Percardiac closure of large apical ventricular septal defects in infants: Novel modifications and mid-term results.

Autor: Changwe GJ; Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China., Hongxin L; Department of Cardiovascular Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China., Zhang HZ; Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China., Wenbin G; Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China., Liang F; Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China., Cao XX; Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China., Chen SL; Department of Cardiovascular Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.
Jazyk: angličtina
Zdroj: Journal of cardiac surgery [J Card Surg] 2021 Mar; Vol. 36 (3), pp. 928-938. Date of Electronic Publication: 2021 Jan 27.
DOI: 10.1111/jocs.15291
Abstrakt: Background/aim: Both open heart surgery and percutaneous approaches retain several limitations in closing large apical muscular ventricular septal defects (AmVSD) in infants. We present probe-assisted percardiac device closure (PDC), an exclusively transoesophageal-echocardiography guided technique, as an alternative with midterm results.
Methods: Thirty-six infants with large AmVSDs (single or multiple-holed) underwent PDC in our department. Mean AmVSD for single and multiple-holed measured 7.2 ± 2.4 mm and 6.3 ± 3.4 mm, respectively. Subjects presented with a spectrum of cardiopulmonary sequelae and growth retardation, either alone or combined. Some were ventilator dependent and re-do cases. In addition, AmVSDs were categorized: cylindrical, tunnel and cave-like shaped as per color Doppler interrogation. Pursuant to cardiac access and deployment technique, subjects were apportioned: group A; inferior median sternotomy (perventricular), B; right mini-thoracotomy (peratrial) and C; complete median sternotomy (perventricular). Under exclusive echocardiography, the Z- or J probe-assisted delivery system was utilized to access AmVSDs and implant device(s) via aforementioned techniques.
Results: Forty-two muscular ventricular septal devices (8.4 ± 2.6 mm) were implanted in 36 subjects uneventfully. Seventeen "complex," and 10 cylindrical or straight tunnel-shapedAmVSDs (including 2 re-do patients) suited perventricular and peratrial techniques respectively. Comparatively, group B exhibited shorter procedural indices than A (p < .01). Five of 15 multiple-holed AmVSDs (four Swiss cheese) required two or three devices for a satisfactory occlusion. Nevertheless, post occlusion insignificant residual shunts( ≤ 2 mm) seldom achieved spontaneous closure, and at 36-month follow-up complete closure was 67%. Residual shunt persisted amongst multiple-holed. All patients improved during follow up.
Conclusion: PDC is feasible, safe and effective alternative technique for AmVSD in infants.
(© 2021 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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