Echocardiographic Assessment and Guidance in Minimally Invasive Surgical Device Closure of Perimembranous Ventricular Septal Defects
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.
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