Surgery for Aortic Insufficiency Associated with Ventricular Septal Defect

Aortic valve repair in children is a challenge. We have adopted a technique of single aortic cusp extension with an autologous pericardial strip in patients diagnosed with severe aortic insufficiency (AI) associated with a ventricular septal defect (VSD). The purpose of this study was to report the short-term outcomes. Seven patients were operated on between January 2002 and December 2003. The mean age was 11.28 ± 2.1 years (range 8–14 years). The VSD was closed with a synthetic patch. Aortic cusp extension was performed at the right coronary cusp in 6 patients and the remainder had a non-coronary cusp extension. The mean diastolic arterial pressure increased from 35.71 ± 6.09 to 74.28 ± 7.31 mm Hg after the operation ( p < 0.001). The postoperative grade of AI was trivial in 4 patients, mild in 1 patient and non-existent in 2 patients. The mean follow-up period was 12.85 ± 6.12 months (range 2–20 months). This technique is very effective in patients with severe AI associated with a VSD. However, long-term durability will need to be carefully followed.

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Percutaneous closure of ventricular septal defect using LifeTechTM Konar-MF VSD Occluder: initial and short-term multi-institutional results

Cardiology in the Young ◽

10.1017/s1047951121002985 ◽

2021 ◽

pp. 1-7

Author(s):

Masood Sadiq ◽

Ahmad Usaid Qureshi ◽

Muhammad Younas ◽

Sohail Arshad ◽

Syed Najam Hyder

Keyword(s):

Ventricular Septal Defect ◽

Aortic Regurgitation ◽

Septal Defect ◽

Defect Closure ◽

Short Term ◽

Ventricular Septal Defect Closure ◽

Coronary Cusp ◽

The Right ◽

Right Coronary Cusp

Abstract Background: Transcatheter ventricular septal defect closure remains a complex procedure with potential complications like complete heart block and aortic regurgitation. The ideal device design for such intervention is still evolving. Aim: To assess the safety, efficacy, and short-term outcome of ventricular septal defect closure using LifeTechTM multifunctional (KONAR-MFTM) VSD Occluder. Patients and methods: In a multicenre study, 44 patients with haemodynamically significant, restrictive ventricular septal defects underwent closure with the KONAR-MFTM device from April, 2019 to March, 2020. Clinical, echocardiographic, and angiographic data were collected and reviewed. Patients were followed up at 1, 3, 6, and 12 months. Results: The median age and weight were 8 (1.7–36) years and 20 (11–79) kg. Of 44 patients, 8 (18%) had a high muscular and 36 (82%) had a perimembranous defect, of which 6 had mild prolapse of the right coronary cusp. The median ventricular septal defect size was 8.8 (3.9–13.4) mm. A retrograde approach was adopted in 39 (88.6%) patients. Nine patients (20.5%) had a small residual leak and there was a slight increase in aortic regurgitation in one patient. One device, which embolised to pulmonary artery was retrieved, and the defect was closed with a larger device. At a median follow-up of 13 (5–18) months, the residual leak persisted in 1 (2.3%) patient. Mild aortic regurgitation in one patient remained unchanged. There were no major complications. Conclusion: Percutaneous closure of ventricular septal defect using KONAR-MFTM device is safe and effective in short and midterm follow-up including selected patients with perimembranous defect and mild prolapse of the right coronary cusp.

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Early and late outcomes of surgical repair of double-chambered right ventricle: a single-centre experience

Cardiology in the Young ◽

10.1017/s1047951120000244 ◽

2020 ◽

Vol 30 (3) ◽

pp. 409-412

Author(s):

Murat Surucu ◽

İlkay Erdoğan ◽

Birgül Varan ◽

Murat Özkan ◽

N. Kürşad Tokel ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Right Ventricle ◽

Septal Defect ◽

Surgical Intervention ◽

Systolic Pressure ◽

Presenting Symptoms ◽

Long Term Follow Up ◽

The Right

AbstractObjective:Double-chambered right ventricle is characterised by division of the outlet portion of the right ventricle by hypertrophy of the septoparietal trabeculations into two parts. We aim to report our experiences regarding the presenting symptoms of double-chambered right ventricle, long-term prognosis, including the recurrence rate and incidence of arrhythmias after surgery.Methods:We retrospectively investigated 89 consecutive patients who were diagnosed to have double-chambered right ventricle and underwent a surgical intervention from 1995 to 2016. The data obtained by echocardiography, cardiac catheterisation, and surgical findings as well as post-operative follow-up, surgical approaches, post-operative morbidity, mortality, and cardiac events were evaluated.Results:Median age at the time of diagnosis was 2 months and mean age at the time of operation was 5.3 years. Concomitant cardiac anomalies were as follows: perimembranous ventricular septal defect (78 patients), atrial septal defect (9 patients), discrete subaortic membrane (32 patients), right aortic arch (3 patients), aortic valve prolapse and/or mild aortic regurgitation (14 patients), and left superior caval vein (2 patients). The mean follow-up period was 4.86 ± 4.6 years. In these patients, mean systolic pressure gradient in the right ventricle by echocardiography before, immediately, and long-term after surgical intervention was 66.3, 11.8, and 10.4 mmHg, respectively. There were no deaths during the long-term follow-up period. Surgical reinterventions were performed for residual ventricular septal defect (2), residual pulmonary stenosis (1), and severe tricuspid insufficiency (1).Conclusion:The surgical outcomes and prognosis of double-chambered right ventricle are favourable, recurrence and fatal arrhythmias are unlikely in long-term follow-up.

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Mural Endocarditis and Embolic Pneumonia Due to Trueperella pyogenes in an Adult Cow with Ventricular Septal Defect

Veterinary Sciences ◽

10.3390/vetsci8120318 ◽

2021 ◽

Vol 8 (12) ◽

pp. 318

Author(s):

Domenico Caivano ◽

Maria Chiara Marchesi ◽

Piero Boni ◽

Fabrizio Passamonti ◽

Noemi Venanzi ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Heart Diseases ◽

Bacterial Endocarditis ◽

Adult Cattle ◽

Ventricular Response ◽

Coronary Cusp ◽

Sudden Decrease ◽

The Right ◽

Right Coronary Cusp

Bacterial endocarditis represents one of the most frequently acquired cardiac diseases in adult cattle. Congenital heart diseases as a ventricular septal defect can facilitate bacterial endocarditis as a consequence of turbulent blood flow through the defect, causing damage to the endocardium. We describe a case of mural endocarditis associated with a ventricular septal defect in an eight-year-old female Holstein Friesian cow. The cow’s history revealed that she had presented dysorexia and a sudden decrease of milk production in the last 10 days prior to the examination. On clinical examination, jugular pulses, tachycardia with irregular heart rate and tachypnea with harsh bronchovesicular sounds were evident. Electrocardiographic examination allowed the diagnosis of an atrial fibrillation with high ventricular response rate. Transthoracic echocardiography revealed a large vegetation originating from the endocardium between the tricuspid and pulmonic valves in the right ventricle outflow. On post-mortem examination, a small muscular septal defect under the right coronary cusp of the aortic valve and a mural vegetative endocarditis were found. An abscess in the chondro-costal junction of the third right rib and metastatic pneumonia were also observed. This case report describes a rare consequence of a small ventricular septal defect that had not been previously diagnosed in an adult cow.

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Assessment of ventricular septal defect with aortic valvar prolapse by means of echocardiography and angiography

Cardiology in the Young ◽

10.1017/s1047951100010854 ◽

1994 ◽

Vol 4 (1) ◽

pp. 44-50 ◽

Cited By ~ 1

Author(s):

Jou-Kou Wang ◽

Hung-Chi Lue ◽

Mei-Hwan Wu ◽

Ming-Lon Young ◽

Ing-Sh Chiu ◽

...

Keyword(s):

Aortic Valve ◽

Ventricular Septal Defect ◽

Septal Defect ◽

Sinus Of Valsalva ◽

Ventricular Septal Defects ◽

Septal Defects ◽

Mean Size ◽

The Mean ◽

The Right

SummaryA total of 80 patients, diagnosed by echocardiography as having ventricular septal defect with aortic valvar prolapse, underwent cardiac catheterization and surgery. Echocardiographic and angiographic results were compared with surgical findings. The ventricular septal defects as observed during surgery were found to be doubly committed and subarterial in 49 (61%), muscular outlet in 10 (13%), and perimembranous in 21(26%). The location had been erroneously categorized by echocardiography and angiography in 12 (15%) and in 15 (19%) patients, respectively. Prolapse of the right coronary leaflet of the aortic valve, as documented by echocardiography, was confirmed by angiography in all but two cases. Prolapse of the noncoronary leaflet was detected by both imaging modalities in three patients. Prolapse of the right coronary and noncoronary leaflets was observed at surgery in 49 and three patients, respectively. The mean size of the ventricular septal defect, when measured by echocardiography, was significantly smaller than that found following surgical measurements (3.3±1.3 vs 8.4±3.8 mm, p<0.001). Our study showed that the ventricular septal defect was erroneously classified in the presence of prolapse of the aortic valve in 15% and 19% of our cases by echocardiography and angiography, respectively. The herniated sinus of Valsalva forming the “roof” of the ventricular septal defect probably redirected the jet across the defect to cause the errors in interpretation. Echocardiography, nevertheless, is as reliable as angiography in our hands in the follow-up of patients with ventricular septal defect opening to the outlet of the right ventricle.

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Impact of preoperative aortic cusp prolapse on long-term outcome after surgical closure of subarterial ventricular septal defect

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(02)81823-x ◽

2002 ◽

Vol 39 ◽

pp. 406

Author(s):

Yiu-fai Cheung ◽

Clement S. Chiu ◽

Tak-cheung Yung ◽

Adolphus K. Chau

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Term Outcome ◽

Long Term Outcome ◽

Aortic Cusp ◽

Surgical Closure

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Paradoxical Infective Endocarditis of the Right Coronary Aortic Cusp in a Restrictive Ventricular Septal Defect: Bernoulli's Phenomenon Revisited

Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging ◽

10.4103/jiae.jiae_13_21 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0

Author(s):

Debasish Das ◽

Debasis Acharya ◽

Tutan Das ◽

Subhas Pramanik

Keyword(s):

Infective Endocarditis ◽

Ventricular Septal Defect ◽

Septal Defect ◽

Aortic Cusp ◽

The Right

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Doubly committed subarterial ventricular septal defect with prolapsed right coronary cusp with moderate aortic regurgitation

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v10i4.34561 ◽

2017 ◽

Vol 10 (4) ◽

pp. 240

Author(s):

Redoy Ranjan ◽

Asit Baran Adhikary ◽

Mohammad Rashal Chowdhury ◽

Md. Kabiruzzaman ◽

Md. Mushfiqur Rahman

Keyword(s):

Ventricular Septal Defect ◽

Aortic Regurgitation ◽

Septal Defect ◽

Systolic Pressure ◽

Failure To Thrive ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Pulmonary Artery Systolic Pressure ◽

Coronary Cusp ◽

Right Coronary Cusp

<p>A 4 year old girl was presented with the respiratory tract infection, breathlessness after taking meal, failure to thrive, abnormal movement of the chest on left side overlying the area of heart and systolic murmur. She developed these symptoms gradually for the last 3.5 years. Echocardiography revealed doubly committed subarterial ventricular septal defect with moderate aortic regurgitation. The size of the ventricular septal defect was 7 x 9 mm at the left ventricular outflow tract. The right coronary cusp of the aortic valve was prolapsed. Left atrium and left ventricle were dilated. The pulmonary artery systolic pressure was 35 mm Hg. The ventricular septal defect was closed with the standard surgical procedure using cardiopulmonary bypass followed by aortotomy and right atriotomy. Immediate post-operative period of this case was uneventful and the patient was discharged on 9<sup>th</sup> post-operative day. Follow-up echocardiography showed no residual ventricular septal defect or aortic regurgitation and the ventricular function was good.</p>

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A New Coated Nitinol Occluder for Transcatheter Closure of Ventricular Septal Defects in a Canine Model

BioMed Research International ◽

10.1155/2013/507919 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Yong Zhou ◽

Feng Chen ◽

Xinmiao Huang ◽

Xianxian Zhao ◽

Hong Wu ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Thrombus Formation ◽

Canine Model ◽

Control Group ◽

New Type ◽

Good Biocompatibility ◽

The Right ◽

Microscopy Examination

Aims. This study evaluated feasibility and safety of implanting the polyester-coated nitinol ventricular septal defect occluder (pcVSDO) in the canine model.Methods and Results. VSD models were successfully established by transseptal ventricular septal puncture via the right jugular vein in 15 out of 18 canines. Two types of VSDOs were implanted, either with pcVSDOs (n=8) as the new type occluder group or with the commercial ventricular septal defect occluders (VSDOs,n=7, Shanghai Sharp Memory Alloy Co. Ltd.) as the control group. Sheath size was 10 French (10 Fr) in two groups. Then the general state of the canines was observed after implantation. ECG and TTE were performed, respectively, at 7, 30, 90 days of follow-up. The canines were sacrificed at these time points for pathological and scanning electron microscopy examination. The devices were successfully implanted in all 15 canines and were retrievable and repositionable. There was no thrombus formation on the device or occurrence of complete heart block. The pcVSDO surface implanted at day 7 was already covered with neotissue by gross examination, and it completed endothelialization at day 30, while the commercial VSDO was covered with the neotissue in 30th day and the complete endothelialization in 90th day.Conclusion. The study shows that pcVSDO is feasible and safe to close canine VSD model and has good biocompatibility and shorter time of endothelialization.

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