P1-43 SURGICAL REPAIR OF POST INFARCTION VENTRICULAR SEPTAL DEFECTS: USEFULNESS OF TWO-PATCH TECHNIQUE IN INFARCT EXCLUSION OPERATION FOR POSTINFARCTION VENTRICULAR SEPTAL DEFECT LOCATED IN THE POSTERIOR SEPTUM

A 7-year-old boy with a history of neonatal pulmonary artery banding underwent almost complete closure of a sieve-like “Swiss-cheese” ventricular septal defect, using a combination sandwich patch technique through a right ventriculotomy. Although defects existed in the high-, mid-, and low-trabecular septa, a right ventriculotomy and division of the muscle trabeculations continuing the septal and moderator bands helped delineate the edges of the defects. Although patients with “Swiss-cheese” ventricular septal defects may be candidates for a Fontan operation conventionally, a combination patch technique could be considered the procedure of choice.

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Primary Surgical Repair of Ventricular Septal Defect

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230301100307 ◽

2003 ◽

Vol 11 (3) ◽

pp. 213-216 ◽

Cited By ~ 9

Author(s):

M Kemal Demirag ◽

Hasan Tahsin Keçeligil ◽

Fersat Kolbakir

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Surgical Repair ◽

Primary Repair ◽

Ventricular Septal Defects ◽

Atrioventricular Canal ◽

Residual Shunt ◽

Mortality And Morbidity ◽

Septal Defects ◽

Early Primary

Between January 1983 and December 2000, 78 patients underwent primary repair of a ventricular septal defect. There were 42 males (54%) and 36 females (46%) of whom 13 (17%) were under 1 year old, 50 (64%) were aged 1–10 years, 11 (14%) were aged 10–20 years, and 4 (5%) were over 20 years old. The ventricular septal defect was a perimembranous type in 60 patients (77%), subarterial (outlet) type in 10 (13%), and atrioventricular canal (inlet) type in 4 (5%). Operative repair was performed with a patch in all except 2 patients. Early postoperative complications included insignificant aortic regurgitation in 4 patients, persistent complete heart block in 1, and residual shunt in 4. There were 5 early deaths (6.4%) and 1 late death (1.8%) in 56 patients followed up. Early primary closure of ventricular septal defects, usually via a right atriotomy, can be performed with acceptable mortality and morbidity rates.

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Surgical Repair of Postinfarction Ventricular Septal Defect by Infarct Exclusion

Seminars in Thoracic and Cardiovascular Surgery ◽

10.1016/s1043-0679(98)70003-6 ◽

1998 ◽

Vol 10 (2) ◽

pp. 105-110 ◽

Cited By ~ 56

Author(s):

Tirone E. David ◽

Susan Armstrong

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Surgical Repair ◽

Infarct Exclusion ◽

Postinfarction Ventricular Septal Defect

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Outcomes of infants and children undergoing surgical repair of ventricular septal defect: a review of the literature and implications for research with an emphasis on pulmonary artery hypertension

Cardiology in the Young ◽

10.1017/s1047951120001146 ◽

2020 ◽

Vol 30 (6) ◽

pp. 799-806

Author(s):

Anna G. Palladino-Davis ◽

Christopher S. Davis

Keyword(s):

Ventricular Septal Defect ◽

Pulmonary Artery ◽

Medical Management ◽

Septal Defect ◽

Surgical Repair ◽

Pulmonary Artery Hypertension ◽

Ventricular Septal Defects ◽

Septal Defects ◽

Defect Repair

AbstractBackground:Pulmonary vascular disease resulting from CHDs may be the most preventable cause of pulmonary artery hypertension worldwide. Many children in developing countries still do not have access to early closure of clinically significant defects, and the long-term outcomes after corrective surgery remain unclear. Focused on long-term results after isolated ventricular septal defect repair, our review sought to determine the most effective medical therapy for the pre-operative management of elevated left-to-right shunts in patients with an isolated ventricular septal defect.Methods:We identified articles specific to the surgical repair of isolated ventricular septal defects. Specific parameters included the pathophysiology and pre-operative medical management of pulmonary over-circulation and outcomes.Results:Studies most commonly focused on histologic changes to the pulmonary vasculature and levels of thromboxanes, prostaglandins, nitric oxide, endothelin, and matrix metalloproteinases. Only 2/44 studies mentioned targeted pharmacologic management to any of these systems related to ventricular septal defect repair; no study offered evidence-based guidelines to manage pulmonary over-circulation with ventricular septal defects. Most studies with long-term data indicated a measurable frequency of pulmonary artery hypertension or diminished exercise capacity late after ventricular septal defect repair.Conclusion:Long-term pulmonary vascular and respiratory changes can occur in children after ventricular septal defect repair. Research should be directed at providing an evidenced-based approach to the medical management of infants and children with ventricular septal defects (and naturally all CHDs) to minimise consequences of pulmonary artery hypertension, particularly as defect repair may occur late in underprivileged societies.

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Increased Prevalence of Ventricular Septal Defect: Epidemic or Improved Diagnosis

PEDIATRICS ◽

10.1542/peds.83.2.200 ◽

1989 ◽

Vol 83 (2) ◽

pp. 200-203

Author(s):

Gerard R. Martin ◽

Lowell W. Perry ◽

Charlotte Ferencz

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Ductus Arteriosus ◽

Coarctation Of The Aorta ◽

Cardiovascular Malformations ◽

Ventricular Septal Defects ◽

Live Births ◽

Septal Defects ◽

Clinical Diagnoses ◽

Control Study

The Baltimore-Washington Infant Study is an ongoing case-control study of congenital cardiovascular malformations in infants in whom the clinical diagnoses have been confirmed by echocardiography, catheterization, surgery, or autopsy. An increase in the prevalence of ventricular septal defects was detected in 1,494 infants with congenital cardiovascular malformations between 1981 and 1984. The prevalence of congenital cardiovascular malformations increased from 3.6 to 4.5 per 1,000 live births (P<.025) and the prevalence of ventricular septal defect increased from 1.0 to 1.6 per 1,000 live births (P< .001). The increase in ventricular septal defects accounted for the total increase in congenital cardiovascular malformations. The prevalence of isolated ventricular septal defect increased from 0.67 to 1.17 per 1,000 live births (P<.001). The prevalence of ventricular septal defect with associated coarctation of the aorta, patent ductus arteriosus, atrial septal defect, and pulmonic stenosis did not change. The prevalence of ventricular septal defect diagnosed by catheterization, surgery, and autopsy did not change; however, defects diagnosed by echocardiography increased from 0.30 to 0.70 per 1,000 live births (P<.001). It is concluded that the reported increase in prevalence of ventricular septal defect is due to improved detection of small, isolated ventricular septal defects and that there is no evidence of an "epidemic."

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Percutaneous-perventricular device closure of ventricular septal defect: mid-term follow-up.

10.21203/rs.2.16046/v2 ◽

2020 ◽

Author(s):

Long Wang ◽

Lin Xie ◽

Weiqiang Ruan ◽

Tao Li ◽

Changping Gan ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Close Monitoring ◽

The Novel ◽

Ventricular Septal Defects ◽

Device Closure ◽

Residual Shunt ◽

Septal Defects ◽

Perventricular Device Closure

Abstract Background: This report presents updated data and mid-term follow-up information to a former study introducing the novel technique of percutaneous-perventricular device closure of doubly committed subarterial ventricular septal defect. Methods: Thirty-eight patients were added to the former series. There were 54 patients in total who had isolated doubly committed subarterial ventricular septal defects and underwent percutaneous-perventricular device closure. Closure outcomes and possible complications were measured in the hospital and during the 2.5-year follow-up. Results: Surgery was successful in 53 patients (98.1%). There was no death, residual shunt, new valve regurgitation or arrhythmia either perioperatively or during the entire follow-up period. Only one patient developed pericardial effusion and tamponade in the former series. The mean hospital stay was 3.2±0.6 days (range, 3.0 to 6.0 days), and only one unsuccessful case needed blood transfusion (1.9%). Conclusions: The percutaneous-perventricular device closure of isolated doubly committed subarterial ventricular septal defects appeared to be safe. Close monitoring for bleeding is essential postoperatively, especially in younger patients. This technique is generally safe with acceptable mid-term follow-up.

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Clinical course in children and adolescents with ventricular septal defect

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492319867001 ◽

2019 ◽

Vol 27 (7) ◽

pp. 529-534

Author(s):

Noor Mohammad Noori ◽

Alireza Teimouri

Keyword(s):

Pulmonary Hypertension ◽

Ventricular Septal Defect ◽

Septal Defect ◽

Clinical Course ◽

Defect Size ◽

Eisenmenger Syndrome ◽

Ventricular Septal Defects ◽

Laboratory Findings ◽

Septal Defects

Background Ventricular septal defect, the most common congenital heart defect, is characterized by an opening between the ventricles. This study aimed to evaluate the clinical course and associations between the characteristics of ventricular septal defect. Methods This cross-sectional study was conducted on 1498 children with ventricular septal defects, aged <19 years, who were referred to our center between 2003 and 2018. The diagnosis was suspected from a combination of clinical and laboratory findings, and confirmed by transthoracic echocardiography. Results Of the 1498 children, 54.9% were boys, 78.4% of defects were perimembranous, 30.4% of patients had pulmonary hypertension, 67.5% had regular follow-up, and 76 (5.1%) had complications including 28 (1.9%) with Eisenmenger syndrome; 10 died due to Eisenmenger syndrome during follow-up. The defects closed spontaneously in 38.9% and after surgery in 20.9%. Boys tended to have more perimembranous, inlet, and outlet forms (56.40%, 50.60%, 51.90%, respectively), whereas girls had more muscular types (51.80%). Most patients with pulmonary hypertension had perimembranous defects (83.10%). The majority of patients with pulmonary hypertension had large (63.40%) or moderate (36.60%) defects. Pulmonary hypertension had a significant association with defect size ( p < 0.001). After surgery, residual defects were found mostly in cases of large defects (84.60%). Most patients with spontaneous closure were younger than 4 years. Conclusion Almost four-fifths of children with ventricular septal defects had perimembranous types, and almost one-third had pulmonary hypertension which was associated with defect size. Two-fifths of the defects closed spontaneously. There was a low incidence of complications after surgery.

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Transcatheter closure of ventricular septal defect with Occlutech Duct Occluder

Cardiology in the Young ◽

10.1017/s1047951117002463 ◽

2018 ◽

Vol 28 (4) ◽

pp. 598-601 ◽

Cited By ~ 2

Author(s):

Sezen Atik-Ugan ◽

Irfan Levent Saltik

Keyword(s):

Ventricular Septal Defect ◽

Patent Ductus Arteriosus ◽

Septal Defect ◽

Transcatheter Closure ◽

Ductus Arteriosus ◽

Ventricular Septal Defects ◽

Septal Defects ◽

Patent Ductus

AbstractPatent ductus arteriosus occluders are used for transcatheter closure of ventricular septal defects, as well as for closure of patent ductus arteriosus. The Occlutech Duct Occluder is a newly introduced device for transcatheter closure of patent ductus arteriosus. Here, we present a case in which the Occlutech Duct Occluder was successfully used on a patient for the closure of a perimembraneous ventricular septal defect.

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Biventricular morphology in adults born with a ventricular septal defect

Cardiology in the Young ◽

10.1017/s1047951118001361 ◽

2018 ◽

Vol 28 (12) ◽

pp. 1379-1385 ◽

Cited By ~ 6

Author(s):

Marie Maagaard ◽

Johan Heiberg ◽

Filip Eckerström ◽

Benjamin Asschenfeldt ◽

Christian E. Rex ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Right Ventricular ◽

Septal Defect ◽

Volume Index ◽

Peak Exercise ◽

Stroke Index ◽

Healthy Controls ◽

Ventricular Septal Defects ◽

Septal Defects ◽

End Diastolic Volume

AbstractVentricular septal defects – large, surgically closed or small, untreated – have demonstrated lower peak exercise capacity compared with healthy controls. The mechanisms behind these findings are not yet fully understood. Therefore, we evaluated biventricular morphology in adults with a ventricular septal defect using MRI. Adults with either childhood surgically closed or small, untreated ventricular septal defects and healthy controls underwent cine MRI for the evaluation of biventricular volumes and quantitative flow scans for measurement of stroke index. Scans were analysed post hoc in a blinded manner. In total, 20 operated patients (22±2 years) and 20 healthy controls (23±2 years) were included, along with 32 patients with small, unrepaired ventricular septal defects (26±6 years) and 28 controls (27±5 years). Operated patients demonstrated larger right ventricular end-diastolic volume index (103±20 ml/m2) compared with their controls (88±16 ml/m2), p=0.01. Heart rate and right ventricular stroke index did not differ between operated patients and controls. Patients with unrepaired ventricular septal defects revealed larger right ventricular end-diastolic volume index (105±17 ml/m2) compared with their controls (88±13 ml/m2), p<0.01. Furthermore, right ventricular stroke index was higher in unrepaired ventricular septal defects (53±12 ml/minute/m2) compared with controls (46±8 ml/minute/m2), p=0.02, with similar heart rates. Both patient groups’ right ventricles were visually characterised by abundant coarse trabeculation. Positive correlations were demonstrated between right ventricular end-diastolic volume indices and peak exercise capacity in patients. Left ventricle measurements displayed no differences between groups. In conclusion, altered right ventricular morphology was demonstrated in adults 20 years after surgical ventricular septal defect repair and in adults with small, untreated ventricular septal defects.

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