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

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.

Epicardial blebs and septal hematoma after ventricular septal defect closure

2020 ◽  
Vol 28 (6) ◽  
pp. 336-338
Author(s):  
Joyce Mary Jose ◽  
Sri Rama Ananta Nagabhushanam Padala ◽  
Sundararaj Rajkumar ◽  
Sreevathsa KS Prasad ◽  
Ajay Kumar Jha
Keyword(s):  
Cardiopulmonary Bypass ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Defect Closure ◽  
Perimembranous Ventricular Septal Defect ◽  
Ventricular Septal Defect Closure ◽  
Life Threatening ◽  
Patch Closure

Rapidly progressive epicardial hemorrhagic blebs during weaning from cardiopulmonary bypass after perimembranous ventricular septal defect closure has not been reported previously. Here, we describe the case of a 3-month-old baby with life-threatening epicardial hemorrhagic blebs and an interventricular septal hematoma after perimembranous ventricular septal defect patch closure.

Hypothermia During Cardiopulmonary Bypass Increases Need for Inotropic Support but Does Not Impact Inflammation in Children Undergoing Surgical Ventricular Septal Defect Closure

2015 ◽  
Vol 40 (5) ◽  
pp. 470-479 ◽  
Author(s):  
Katharina Rose Luise Schmitt ◽  
Katsiaryna Fedarava ◽  
Georgia Justus ◽  
Mathias Redlin ◽  
Wolfgang Böttcher ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Inotropic Support ◽  
Defect Closure ◽  
Ventricular Septal Defect Closure

scholarly journals Does mitral valve repair matter in infants with ventricular septal defect combined with mitral regurgitation?

2018 ◽  
Vol 11 (2) ◽  
pp. 85-92
Author(s):  
Yuriy Yu Kulyabin ◽  
Ilya A Soynov ◽  
Alexey V Zubritskiy ◽  
Alexey V Voitov ◽  
Nataliya R Nichay ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ventricular Septal Defect ◽  
Postoperative Period ◽  
Septal Defect ◽  
Early Postoperative Period ◽  
Valve Repair ◽  
Significant Difference

OBJECTIVES: This study aimed to assess mitral valve function after repair of ventricular septal defect (VSD) combined with mitral regurgitation (MR) in the mid-term follow-up period, to evaluate the clinical utility of simultaneous mitral valve repair (MVR). METHODS: From June 2005 to March 2014, 60 patients with VSD and MR underwent surgical treatment. After performing propensity score analysis (1:1) for the entire sample, 46 patients were selected and divided into 2 groups: those with VSD closure and MVR - 23 patients and those with VSD closure without mitral valve intervention - 23 patients. The follow-up period - 32 (28;40) months. RESULTS: There was no postoperative mortality in either group. There was no significant difference in the duration of the postoperative period between groups. Mean cardiopulmonary bypass time and aortic cross-clamping time were significantly longer in the 'VSD + MVR' group (cardiopulmonary bypass, P=0.023; aortic cross-clamp, P< 0.001). There was no significant difference in regurgitation area (P=0.30) and MR grade (P= 0.76) between groups postoperatively. There was no significant difference in freedom from MR ≥ 2+ between groups (log-rank test, P= 0.28). The only significant risk factor for recurrent MR ≥ 2+ during the follow-up period was mild residual MR in the early postoperative period ( P=0.037). CONCLUSIONS: In infants with VSD combined with MR, simultaneous MVR has no benefits simultaneous MVR provided no advantage over that of isolated VSD closure. We found that the presence of mild residual MR in the early postoperative period predisposes the development of MR ≥ 2+ in follow-up period.

scholarly journals Perioperative Management of Patients with Ventricular Septal Defect, Severe Tricuspid Regurgitation and Gerbode Defects

2021 ◽  
Vol 1 (1) ◽  
pp. 27
Author(s):  
Purwoko Purwoko ◽  
Ardhana Surya Aji
Keyword(s):  
Pulmonary Hypertension ◽  
Ventricular Septal Defect ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Perioperative Management ◽  
Septal Defect ◽  
The Body ◽  
Severe Pulmonary Hypertension ◽  
Severe Tricuspid Regurgitation ◽  
Gerbode Defect

<p>Ventricular Septal Defect (VSD) is a congenital heart disease that causes the connection between left and right ventricles called a Gerbode defect. Manifestation of a Gerbode defect is damage to the opening tricuspid valve caused regurgitation of the tricuspid valve. Delay in diagnosis and intervention will affect pre-operative nutritional status and malnutrition.</p><p>We reported a boy aged 2 months, weighing 3100 grams with biliary atresia followed by VSD, severe TR, and Gerbode defect who will undergo the Kasai procedure. Preoperative physical examination showed GCS E4V5M6, SpO2 100%. The skin gets icteric all over the body and conjunctiva. The cardiovascular system has a regular I-II heart sound, 2/3 mid clavicular S noise as high as 2 ICS and a pansystolic murmur. The examination of the abdomen is slight distended. Child pug score 8. Hemoglobin value 6.7gr%, hematocrite 37%, APTT 44.8 seconds, SGOT 443 U / L, SGPT 560 U / L, total bilirubin 23.89 mg / dl, direct bilirubin 13.92 mg / dl, and indirect bilirubin 9.97 mg / dl.</p><p>The goal of anesthesia in VSD, Severe Tricuspid Regurgitation (TR) with Gerbode Defect is preventing excessive ventilation to avoid severe pulmonary hypertension. The choice of anesthetic agent is based on the patient's physiology and balancing pulmonary and systemic blood flow. Perioperative management of cases of VSD, TR Severe with Gerbode defect in the following report describes the importance of understanding the pathophysiology of VSD and Gerbode defects to obtain a good outcome.</p><p>Perioperative management of VSD patients, severe tricuspid regurgitation with Gerbode defect requires more supervision, especially to minimize the increase in PVR, maintain systemic vascular resistance (SVR) and avoid excessive ventilation to prevent severe pulmonary hypertension.</p>

scholarly journals Concomitant Tricuspid Valve Repair during Minimally Invasive Mitral Valve Repair

2019 ◽  
Vol 68 (06) ◽  
pp. 486-491
Author(s):  
Bettina Pfannmueller ◽  
Martin Misfeld ◽  
Piroze Davierwala ◽  
Stefan Weiss ◽  
Michael Andrew Borger
Keyword(s):  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Tricuspid Valve ◽  
Early Mortality ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Invasive Approach ◽  
Cardiopulmonary Bypass Time ◽  
Significant Difference

Abstract Background Concomitant use of tricuspid valve (TV) surgery and minimally invasive mitral valve (MV) repair is debatable due to a prolonged time of surgery with presumably elevated operative risk. Herein, we examined cardiopulmonary bypass times and 30-day mortality in patients who underwent MV repair with and without concomitant TV surgery. Methods We retrospectively evaluated 3,962 patients with MV regurgitation who underwent minimally invasive MV repair without (n = 3,463; MVr group) and with (n = 499; MVr + TVr group) concomitant TV surgery between 1999 and 2014. Preoperative parameters between the groups were significantly different; therefore, propensity score matching was performed. Results Mean cardiopulmonary bypass time for all patients was 125.5 ± 55.8 minutes in MVr and 162.0 ± 58.0 minutes in MVr + TVr (p < 0.001). Overall 30-day mortality was significantly different between these groups (4.8 vs. 2.1%; p < 0.001); however, after adjustment, there was no significant difference (3.3 vs. 1.2%; p = 0.07). Backward logistic regression revealed that cardiopulmonary bypass time was not a significant predictor for early mortality within the MVr + TVr cohort. Conclusion Concomitant TV repair using prosthetic rings through a minimally invasive approach is safe and does not lead to elevated early mortality in our patient cohort. Therefore, prolonged cardiopulmonary bypass time should not be the sole reason to rule out MV repair with concomitant TV repair and to prefer the use of suture techniques, which saves only a few minutes compared with prosthetic ring implantation.

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