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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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Lu J, Lian X, Wen P, Liu Y. Case report: Recovery of long-term delayed complete atrioventricular block after minimally invasive transthoracic closure of ventricular septal defect. Front Cardiovasc Med 2023; 10:1226139. [PMID: 37560118 PMCID: PMC10407103 DOI: 10.3389/fcvm.2023.1226139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/12/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Long-term delayed complete atrioventricular block (CAVB) is a serious complication of ventricular septal defect (VSD) closure treatment. Thus, cardiac surgeons have made significant efforts to explore its causes and reduce its incidence. In recent years, minimally invasive transthoracic closure (MITC) of VSD has been used widely and successfully in China as it is easy to repeat, ensures individualized closure, and can be debugged repeatedly. Theoretically, the possibility of the recurrence of CAVB is lower than that with transcatheter closure. Although the incidence of CAVB after MITC of VSD is inevitable, long-term delayed CAVB has rarely been reported. CASE DESCRIPTION Herein, we report a case of delayed CAVB that occurred 2 years and 5 months after performing MITC of a perimembranous VSD. The cardiac rhythm recovered after the occluder was removed surgically. CONCLUSION The findings of our case report emphasize that since delayed CAVB may occur in the long term after MITC of VSD, the safety of MITC of VSD should be reassessed, the indications for MITC should be strictly followed, and long-term follow-up, including lifelong follow-up, is recommended for patients postoperatively. In addition, the occluder should be removed surgically in patients with CAVB as it may restore normal heart rhythm.
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Affiliation(s)
| | | | | | - Yuhang Liu
- Department of Cardiovascular Surgery, Dalian Women and Children's Medical Group, Dalian, China
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Ran T, Feng L, Li M, Yi Q, Zhu X, Ji X. Clinical analysis and medium-term follow-up of simultaneous interventional therapy for compound congenital heart disease in children: a single-center retrospective study. Front Pediatr 2023; 11:1193136. [PMID: 37425280 PMCID: PMC10325865 DOI: 10.3389/fped.2023.1193136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Objective This study aimed to explore the safety and efficacy of simultaneous interventional therapy for compound congenital heart disease (CCHD) in children. Methods In total, 155 children with CCHD who received simultaneous interventional therapy at the Children's Hospital of Chongqing Medical University between January 2007 and December 2021 were included in study. Data on clinical manifestations, transthoracic echocardiography, electrocardiogram, and follow-up were retrospectively analyzed. Results The most common type of CCHD was atrial septal defect (ASD) combined with ventricular septal defect (VSD), accounting for 32.3% of the patients. Simultaneous interventional therapy was successfully administered to 151 children (97.4%). The pulmonary gradient of patients with pulmonary stenosis decreased from 47.3 ± 21.9 mmHg to 15.2 ± 12.2 mmHg (P < 0.05) immediately after the procedure. One patient had failed PBPV as he had residual PS >40 mmHg post procedure. The right ventricular dimension and left ventricular end-diastolic dimension significantly decreased in the first month after the procedure in patients with ASD combined with VSD. Twenty-five (16.1%) patients had mild residual shunt, which spontaneously disappeared in more than half of these patients 6 months after the procedure. The major adverse events were minimal (n = 4, 2.58%), including one patient requiring drug treatment for complete atrioventricular block and three patients receiving surgical treatment because of cardiac erosion, anterior tricuspid valve chordae rupture, and hemolysis, respectively. Conclusions ASD combined with VSD is the most common type of CCHD in children, and simultaneous interventional therapy for CCHD in children is safe and effective with satisfactory results. Ventricular remodeling can be reversed in patients with ASD combined with VSD 1 month after the procedure. Most adverse events associated with interventional therapy are mild and manageable.
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Affiliation(s)
- Tingting Ran
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lingxin Feng
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Mi Li
- Department of Cardiovascular Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Qijian Yi
- Department of Cardiovascular Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xu Zhu
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaojuan Ji
- Department of Ultrasound, Chongqing General Hospital, Chongqing, China
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Song S, Shao Z, Liang W, Dong H, Li B, Zhao L, Li M, Fan T. Peratrial device closure of perimembranous ventricular septal defects via a small right subaxillary incision: Midterm results in patients <12 months of age. Int J Cardiol 2023; 372:50-54. [PMID: 36460210 DOI: 10.1016/j.ijcard.2022.11.060] [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: 07/25/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Both percutaneous and perventricular device closures of perimembranous ventricular septal defects (Pm-VSDs) are alternatives to surgical procedures,but they all present certain drawbacks. OBJECTIVE To report our clinical experiences and midterm follow-up results of minimally invasive peratrial device closure of Pm-VSDs under the guidance of transesophageal echocardiography(TEE) in patients <12 months of age. METHODS Between January 2015 and December 2020,268 patients <12 months of age with Pm-VSDs underwent peratrial device closure in our institute. The procedure was performed under TEE guidance via a small right subaxillary incision. The delivery pathways is established by manipulating the hollow probe, and then the device is installed. RESULTS A total of 263 cases (98.1%) underwent successful closure, whereas five cases failed and were converted to cardiopulmonary bypass operation via the original incision during the procedure. The mean age was 9.5 ± 2.0 months and the mean body weight was 8.8 ± 1.4 kg. The mean diameter of the VSD was 4.4 ± 0.5 mm. One patient (0.4%) underwent a second thoracotomy for postoperative intercostal hemorrhage on the second day after surgery. The mean diameter of the occluder size was 5.5 ± 0.6 mm. During the follow-up (4.3 ± 1.4 y), there was no mortality, no new aortic valve regurgitation and atrioventricular block. CONCLUSION Peratrial device closure of Pm-VSDs via the right subaxillary route under TEE guidance is safe and effective at midterm follow-up, confirming this is an valuable alternative method for patients <12 months of age.
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Affiliation(s)
- Shubo Song
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Zehua Shao
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Weijie Liang
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Haoju Dong
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Bin Li
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Liyun Zhao
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Menghao Li
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Taibing Fan
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China.
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Yu J, Ye J, Zhang Z, Yang X, Ma L, Qian J, Zhao L, Qiang S. Value of transesophageal echocardiography in device closure of perimembranous ventricular septal defects in children via ultra‐minimal trans intercostal incision. J Card Surg 2022; 37:1171-1179. [PMID: 35188288 DOI: 10.1111/jocs.16311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/21/2021] [Accepted: 12/07/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Jin Yu
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Ultrasound Diagnosis, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Jingjing Ye
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Ultrasound Diagnosis, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Zewei Zhang
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Xiuzhen Yang
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Ultrasound Diagnosis, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Lianglong Ma
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Jingjing Qian
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Ultrasound Diagnosis, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Lei Zhao
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Ultrasound Diagnosis, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Shu Qiang
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
- Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
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Aluri M, Alfares F, Sandhu SK. The role of transesophageal echocardiography in device closure of perimembranous ventricular septal defects with the hybrid approach. J Card Surg 2022; 37:1180-1181. [PMID: 35170089 DOI: 10.1111/jocs.16318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Manisha Aluri
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Fahad Alfares
- University of Miami Miller School of Medicine, Miami, Florida, USA
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Singhi AK, Sivakumar K. Echocardiographic Classification of Perimembranous Ventricular Septal Defect Guides Selection of the Occluder Design for Their Transcatheter Device Closure. J Cardiovasc Imaging 2021; 29:316-326. [PMID: 34080335 PMCID: PMC8592680 DOI: 10.4250/jcvi.2020.0218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/31/2021] [Accepted: 02/14/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Perimembranous ventricular septal defects (VSDs) has proximate relation to the aortic and tricuspid valves as well as the conduction tissues. Transcatheter closure utilizes various off-label device designs. METHODS Perimembranous VSD without aortic margin were classified as group A, with thick aortic margin as group B, with membranous septal aneurysm as group C and defects restricted by tricuspid valve attachments as group D. The proposed ideal design was asymmetric device in group A; duct occluder I (ADOI) and muscular ventricular septal occluder (MVSO) in group B; thin profile duct occluder II (ADOII) in group C and ADOI in group D. Device was 0-2 mm larger than the defect. RESULTS Eighty patients with VSD measuring 6.83 ± 2.87mm underwent successful closure. Device was retrieved before release in one group A and one group C patient due to aortic regurgitation. Asymmetric device was used in 16 group A defects. Among group B defects, ADOI was used in 5, ADOII in 5, MVSO in one and asymmetric device in 3. Group C defects were closed with ADOI in 7, ADOII in 10 and asymmetric device in 3. Three patients with multiple exits had 2 ADOII devices. Group D defects were closed using ADOI in 20 and ADOII in 10 patients. There was no late aortic regurgitation or heart block on a follow-up exceeding 7 years. CONCLUSIONS This echocardiographic classification helps device selection in every single patient. While asymmetric device is uniquely suited for group A defects, different designs are appropriate in the other groups.
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Affiliation(s)
- Anil Kumar Singhi
- Department of Pediatric Cardiology, Medica Super Specialty Hospital, Kolkata, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India.
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Response to a comment by H. Bu and Y. Yang on the article "Transcatheter closure of a perimembranous ventricular septal defect with Nit-Occlud Lê VSD Coil: A French multicentre study" by A. Houeijeh et al. Arch Cardiovasc Dis 2020; 113:830-831. [PMID: 33168450 DOI: 10.1016/j.acvd.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022]
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