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Nakayama Y, Horimoto Y, Suzuki K, Takiguchi M, Ishihara K, Umehara N, Shinkawa T. Clinical Course of Residual Ventricular Septal Defects After Congenital Heart Disease Repair. Pediatr Cardiol 2024:10.1007/s00246-024-03542-5. [PMID: 38916670 DOI: 10.1007/s00246-024-03542-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 06/06/2024] [Indexed: 06/26/2024]
Abstract
The clinical course of residual ventricular septal defects after congenital heart disease repair is not completely elucidated in the medical literature. This study assessed the incidence, size, and clinical course of residual defects.This single-center retrospective study included 132 patients who survived after ventricular septal defect patch closure (n = 107) and intracardiac repair of double-outlet right ventricle (n = 16) and tetralogy of Fallot (n = 9). Residual defect was evaluated on transthoracic echocardiogram upon hospital discharge and at outpatient clinic visits.The median age at surgery was 1.2 (0.3-13.9) years. In total, 45 (34.1%) patients presented with residual defects upon hospital discharge. The residual defects were within 2 mm (n = 27), 2-3 mm (n = 15), and > 3 mm (n = 3), and the median size was 1.5 (0.5-3.8) mm. There was no late mortality during a median follow-up of 5.4 years. Among 42 residual defects measuring < 3 mm upon hospital discharge, 37 (82.2%) spontaneously closed. Further, five defects decreased in size (1.8 ± 0.6 mm upon hospital discharge vs1.2 ± 0.8 mm at the latest visits, p = 0.15). However, the size of three residual defects measuring > 3 mm upon hospital discharge increased, and two patients required re-surgery for residual defect.Significant residual defect requiring reoperation was rare. In most cases, residual defects measuring < 3 mm upon hospital discharge spontaneously closed within 5 years, and the size of the other defects decreased.
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Affiliation(s)
- Yuki Nakayama
- Department of Pediatric Cardiovascular Surgery, Matsudo City General Hospital, 993-1, Sendabori, Matsudo, Chiba, 270-2296, Japan.
| | - Yoshihiko Horimoto
- Department of Pediatrics, Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Kazuhiro Suzuki
- Department of Pediatrics, Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Makoto Takiguchi
- Department of Pediatric Cardiovascular Surgery, Matsudo City General Hospital, 993-1, Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Kazuaki Ishihara
- Department of Pediatric Cardiovascular Surgery, Matsudo City General Hospital, 993-1, Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Nobuhiro Umehara
- Department of Cardiovascular Surgery, Matsudo City General Hospital, 993-1, Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Takeshi Shinkawa
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
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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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Sandoval Boburg R, Schlensak C, Hofbeck M, Magunia H, Berger R, Jost W, Mustafi M. Routine Detachment of the Anterior and Septal Tricuspid Leaflets Simplifies VSD Closure and Improves the Outcomes. Medicina (B Aires) 2022; 58:medicina58121849. [PMID: 36557051 PMCID: PMC9787562 DOI: 10.3390/medicina58121849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Background and Objectives: The closure of perimembranous ventricular septal defects (VSDs) is one of the most common surgeries performed in infancy. The technique of detachment of the anterior and septal leaflets of the tricuspid valve (TV) with subsequent leaflet augmentation is frequently used for isolated as well as non-isolated VSD closure. In this study, we compared the incidence of tricuspid regurgitation (TR) in patients who underwent a VSD repair with and without detachment of the TV in the short- and long-term follow-up. Materials and Methods: A retrospective study that included 140 patients who underwent perimembranous VSD closure at our center from 2011-2016, where 102 of these patients underwent the procedure with detachment of the TV, was performed. The follow-up data were obtained from postoperative echocardiography performed in the follow-up visits. A total of 62 patients underwent follow-up at our center, where the follow-up time ranged from 1 to 9 years, with a mean of 71 ± 2.47 months. Results: Regarding patients who underwent a VSD repair with a detachment of the TV, 98.1% of the patients had none to mild TR, compared to 94.7% in patients without intraoperative TV detachment at the time of discharge. There were no reported cases of moderate to severe TR, atrioventricular blocks, aortic insufficiency, or deaths. A total of 98.1% of patients who underwent follow-up at our center with a TV detachment had none to mild TR compared to 94.7% in the group without TV detachment. Conclusion: TV detachment with leaflet augmentation for VSD closure is safe and effective and does not increase the incidence of TR in the short- and long-term follow-up.
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Affiliation(s)
- Rodrigo Sandoval Boburg
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
- Correspondence: ; Tel.: +49-(0)7071-29-68185
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Michael Hofbeck
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Harry Magunia
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Rafal Berger
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Walter Jost
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Migdat Mustafi
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
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