Minimally-invasive-perventricular-device-occlusion versus surgical-closure for treating perimembranous-ventricular-septal-defect: 3-year outcomes of a multicenter randomized clinical trial

Background: Perimembranous ventricular septal defect (pmVSD) is a common congenital heart disease. Transaxillary occluder device closure of the pmVSD has been proved effective and an alternative to surgical closure. The study aimed to evaluate the immediate operation outcomes and the early and midterm follow-up outcomes of transaxillary occluder device closure. Methods: From January 2014 to December 2017, we retrospectively analyzed the patients who underwent transaxillary device closure of the pmVSD. All patients underwent transthoracic echocardiography (TTE), chest x-ray, and electrocardiogram (ECG) before and after the procedure (before discharging). Follow-up evaluation was completed at the time of 3, 6, 12 months and yearly thereafter in outpatient setting with TTE and ECG. Results: A total of 428 patients (216 male, 212 female) underwent transaxillary occluder device closure of the pmVSD under the guidance of transesophageal echocardiography (TEE). The mean age at the operation time was 2.2 ± 1.5 year (range 0.5-16.2 year). The mean weight was 8.5 ± 4.1 kg (range 6-61 kg). The mean size of the occluder implanted in the operation was 5.3 ± 1.4 (range 4-8 mm), matching the mean defect size of 4.2 ± 1.1 (range 3-6 mm). The device closure operation was successfully achieved in 422 pmVSD patients (98.6%), and 6 patients failed in occluding and were converted to open surgery because of a great residual shunt and obvious device-related aortic regurgitation . Immediate complete closure was detected by postoperative TEE in all, but 3 patients had trivial residual shunting. Total early adverse events emerged in 47 patients (11.1%). New mild tricuspid and aortic regurgitation occurred in 17 and 3 patients and disappeared in follow-up. Abnormal atrioventricular conduction events emerged in 23 patients, including left anterior block, complete right bundle branch block (CRBBB), incomplete right bundle branch block (IRBBB), administrated with close follow-up. Pericardial effusion occurred in 2 other patients, managed with puncture drainage. During a median follow-up period of 26.8 months (range 6-48 months), no serious adverse event and later-on complete atrioventricular block were encountered. Conclusion: In our experience, transaxillary device closure was performed via right infra-axillary mini-incision (invisible) guided by TEE, with low incidence of postoperative adverse events, confirming that transaxillary device closure of the pmVSD under the guidance of TEE is an effective alternative to surgical closure in well-selected pmVSD patients.

Download Full-text

Minimally Invasive Peratrial Device Closure of Perimembranous Ventricular Septal Defect Through a Right Infraaxillary Route: Clinical Experience and Preliminary Results

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2016.05.069 ◽

2017 ◽

Vol 103 (1) ◽

pp. 199-204 ◽

Cited By ~ 3

Author(s):

Shubo Song ◽

Taibing Fan ◽

Bin Li ◽

Weijie Liang ◽

Haoju Dong ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Minimally Invasive ◽

Clinical Experience ◽

Septal Defect ◽

Device Closure ◽

Preliminary Results ◽

Perimembranous Ventricular Septal Defect

Download Full-text

Outcomes of Tricuspid Valve Detachment for Isolated Ventricular Septal Defect Closure

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1735457 ◽

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.

Download Full-text

A Novel Approach for Transcatheter Management of Perimembranous Ventricular Septal Defect with a Subaortic Ridge

Journal of Interventional Cardiology ◽

10.1155/2021/6329273 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Hussein A. Wahab ◽

Hussein A. Alsalkhi ◽

Khalid A. Khalid ◽

Ahmmed F. Abusuda

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Interventricular Septum ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Type I ◽

Female Ratio ◽

Surgical Closure ◽

Perimembranous Ventricular Septal Defect ◽

The Mean

Introduction. Surgical closure of the perimembranous ventricular septal defect (PM VSD) and resection of the subaortic ridge are the standard methods of management, but there is no definitive agreement regarding the timing of surgery. Objectives. To evaluate the safety and efficacy of the management of patients with PM VSD and subaortic ridge with or without AR via transcatheter closure of the defect and compressing the ridge against the ventricular septum using Amplatzer ductal occluder type I (ADO-I). Patients and Methods. We introduced a new approach for transcatheter management of PM VSD and subaortic ridge by closing the VSD and capturing or compressing the ridge against the interventricular septum (IVS) using the ADO-I device. Thirty-eight (9.5%) of 398 patients with a PM VSD were found to have subaortic ridge and were enrolled in this study from August 1, 2014, to February 1, 2018, at the Ibn Albitar Center for Cardiac Surgery, Baghdad, Iraq. Results. The ages and weights of patients ranged from 1.5 to 25 years and 7 to 73 kg, respectively. The male-to-female ratio was 2.2 : 1. The VSD sizes ranged from 4 to 8 mm, and the median distance of the ridge from the proximal edge of the VSD was 2.5 mm. Prior to closure, 13 patients (34.2%) had mild and mild-to-moderate aortic regurgitation (AR), and nine patients (23.7%) had mild-to-moderate left ventricular outflow tract (LVOT) obstruction. The mean AR pressure half-time increased significantly after intervention (from 385 ± 38 ms to 535 ± 69 ms (significant P value, 0.001)), and the mean of the peak pressure gradient across the LVOT decreased from 33 ± 7 mmHg to 15 ± 2.4 mmHg (significant P value, 0.001). Successful procedures were achieved in 33 patients (86.8%). Conclusion. Transcatheter management of patients with PM VSD and subaortic ridges with or without AR is feasible and effective.

Download Full-text