scholarly journals A Review of the Therapeutic Management of Multiple Ventricular Septal Defects

2021 ◽  
Author(s):  
Ujjwal Chowdhury ◽  
Robert Anderson ◽  
Diane E. Spicer ◽  
Lakshmi Sankhyan ◽  
Niwin George ◽  
...  
Keyword(s):  
Severe Pulmonary Hypertension ◽  
Associated Anomalies ◽  
Ventricular Septal Defects ◽  
Perioperative Mortality ◽  
Radiographic Findings ◽  
Pooled Data ◽  
Septal Defects ◽  
Multiple Defects ◽  
Hybrid Approaches ◽  
The Right

Background and Aim: We showed in our anatomical review, ventricular septal defects existing as multiple entities can be considered in terms of three major subsets. We address here the diagnostic challenges, associated anomalies, the role and techniques of surgical instead of interventional closure, and the outcomes. including reinterventions, for each subset. Methods: We reviewed 80 published investigations, noting radiographic findings, and the results of clinical imaging elucidating the location, number, size of septal defects, and associated anomalies, and the effect of severe pulmonary hypertension. Results: Overall, perioperative mortality for treatment of residual multiple defects has been cited to be between zero and 14.2%, with morbidity estimated between 6% to 13%. Perioperative mortality is twice as high for perimembranous compared to muscular defects, with need for reoperation is over four times higher. Perventricular hybrid approaches are useful for closure of high anterior or apical defects. Overall, results have been unsatisfactory. Pooled data reveals incidences between 2.8% and 45% for device-related adverse events. Currently, however, outcomes cannot be assessed on the basis of the different anatomical sub-sets. Conclusions: We have addressed the approaches, and the results, of therapeutic treatment in terms of co-existing discrete defects, the Swiss-cheese septum, and the arrangement in which a solitary apical muscular defect gives the impression of multiple defects when viewed from the right ventricular aspect. Treatment should vary according to the specific combination of defects.

Delayed Closure of Multiple Muscular Ventricular Septal Defects in an Infant after Coarctation Repair and a Hybrid Procedure�A Case Report

2011 ◽  
Vol 14 (1) ◽  
pp. 67 ◽  
Author(s):  
Ireneusz Haponiuk ◽  
Maciej Chojnicki ◽  
Radosaw Jaworski ◽  
Jacek Juciski ◽  
Mariusz Steffek ◽  
...  
Keyword(s):  
Septal Defect ◽  
Color Doppler ◽  
Hybrid Approach ◽  
Ventricular Septal Defects ◽  
Color Doppler Echocardiography ◽  
Septal Defects ◽  
Coarctation Repair ◽  
Step Procedure ◽  
The Right ◽  
Delayed Closure

There are several strategies of surgical approach for the repair of multiple muscular ventricular septal defects (mVSDs), but none leads to a fully predictable, satisfactory therapeutic outcome in infants. We followed a concept of treating multiple mVSDs consisting of a hybrid approach based on intraoperative perventricular implantation of occluding devices. In this report, we describe a 2-step procedure consisting of a final hybrid approach for multiple mVSDs in the infant following initial coarctation repair with pulmonary artery banding in the newborn. At 7 months, sternotomy and debanding were performed, the right ventricle was punctured under transesophageal echocardiographic guidance, and the 8-mm device was implanted into the septal defect. Color Doppler echocardiography results showed complete closure of all VSDs by 11 months after surgery, probably via a mechanism of a localized inflammatory response reaction, ventricular septum growth, and implant endothelization.

Pulmonary arterial changes in patients with ventricular septal defects and severe pulmonary hypertension

1986 ◽  
Vol 7 (3) ◽  
pp. 147-154 ◽  
Author(s):  
Ruthellen Fried ◽  
George Falkovsky ◽  
Jane Newburger ◽  
A. I. Gorchakova ◽  
Marlene Rabinovitch ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Severe Pulmonary Hypertension ◽  
Ventricular Septal Defects ◽  
Septal Defects ◽  
Pulmonary Arterial

scholarly journals The Fate of the Outflow Tract Septal Complex in Relation to the Classification of Ventricular Septal Defects

2019 ◽  
Vol 6 (1) ◽  
pp. 9 ◽  
Author(s):  
Robert Anderson ◽  
Justin Tretter ◽  
Diane Spicer ◽  
Shumpei Mori
Keyword(s):  
Outflow Tract ◽  
Ventricular Septum ◽  
Ventricular Septal Defects ◽  
Atrioventricular Canal ◽  
Dorsal Wall ◽  
Septal Defects ◽  
Major Significance ◽  
Ongoing Development ◽  
The Right

It is now established that the entity often described as an “aortopulmonary septal complex” is better considered as an “outflow tract septal complex”. This change is crucial for appropriate understanding of not only malformations of the outflow tract, but also ventricular septal defects. Thus, the embryonic outflow tract, as it develops, is separated into its two components by fusion of a protrusion from the dorsal wall of the aortic sac with the distal end of the outflow cushions. The key point with regard to morphogenesis is that, with ongoing development, these structures lose their septal integrity, although they can still be identified as septal structures when the ventricular septum itself is deficient. In the normal postnatal heart, however, the aortic and pulmonary components have their own walls throughout the length of the outflow tracts. All of this is of clinical significance, since some current concepts of categorisation of the ventricular septal defects are based on the existence in the normal heart of a “conal septum”, along with a “septum of the atrioventricular canal”. In this review, we show how analysis of postnatal hearts reveals the definitive ventricular septum to possess only muscular and fibrous components in the absence of either discrete outflow or inlet components. We also show that this information regarding development, in turn, is of major significance in determining whether categorisation of ventricular septal defects is best approached, in the first instance, on the basis of the borders of the defects or the fashion in which they open to the right ventricle.

Abstract 15801: Early and Late Risk of Mortality or Development of Severe Pulmonary Hypertension Following Closure of Ventricular Septal Defects in Children With Severe Pulmonary Hypertension and Elevated Pulmonary Vascular Resistance Using Traditional or Uni-directional Flap Valve Patch Closure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
William M Novick ◽  
Oleksandr Golovenko ◽  
Vasyl Lazorhyshynets ◽  
Vitaly Dedovich ◽  
Iryna Perepeka ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Severe Pulmonary Hypertension ◽  
Ventricular Septal Defects ◽  
Risk Of Death ◽  
Septal Defects ◽  
Number Of Patients ◽  
Flap Valve

Introduction: Children with large ventricular septal defects, severe pulmonary hypertension (PHT), and elevated pulmonary vascular resistance (PVR) are frequently denied operation in low and middle-income countries secondary to concerns of high mortality and development of severe pulmonary hypertension following operation, early and late. Hypothesis: We hypothesized that closure with a uni-directional flap valve patch (DP) would provide lower mortality and better survival without severe PHT. Methods: From 5/96 - 12/2016 all patients undergoing VSD closure with severe PHT and elevated PVR by either traditional (TP) or DP closure were followed annually. Baseline and O 2 provocation catheterization were performed before operation. Echocardiograms were performed at discharge and follow-up. The decision on TP or DP closure was based upon age and surgeon preference. Beginning in 2005 all patients regardless of technique received sildenafil 3 mgs/kg/day for 3 months before operation. Results: The number of patients receiving operation was 129, of which 40 received the DP. Males were 66/129, age and weight differed significantly for DP group compared to the TP group (7.5 vs 2.6 years, p<0.001 and 20 vs 11.5 kgs, p<0.001).Catheterization baseline data, PVR 9.0 vs 7.4 for DP and TP respectively (p<0.001), negative vasoactive test 32.5% vs 13.5% for DP and TP respectively (p=0.016). Mortality was 1/40 for DP and 9/89 for TP. Pulmonary to Systemic systolic pressure ratio was lower at discharge vs baseline cath (0.38 vs 0.99, p<0.001). Predictors of late severe pulmonary hypertension were PVR/SVR >0.5, p<0.024; and a negative vasoactive test of <10% decrease, p<0.001. PHT at last follow-up, none or mild 86/115 (74.8%), moderate 16/115 (13.9%) or severe 13/115 (11.3%). Conclusions: DP patients had less risk of death and both groups had few patients with severe PHT at late follow-up..

Transcatheter closure of a membranous ventricular septal defect in a 1.8-kg infant using Amplatzer Duct Occluder II additional size device

2017 ◽  
Vol 27 (7) ◽  
pp. 1437-1440
Author(s):  
Bhavik Champaneri ◽  
Mahesh Kappanayil ◽  
Raman K. Kumar
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Artery Occlusion ◽  
Amplatzer Duct Occluder ◽  
Ventricular Septal Defects ◽  
Septal Defects ◽  
Femoral Artery Occlusion ◽  
Catheter Closure ◽  
The Right

AbstractCatheter closure of membranous ventricular septal defects is generally not considered feasible in small infants. We report the successful closure of a membranous ventricular septal defect in a 1.8-kg infant with bilateral femoral artery occlusion using Amplatzer Duct Occluder II additional size device. The ventricular septal defect was crossed from the right ventricle, and the device was deployed using transthoracic echocardiographic guidance.

scholarly journals Mosaic Trisomy 18 in a Five-Month-Old Infant

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Ana Laura Fitas ◽  
Mafalda Paiva ◽  
Ana Isabel Cordeiro ◽  
Luís Nunes ◽  
Gonçalo Cordeiro-Ferreira
Keyword(s):  
Clinical Findings ◽  
Trisomy 18 ◽  
Pulmonary Artery Stenosis ◽  
Feeding Problems ◽  
Ventricular Septal Defects ◽  
Septal Defects ◽  
Irregular Pattern ◽  
History Of ◽  
The Right ◽  
Mosaic Trisomy

Individuals with mosaic trisomy 18, only approximately 5% of all trisomy 18 cases, carry both a trisomy 18 and an euploid cell line. Their clinical findings are highly variable, from the absence of dysmorphic features to the complete trisomy 18 syndrome. A five-month-old daughter of a 38-year-old mother, with vomiting and feeding problems, was referred to our department. She was undernourished and had axial hypotony and developmental delay, an irregular pattern of hypopigmentation on the right side of the abdomen, and moderate sagittal body asymmetry with left-side muscular hemihypotrophy. Mild craniofacial dysmorphy included dolichocephaly, frontal bossing, prominentocciput, long downslanting palpebral fissures, hypertelorism, and retrognathia. A complex heart defect with atrial and ventricular septal defects, pulmonary artery stenosis, and bicuspid aortic valve was identified. Cytogenetic analysis revealed mosaic trisomy 18 with trisomy in 90% of peripheral lymphocytes and 17% of skin fibroblasts. This case adds to our knowledge of the phenotypic spectrum and the natural history of mosaic trisomy 18 by adding a dysmorphic feature and a cardiac abnormality that, to the best of our knowledge, had not been previously described.

The echocardiographic anatomy of ventricular septal defects

1997 ◽  
Vol 7 (4) ◽  
pp. 471-484 ◽  
Author(s):  
Michael A. Gatzoulis ◽  
Jia Li ◽  
Siew Yen Ho
Keyword(s):  
Right Ventricle ◽  
Atrioventricular Conduction ◽  
Ventricular Septal Defects ◽  
Cross Sectional ◽  
Septal Defects ◽  
Echocardiographic Images ◽  
The Right ◽  
Descriptive Method ◽  
Membranous Septum

AbstractMany of the controversies surrounding the description of ventricular septal defects arise from differences in the perspectives from which they are viewed. In this review, we analyse these defects as seen in cross-sectional echocardiographic images, correlating them with morphologic specimens. The classification we advocate, which now has a suitable pedigree, is a simple descriptive method distinguishing between perimembranous, muscular, and doubly committed types of defects. The approach is to categorise the defects as seen from the right ventricle, the usual port of access for surgeons. The term ‘perimembranous’ highlights the proximity of the atrioventricular conduction axis to the margin of the defects in which the remnant of the membranous septum forms a direct border. This system is applicable to all interventricular communications, no matter how malformed the heart may be in which they are enclosed.

Spontaneous closure of muscular ventricular septal defect identified by echocardiography in neonates

1998 ◽  
Vol 8 (4) ◽  
pp. 500-505 ◽  
Author(s):  
Zhong-Dong Du ◽  
Nathan Roguin ◽  
Xing-Jian Wu
Keyword(s):  
Natural History ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Spontaneous Closure ◽  
Ventricular Septal Defects ◽  
Muscular Ventricular Septal Defect ◽  
Septal Defects ◽  
Multiple Defects ◽  
Single Defect ◽  
History Of

AbstractMuscular ventricular septal defects were diagnosed by echocardiography in 97 neonates within 7 days of birth. In 82 of the neonates (84.5%), the defect was solitary, while 15 had multiple defects. The solitary defects was located at mid-septal, apical, anterior and inlet locations in 42 (51.2%), 21 (25.6%), 14 (17.1%) and 5 (6.1%) neonates, respectively. Multiple defects occurred in the apical, anterior and mid-septal areas. The diameter of the solitary defects ranged from 1 to 6 mm (2.3 ± 0.8 mm), while the multiple lesions were 1 to 4 mm in diameter (2.1 2.3 ± 0.8 mm 0.8 mm) in 28 instances in which they could measured. It proved possible to follow 79 of the patients for period of 10 to 13 months. The defects closed spontaneously in 56 (84.8%) of 66 patients with a single defect, and in 7 (53.8%) of 13 of those with multiple defects (P<0.05). For the solitary defects, the position and size were factors determining the likelihood and speed of closure. Defects located at the apical septum, or defects larger than 4 mm in diameter, closed slowly and at a later stage. Echocardiography is an useful technique in establishing of natural history of muscular ventricular septal defects encountered in neonates.

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