Tricuspid valve detachment for ventricular septal defect closure in infants <5 kg: should we be hesitant?

2021 ◽  
Author(s):  
Jae Hong Lee ◽  
Sungkyu Cho ◽  
Jae Gun Kwak ◽  
Hye Won Kwon ◽  
Yujin Kwak ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Clinical Outcomes ◽  
Tricuspid Valve ◽  
Septal Defect ◽  
Propensity Score Matching Analysis ◽  
All Cause Mortality ◽  
Ventricular Septal Defect Closure ◽  
Group D ◽  
Valve Detachment

Abstract OBJECTIVES We compared the clinical outcomes between tricuspid valve detachment (TVD) and non-TVD for ventricular septal defect (VSD) closure in infants &lt;5 kg. METHODS From January 2004 to April 2020, 462 infants &lt;5 kg with VSD without more complex intracardiac lesions and who had undergone VSD closure through the trans-atrial approach were enrolled. Propensity score-matching analysis was performed. Clinical outcomes were compared between the paired TVD group (group D) and paired non-TVD group (group N). RESULTS The median age and body weight at operation were 1.9 months [interquartile range(IQR), 1.4–2.5] and 4.2 kg (IQR, 3.7–4.6). The median follow-up duration was 83.4 months (IQR, 43.5–130.4). After matching, 44 pairs were extracted from each group. There were no significant differences in all-cause mortality (P = 0.176), reoperation (P = 0.172), postoperative morbidities, including residual VSD, aortic regurgitation, atrioventricular block and significant tricuspid regurgitation (TR) (P = 0.346) between group D and group N. However, group D showed significantly less TR progression during follow-up (P = 0.019). CONCLUSIONS In infants &lt;5 kg, TVD can be a reasonable and valid option for successful VSD closure without morbidities, including TR progression if the indication exists.

scholarly journals Does tricuspid valve detachment improve outcomes compared with the non-tricuspid valve detachment approach in ventricular septal defect closure?

2020 ◽  
Author(s):  
Yunfei Ling ◽  
Xiaohui Bian ◽  
Yue Wang ◽  
Yongjun Qian
Keyword(s):  
Cardiopulmonary Bypass ◽  
Ventricular Septal Defect ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Septal Defect ◽  
The Other ◽  
Cardiopulmonary Bypass Time ◽  
Significant Difference ◽  
Ventricular Septal Defect Closure ◽  
Valve Detachment

Summary A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the tricuspid valve detachment (TVD) approach to ventricular septal defect repair provides superior outcomes compared with the non-TVD approach. Altogether more than 54 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. A total of 2059 participants were enrolled in the 10 studies, including 2 prospective studies and 8 retrospective studies. Six studies demonstrated a longer cardiopulmonary bypass time or aortic clamp time in the TVD group, whereas 4 studies showed no difference. Only 1 study reported a lower incidence of trivial tricuspid regurgitation in the TVD group, whereas the other 9 studies showed no significant difference. One study showed that a higher incidence of residual shunting occurred in those patients who had indications for TVD but did not perform detachment during surgery. No difference in postoperative residual shunting was demonstrated in the other 9 studies. We conclude that surgeons should be reassured that if TVD is required to repair the ventricular septal defect, although it may lead to longer cardiopulmonary bypass time and cross-clamp times, outcomes are equivalent in terms of the degree of tricuspid regurgitation and incidence of the residual ventricular septal defect.

Liberal use of tricuspid valve detachment for transatrial ventricular septal defect closure

2003 ◽  
Vol 76 (4) ◽  
pp. 1073-1077 ◽  
Author(s):  
Ryo Aeba ◽  
Toshiyuki Katogi ◽  
Kenichi Hashizume ◽  
Kiyoshi Koizumi ◽  
Yoshimi Iino ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Tricuspid Valve ◽  
Septal Defect ◽  
Defect Closure ◽  
Ventricular Septal Defect Closure ◽  
Valve Detachment

scholarly journals Outcomes of Tricuspid Valve Detachment for Isolated Ventricular Septal Defect Closure

2021 ◽  
Vol 69 (S 03) ◽  
pp. e48-e52
Author(s):  
John Schittek ◽  
Jörg S. Sachweh ◽  
Florian Arndt ◽  
Maria Grafmann ◽  
Ida Hüners ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Tricuspid Valve ◽  
Septal Defect ◽  
Control Group ◽  
Av Block ◽  
Residual Shunt ◽  
Surgical Closure ◽  
Perimembranous Ventricular Septal Defect ◽  
Ventricular Septal Defect Closure ◽  
Valve Detachment

AbstractPartial detachment of the septal and anterior leaflets of the tricuspid valve (TV) is a technique to visualize a perimembranous ventricular septal defect (VSD) for surgical closure in cases where the VSD is obscured by TV tissue. However, TV incision bears the risk of causing relevant postoperative TV regurgitation and higher degree atrioventricular (AV) block. A total of 40 patients were identified retrospectively in our institution who underwent isolated VSD closure between January 2013 and August 2015. Visualization of the VSD was achieved in 20 patients without and in 20 patients with additional partial detachment of the TV. The mean age of patients with partial tricuspid valve detachment (TVD) was 0.7 ± 0.1 years compared with 1 ± 0.3 years (p = 0.22) of patients without TVD. There was no difference in cardiopulmonary bypass time between patients of both groups (123 ± 11 vs. 103 ± 5 minutes, p = 0.1). Cross-clamp time was longer if the TV was detached (69 ± 5 vs. 54 ± 4 minutes, p = 0.023). There was no perioperative mortality. Echocardiography at discharge and after 2.5 years (2 months–6 years) of follow-up showed neither a postoperative increase of tricuspid regurgitation nor any relevant residual shunt. Postoperative electrocardiograms were normal without any sign of higher degree AV block. TVD offers enhanced exposure and safe treatment of VSDs. It did not result in higher rates of TV regurgitation or relevant AV block compared with the control group.

scholarly journals Tricuspid Valve Detachment in Ventricular Septal Defect Closure Does Not Impact Valve Function

2018 ◽  
Vol 106 (1) ◽  
pp. 145-150
Author(s):  
Charles D. Fraser ◽  
Xun Zhou ◽  
Sandeep Palepu ◽  
Cecillia Lui ◽  
Alejandro Suarez-Pierre ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Tricuspid Valve ◽  
Septal Defect ◽  
Defect Closure ◽  
Ventricular Septal Defect Closure ◽  
Valve Function ◽  
Valve Detachment

Temporary Tricuspid Valve Detachment for Ventricular Septal Defect Closure: Is It Worth Doing It?

2015 ◽  
Vol 16 (2) ◽  
pp. 99
Author(s):  
Alexander Weymann ◽  
Stanimir Georgiev ◽  
Carsten Vogelsang ◽  
Annette Ivad ◽  
Matthias Karck ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Septal Defect ◽  
Control Group ◽  
Ventricular Septal Defects ◽  
Residual Shunt ◽  
Septal Defects ◽  
Ventricular Septal Defect Closure ◽  
Potential Risks ◽  
Valve Detachment

<p><b>Background:</b> Tricuspid valve detachment (TVD) may improve the access for closing certain ventricular septal defects (VSDs), but it has some potential risks. We aimed to study the benefits and drawbacks of this technique.</p><p><b>Methods:</b> The midterm outcomes of all 20 patients who underwent a TVD closure for VSD were reviewed and compared with a control group of 15 patients with VSD closure without TVD.</p><p><b>Results:</b> There was no significant residual shunt in either group at the last actuarial follow-up. Tricuspid regurgitation occurred in both groups (45% in the TVD group and 27% in the control group, <i>P</i> = .48). These lesions were considered insignificant in all patients. There were no atrioventricular blocks, and all patients were in sinus rhythm. The cardiopulmonary bypass times were significantly higher in the TVD group than in the control group (91.6 � 17.2 minutes versus 68.3 � 15.7 minutes, <i>P</i> ? .01), as were the aortic cross-clamping times (50.7 � 12.1 minutes versus 35.9 � 14.4 minutes, <i>P</i> ? .01).</p><p><b>Conclusion:</b> Our results, along with results from other series, suggest that TVD can be used effectively and safely for closure of certain VSDs.</p>

Outcomes of closure of doubly committed subarterial ventricular septal defects in adults

2020 ◽  
Vol 30 (5) ◽  
pp. 599-606
Author(s):  
Zhaoyang Chen ◽  
Wanhua Chen ◽  
Hang Chen ◽  
Zhenmei Liao ◽  
Qiang Chen ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Ventricular Septal Defect ◽  
Aortic Regurgitation ◽  
Septal Defect ◽  
Intervention Group ◽  
Adult Patients ◽  
Defect Closure ◽  
Ventricular Septal Defect Closure ◽  
Sinus Valsalva Aneurysm

AbstractBackground:Outcome data of doubly committed subarterial ventricular septal defect closure in adults are limited.Methods:A review was made of the inpatients >18 years of age who underwent doubly committed subarterial ventricular septal defect closure between June 2010 and June 2017.Results:The patients were categorised into two groups: The valve intervention group consisted of 31 patients who underwent aortic valvuloplasty, aortic valve replacement, or repair of sinus Valsalva aneurysm in addition to doubly committed subarterial ventricular septal defect closure; non-valvular intervention group comprised 58 patients who underwent only doubly committed subarterial ventricular septal defect closure. The groups did not differ by sex and age. Patients in the valve intervention group, with a larger ventricular septal defect size, were shorter and tended to be lighter. The valve intervention group had more patients with pneumonia perioperatively. No infective endocarditis and reoperation were noted during the study period. At last follow-up, 91 and 96.6% of the studied patients were free from left ventricle dilation and pulmonary hypertension. In patients without pre-operative aortic regurgitation, 12 developed new mild aortic regurgitation during the follow-up.Conclusions:About 34.8% of adult patients with doubly committed subarterial ventricular septal defect required concurrent intervention on aortic valve or sinus Valsalva aneurysm. The midterm results of doubly committed subarterial ventricular septal defect closure in adult patients were favourable. However, the incidence of new mild aortic regurgitation after ventricular septal defect closure was high (27.3%). Long-term follow-up of aortic regurgitation progression is needed.

Mid-term results of percutaneous ventricular septal defect closure with Amplatzer Duct Occluder-II in children

2017 ◽  
Vol 27 (9) ◽  
pp. 1726-1731 ◽  
Author(s):  
Ozge Pamukcu ◽  
Nazmi Narin ◽  
Ali Baykan ◽  
Suleyman Sunkak ◽  
Onur Tasci ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Defect Closure ◽  
Amplatzer Duct Occluder ◽  
Total Procedure Time ◽  
Study Centre ◽  
Ventricular Septal Defect Closure ◽  
The Mean ◽  
Mid Term Results

AbstractAimThe aim of this study was to share the mid-term results of percutaneous ventricular septal defect closure using Amplatzer Duct Occluder-II in children.BackgroundNowadays, percutaneous ventricular septal defect closure is accepted as an alternative to surgery, but so far no ideal device has been developed for this procedure.MethodsIn the study centre, between April, 2011 and October, 2016, the ventricular septal defect of 49 patients was closed percutaneously using the Amplatzer Duct Occluder-II device, and seven of them were <1 year old.ResultsThe mean age of patients was 86.8±52.6 months. The mean weight of the patients was 24.3±16 kg. The mean diameter of the defect was 3.7±1.4 mm. Mean fluoroscopy time and total procedure time were 37±19.3 and 74.1±27 minutes, respectively. The types of ventricular septal defects were muscular in six patients, and were perimembranous in the rest of them. We did not face any major complications during the procedure, but one patient was admitted with a complete atrioventricular block in the 6th month of follow-up. The total follow-up period was 66 months.ConclusionTo our knowledge, our study includes the largest series of paediatric patients whose ventricular septal defect was closed using Amplatzer Duct Occluder-II percutaneously. When the complications during the 66-month follow-up period are taken into consideration, we can state that Amplatzer Duct Occluder-II is a safe and effective device, even in infants aged <1 year.

The mid-term outcome of interventricular septal hematoma after ventricular septal defect closure

2021 ◽  
pp. 021849232110666
Author(s):  
Masaya Aoki ◽  
Yuki Ikeno ◽  
Keijiro Ibuki ◽  
Sayaka Ozawa ◽  
Keiichi Hirono ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Enzyme Inhibitor ◽  
Single Photon ◽  
Interventricular Septum ◽  
Photon Emission ◽  
Defect Closure ◽  
Low Cardiac Output Syndrome ◽  
Ventricular Septal Defect Closure

We present the case report of a patient who developed interventricular septal hematoma as a complication during perimembranous ventricular septal defect closure. Although cardiopulmonary bypass was re-established and the hematoma was aspirated, postoperative echocardiography revealed that the hematoma reaccumulated in the interventricular septum. She suffered from low-cardiac-output syndrome for 1 week requiring a large amount of inotropic agents. Postoperative echocardiography revealed that the interventricular septal hematoma gradually disappeared. At 1 year follow-up, 99mTc-tetrofosmin myocardial single-photon emission computed tomographic revealed myocardial ischemia in the inferior and septal walls. At 4 years follow-up, her cardiac function has gradually improved. She has no symptoms of heart failure with angiotensin-converting enzyme inhibitor and beta-blocker.

Single versus Biventricular Repair for Discordant Hearts

1996 ◽  
Vol 4 (3) ◽  
pp. 161-163 ◽  
Author(s):  
KG Jaya Prasanna ◽  
Rajesh Sharma ◽  
Krishna Subramany Iyer ◽  
Balram Airan ◽  
Anil Bhan ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Pulmonary Stenosis ◽  
Early Death ◽  
Biventricular Repair ◽  
Long Term Result ◽  
Ventricular Septal Defect Closure ◽  
Double Switch

We reviewed our surgical experience, over a 7-year period, of 38 patients with congenitally corrected transposition of the great arteries with ventricular septal defect and pulmonary stenosis, who were anatomically well-suited for a biventricular repair. Follow-up ranged from 2 to 9 years (mean 5.3 years). One group of patients underwent a univentricular repair; there were 2 early deaths (8%) among the 24 patients who underwent a Fontan-type repair and 5 patients had prolonged pleural effusion. There was no early mortality in the 3 patients who underwent a bidirectional Glenn anastomosis but there was 1 late death. Patients undergoing a biventricular repair comprised 6 who had closure of a ventricular septal defect and pulmonary valvotomy, and 5 who had ventricular septal defect closure and conduit repair. There was 1 early death (9%) and 2 patients developed iatrogenic complete heart block in this group but there was no late mortality. None of these patients had a double switch procedure. With the advent of the double switch procedure, there are now 3 modes of management for these defects. Determining which of these provides the best long-term result is still a matter for debate.

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