Ren J, Ma Q, Xing H, Li D, Tian D, Wan Y, Yu S, Chen T, Yang X, Yang J. Transcatheter closure of congenital perimembranous ventricular septal defect in children using symmetric occluders: an 8-year multiinstitutional experience. Ann Thorac Surg 2012; 94:592-8. [PMID: 22626754 DOI: 10.1016/j.athoracsur.2012.03.067] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/21/2012] [Accepted: 03/26/2012] [Indexed: 01/08/2023]
Abstract
BACKGROUND Perimembranous ventricular septal defects (pmVSDs) are one of the most common forms of congenital cardiac malformation in children. Results of transcatheter pmVSD closure remain debatable, prompting the need for further evaluation with regard to the safety and efficacy of this procedure. The aim of the study was to analyze the safety, efficacy, and long-term follow-up data associated with transcatheter closure of pmVSDs in children using symmetric occluders. METHODS From December 2002 to October 2011, 525 children with pmVSDs between 2 and 12 years of age underwent transcatheter closure at three major heart centers in northwest China with symmetric pmVSD occluders. All patients were followed up until October 2011 with electrocardiogram and transthoracic echocardiography. Adverse events were recorded and evaluated. RESULTS There were 252 male and 273 female patients with an average weight of 21.5 kg. The mean age at the time of transcatheter closure was 5.6 years, and the average ratio of pulmonic to systemic blood flow was 2.5. Transcatheter intervention was successfully performed in 502 patients (95.6%). The median device size implanted was 6.5 mm (range, 4 to 18 mm). During a median 45-month follow-up period, no mortality occurred. A total of three major adverse events (0.6%) were reported; two were valve-related. Meanwhile, 104 minor adverse events were detected during the entire follow-up period. All individuals experiencing major adverse events were younger than 3 years of age. The incidence of major adverse events in patients younger than 3 years old was significantly higher than that of patients older than 3 years old (3.75% versus 0.00%; Fisher's exact test p=0.004). CONCLUSIONS Data from the current study suggest that transcatheter pmVSD closure using symmetric occluders displayed an excellent success rate and long-term follow-up results. The transcatheter approach provides a less-invasive alternative to open surgery and displays some promise in the treatment of pmVSDs in certain patient populations.
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Affiliation(s)
- Lei Wang
- Department of Cardiology, Xi'an Children Hospital, Fourth Military Medical University, Xi'an, People's Republic of China
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Gruenstein DH, Bass JL. Transcatheter device closure of congenital ventricular septal defects. PROGRESS IN PEDIATRIC CARDIOLOGY 2012. [DOI: 10.1016/j.ppedcard.2012.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kilicgedik A, Karabay CY, Aung SM, Guler A, Kalayci A, Tasar O, Kirma C. A successful percutaneous closure of ventricular septal defect following septal myectomy in patients with hypertrophic obstructive cardiomyopathy. Perfusion 2012; 27:253-5. [DOI: 10.1177/0267659112439597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Postoperative ventricular septal defect (post-op VSD) after septal myectomy in patients with hypertrophic obstructive cardiomyopathy is a rare and unexpected complication. We report a case of successful percutaneous closure of VSD following septal myectomy and mitral valve replacement in a patient with intrinsic mitral valve disease and severe mitral valve regurgitation together with hypertrophic obstructive cardiomyopathy.
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Affiliation(s)
- A Kilicgedik
- Can Yücel Koşuyolu Heart and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - CY Karabay
- Can Yücel Koşuyolu Heart and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - SM Aung
- Can Yücel Koşuyolu Heart and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - A Guler
- Can Yücel Koşuyolu Heart and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - A Kalayci
- Can Yücel Koşuyolu Heart and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - O Tasar
- Can Yücel Koşuyolu Heart and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - C Kirma
- Can Yücel Koşuyolu Heart and Research Hospital, Cardiology Clinic, Istanbul, Turkey
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Yang R, Kong XQ, Sheng YH, Zhou L, Xu D, Yong YH, Sun W, Zhang H, Cao KJ. Risk Factors and Outcomes of Post-Procedure Heart Blocks After Transcatheter Device Closure of Perimembranous Ventricular Septal Defect. JACC Cardiovasc Interv 2012; 5:422-7. [DOI: 10.1016/j.jcin.2012.01.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 12/13/2011] [Accepted: 01/05/2012] [Indexed: 11/26/2022]
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Rentschler ME, Hart KD, Mitchell MB. Initial Design and Evaluation of a Pediatric Intra-Cardiac Camera System for Ventricular Septal Defects. J Med Device 2012. [DOI: 10.1115/1.4005778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The primary objective of this project is to design, fabricate, and test a small, integrated camera system for aiding in the visualization and surgical repair of certain types of ventricular septal defects (VSD), in pediatric patients. Currently, no purpose-designed commercial device to view VSDs from the left ventricle of the heart exists. The left ventricular perspective is ideal for obtaining an unobstructed view of the VSD. This VSD camera device would also provide a platform for passing a suture through the hole in the ventricular septum, with future work implementing additional tools capable of more advanced tasks. This camera device will help solve some of the major issues currently associated with cardiac imaging and surgical closure of VSDs in newborns and young children This paper examines the design development and preliminary evaluation of a proof of concept device. Included are preliminary results of image quality comparisons, design details of a pediatric-specific VSD camera device, and initial outcomes from in vitro testing.
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Affiliation(s)
- Mark E. Rentschler
- Department of Mechanical Engineering, University of Colorado at Boulder; Department of Surgery (secondary appointment), University of Colorado Anschutz Medical Campus, 427 UCB, 1111 Engineering Drive, Boulder, CO 80309-0427
| | - Keir D. Hart
- Department of Mechanical Engineering, University of Colorado at Boulder, 427 UCB, 1111 Engineering Drive, Boulder, CO 80309-0427
| | - Max B. Mitchell
- Department of Surgery, University of Colorado Anschutz Medical Campus, Director,Mechanical Circulatory Support Program, The Children’s Hospital Denver, 13123 E. 16th Ave. B200, Aurora, CO 80045
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