Echocardiographic Assessment and Guidance in Minimally Invasive Surgical Device Closure of Perimembranous Ventricular Septal Defects
DOI:
https://doi.org/10.1532/HSF98.2014340Abstract
Background: The primary aim of this study was to explore the safety and feasibility of minimally invasive surgical device closure of perimembranous ventricular septal defects (PMVSDs) in children using echocardiography for preoperative assessment and intraoperative guidance.
Methods: We enrolled 942 children diagnosed with PMVSDs from April 2010 to October 2013. All children underwent full evaluation by transthoracic echocardiography (TTE) and multiplane transesophageal echocardiography (MTEE) to determine the sizes, types and spatial positions of defects and their proximity to the adjacent tissues. The PMVSDs were surgically occluded using MTEE for guidance.
Results: Eight hundred eighty-nine (94.37%) of 942 children underwent successful closure of PMVSDs. Symmetric devices were used in 741 children (including 38 A4B2 occluders) and asymmetric devices were used in the other 148. All patients received follow-ups at regular intervals after successful occlusion. The occluders remained firmly in place. No noticeable residual shunt or valvular regurgitation was discovered, with the exception of one child whose original mild aortic regurgitation progressed to moderate by the 18 month follow-up. Overall there were no significant arrhythmias with the exception of 3 children, all of whom experienced postsurgical acute attacks of Adams-Stokes syndrome.
Conclusions: Minimally invasive surgical device closure of PMVSDs is safe and feasible. TTE and MTEE play vital roles in all stages of treatment of PMVSDs.
References
Amin Z, Danford DA, Lof J, Duncan KF, Froemming S. 2004. Intraoperative device closure of perimembranous ventricular septal defects without cardiopulmonary bypass: preliminary results with the perventricular technique. J Thorac Cardiovasc Surg 127:234-41.nAmin Z, Woo R, Danford DA, et al. 2006. Robotically assisted perventricular closure of perimembranous ventricular septal defects: Preliminary results in yucatan pigs. J Thorac Cardiovasc Surg 131:427-32.nAnil SR, Sreekanth R, Bhalerao S, et al. 2005. Transcatheter closure of perimembranous ventricular septal defect with amplatzer membranous occluder. Indian Heart J 57:698-703.nBacha EA, Cao QL, Starr JP, et al. 2003. Perventricular device closure of muscular ventricular septal defects on the beating heart: Technique and results. J Thorac Cardiovasc Surg 126:1718-23.nBai W, An Q, Tang H. 2012. Application of transesophageal echocardiography in minimally invasive surgical closure of ventricular septal defects. Tex Heart Inst J 39:211-4.nBol-Raap G, Weerheim J, Kappetein AP, Witsenburg M, Bogers AJ. 2003. Follow-up after surgical closure of congenital ventricular septal defect. Eur J Cardiothorac Surg 24:511-15.nCao H, Chen Q, Zhang GC, et al. 2011. Intraoperative device closure of perimembranous ventricular septal defects in the young children under transthoracic echocardiographic guidance; initial experience. J Cardiothorac Surg 6:166.nCao QL, Zabal C, Koenig P, Sandhu S, Hijazi ZM. 2005. Initial clinical experience with intracardiac echocardiography in guiding transcatheter closure of perimembranous ventricular septal defects: Feasibility and comparison with transesophageal echocardiography. Catheter Cardiovasc Interv 66:258-67.nChen Q, Chen LW, Wang QM, et al. 2010. Intraoperative device closure of doubly committed subarterial ventricular septal defects: initial experience. Ann Thorac Surg 90:869-73.nFischer G, Apostolopoulou SC, Rammos S, et al. 2007. The amplatzer membranous VSD occluder and the vulnerability of the atrioventricular conduction system. Cardiol Young 17:499-504.nFreedom RM, White RD, Pieroni DR, et al. 1974. The natural history of the so-called aneurysm of the membranous ventricular septum in childhood. Circulation 49:375-84.nHolzer R, de Giovanni J, Walsh KP, et al. 2006. Transcatheter closure of perimembranous ventricular septal defects using the amplatzer membranous VSD occluder: immediate and midterm results of an international registry. Catheter Cardiovasc Interv 68:620-28.nHu HB, Jiang SL, Xu ZY, et al. 2004. Transcatheter closure of perimembranous ventricular septal defects using the new amplatzer membranous VSD occluder: A short-term evaluation. Zhonghua Yi Xue Za Zhi 84:1592-96.nNihoyannopoulos P. Aortic Valve Disease: A. Aortic Stenosis. In: Echocardiography. Nihoyannopoulos P, Kisslo J, eds. London New York: Springer Dordrecht Heidelberg, 2009:117-227.nQuansheng X, Silin P, Zhongyun Z, et al. 2009. Minimally invasive perventricular device closure of an isolated perimembranous ventricular septal defect with a newly designed delivery system: preliminary experience. J Thorac Cardiovasc Surg 137:556-9.nTynan M, Anderson RH, Baker EJ, et al. Ventricular septal defects. In: Paediatric Cardiology 2nd ed. Anderson RH, Baker EJ, Macartney FJ, Rigby ML, Shinebourne EA, Tynan M, eds. London: Churchill Livingstone; 2002:983-1014.nVidne BA, Chiariello L, Wagner H, Subramanian S. 1976. Aneurysm of the membranous ventricular septum. Surgical consideration and experience in 29 cases. J Thorac Cardiovasc Surg 71:402-9.nYang R, Sheng Y, Cao K, et al. 2011. Transcatheter closure of perimembranous ventricular septal defect in children: Safety and efficiency with symmetric and asymmetric occluders. Catheter Cardiovasc Interv 77:84-90.n
Published
How to Cite
Issue
Section
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).
