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Ventricular Septal Defects. CONGENIT HEART DIS 2022. [DOI: 10.1016/b978-1-56053-368-9.00016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sivalingam S, Haranal M, Pathan IH. Aortic valve neocuspidization for aortic regurgitation associated with ventricular septal defect. Interact Cardiovasc Thorac Surg 2021; 34:315-321. [PMID: 34499736 PMCID: PMC8766201 DOI: 10.1093/icvts/ivab239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/01/2021] [Accepted: 07/25/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Different methods of aortic valve repair have been described in the literature for aortic regurgitation (AR) associated with doubly committed subarterial ventricular septal defects. Our goal was to present our experience with aortic valve reconstruction of a single leaflet using the aortic valve neocuspidization technique in this subset of patients. METHODS It is a retrospective review of 7 patients with doubly committed subarterial ventricular septal defects with significant (>moderate) AR who underwent the single-leaflet neocuspidization technique of aortic valve reconstruction from January 2016 to January 2019. Data were collected from medical records. All patients had thorough 2-dimensional echocardiographic assessment preoperatively and during the follow-up period. Primary end points were freedom from postoperative AR and freedom from reoperation and all-cause mortality within the follow-up period with secondary end points of freedom from thromboembolism and infective endocarditis. RESULTS Out of 7 patients, 6 were male and 1 was female. There were no perioperative deaths. The mean follow-up period was 2.6 ± 0.8 years. No deaths occurred during the follow-up period. At the latest follow-up examination, only 2 patients showed mild AR and were asymptomatic. There was no documented event of infective endocarditis or thromboembolism during the follow-up period. CONCLUSIONS The aortic leaflet neocuspidization procedure for the aortic valve is a relatively new concept. Availability of a template makes it an easily reproducible valve repair in paediatric patients with a single-leaflet abnormality. This technique preserves the remaining 2 normal leaflets, thus promoting the growth potential while maintaining near normal aortic root complex dynamics.
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Affiliation(s)
- Sivakumar Sivalingam
- Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia
| | - Maruti Haranal
- Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia
| | - Iqbal Hussain Pathan
- Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia
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Outcomes of closure of doubly committed subarterial ventricular septal defects in adults. Cardiol Young 2020; 30:599-606. [PMID: 32308178 DOI: 10.1017/s1047951120000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Outcome data of doubly committed subarterial ventricular septal defect closure in adults are limited. METHODS A review was made of the inpatients >18 years of age who underwent doubly committed subarterial ventricular septal defect closure between June 2010 and June 2017. RESULTS The patients were categorised into two groups: The valve intervention group consisted of 31 patients who underwent aortic valvuloplasty, aortic valve replacement, or repair of sinus Valsalva aneurysm in addition to doubly committed subarterial ventricular septal defect closure; non-valvular intervention group comprised 58 patients who underwent only doubly committed subarterial ventricular septal defect closure. The groups did not differ by sex and age. Patients in the valve intervention group, with a larger ventricular septal defect size, were shorter and tended to be lighter. The valve intervention group had more patients with pneumonia perioperatively. No infective endocarditis and reoperation were noted during the study period. At last follow-up, 91 and 96.6% of the studied patients were free from left ventricle dilation and pulmonary hypertension. In patients without pre-operative aortic regurgitation, 12 developed new mild aortic regurgitation during the follow-up. CONCLUSIONS About 34.8% of adult patients with doubly committed subarterial ventricular septal defect required concurrent intervention on aortic valve or sinus Valsalva aneurysm. The midterm results of doubly committed subarterial ventricular septal defect closure in adult patients were favourable. However, the incidence of new mild aortic regurgitation after ventricular septal defect closure was high (27.3%). Long-term follow-up of aortic regurgitation progression is needed.
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Zhou S, Zhao L, Fan T, Li B, Liang W, Dong H, Song S, Liu L. Perventricular device closure of doubly committed sub-arterial ventricular septal defects via a left infra-axillary approach. J Card Surg 2017; 32:382-386. [PMID: 28543756 DOI: 10.1111/jocs.13155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study sought to evaluate the feasibility, safety, and efficacy of perventricular device closure of a doubly committed sub-arterial ventricular septal defect (dcVSD) through a left infra-axillary approach. METHOD Forty-five patients, with a dcVSD of less than 8 mm in diameter, were enrolled in this study. The pericardium was exposed and opened through a left infra-axillary mini-incision. Two parallel purse-string sutures were placed on the right ventricle outflow tract and under transesophageal echocardiography guidance, a delivery sheath loaded with the device was inserted into the right ventricle and advanced through the defect into the left ventricle. The device, connected to a delivery cable, was then deployed. RESULTS Forty-one patients achieved successful device closure. In four patients, the device failed to occlude the VSD due to device dislodgement, device-related aortic regurgitation, and residual shunts, and open surgical repair was required. The mean dcVSD diameter was 4.5 ± 1.0 mm (range, 3.0-8.0 mm). The implanted device size was 6.0 ± 1.5 mm (range, 4-10 mm). All patients were implanted with an eccentric device. The mean intracardiac manipulation time was 20.9 ± 7.1 min (range, 9-45 min). The procedure time was 62.5 ± 19.5 min (range 34-105 min). There were no severe adverse events. CONCLUSIONS Perventricular device closure of a dcVSD through a left infra-axillary approach is feasible, safe, and efficacious in selected patients with dcVSD.
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Affiliation(s)
- Sijie Zhou
- Department of Cardiovascular Surgery and Ultrasound, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Liyun Zhao
- Department of Cardiovascular Surgery and Ultrasound, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Taibing Fan
- Department of Cardiovascular Surgery and Ultrasound, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Bin Li
- Department of Cardiovascular Surgery and Ultrasound, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Weijie Liang
- Department of Cardiovascular Surgery and Ultrasound, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Haoju Dong
- Department of Cardiovascular Surgery and Ultrasound, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Shubo Song
- Department of Cardiovascular Surgery and Ultrasound, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Liu
- Department of Cardiovascular Surgery and Ultrasound, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
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Shamsuddin AM, Chen YC, Wong AR, Le TP, Anderson RH, Corno AF. Surgery for doubly committed ventricular septal defects. Interact Cardiovasc Thorac Surg 2016; 23:231-4. [PMID: 27170744 DOI: 10.1093/icvts/ivw129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/09/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Doubly committed ventricular septal defects (VSDs) account for up to almost one-third of isolated ventricular septal defects in Asian countries, compared with only 1/20th in western populations. In our surgical experience, this type of defect accounted for almost three-quarters of our practice. To date, patch closure has been considered the gold standard for surgical treatment of these lesions. Our objectives are to evaluate the indications and examine the outcomes of surgery for doubly committed VSDs. METHODS Between October 2013, when our service of paediatric cardiac surgery was opened, and December 2014, 24 patients were referred for surgical closure of VSDs. Among them, 17 patients (71%), with the median age of 6 years, ranging from 2 to 9 years, and with a median body weight of 19 kg, ranging from 11 to 56 kg, underwent surgical repair for doubly committed defects. In terms of size, the defect was considered moderate in 4 and large in 13. Aortic valvular regurgitation (AoVR) was present in 11 patients (65%) preoperatively, with associated malformations found in 14 (82%), with 5 patients (29%) having two or more associated defects. RESULTS After surgery, there was trivial residual shunting in 2 patients (12%). AoVR persisted in 6 (35%), reducing to trivial in 5 (29%) and mild in 1 (6%). Mean stays in the intensive care unit and hospital were 2.6 ± 1.2 days, ranging from 2 to 7 days, and 6.8 ± 0.8 days, ranging from 6 to 9 days, respectively. The mean follow-up was 14 ± 4 months, ranging from 6 to 20 months, with no early or late deaths and without clinical deterioration. CONCLUSIONS The incidence of doubly committed lesions is high in our experience, frequently associated with AoVR and other associated malformation. Early detection is crucial to prevent further progression of the disease. Patch closure remains the gold standard in management, not least since it allows simultaneous repair of associated intracardiac defects.
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Affiliation(s)
- Ahmad Mahir Shamsuddin
- Pediatric and Congenital Cardiac Surgery Unit, Department of Surgery, School of Medical Sciences, Health Campus, University of Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Yen Chuan Chen
- Pediatric and Congenital Cardiac Surgery Unit, Department of Surgery, School of Medical Sciences, Health Campus, University of Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Abdul Rahim Wong
- Pediatric Cardiology Unit, Department of Pediatrics, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia
| | - Trong-Phi Le
- Department for Structural and Congenital Heart Disease, Heart Center Bremen, Klinikum Links der Weser, Bremen, Germany
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, International Centre for Life, Newcastle upon Tyne, UK
| | - Antonio F Corno
- Pediatric and Congenital Cardiac Surgery, East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK
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Transfemoral Device Occlusion and Minimally Invasive Surgical Repair for Doubly Committed Subarterial Ventricular Septal Defects. Pediatr Cardiol 2015; 36:1624-9. [PMID: 26033347 DOI: 10.1007/s00246-015-1207-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
Transfemoral device occlusion and minimally invasive surgical repair are performed for doubly committed subarterial ventricular septal defect (dcVSD) to reduce the invasiveness of the conventional surgical repair through a median sternotomy. However, few studies have compared them in terms of effectiveness and cost. Inpatients with isolated dcVSD who had undergone transfemoral device occlusion or minimally invasive surgical repair from January 2011 to June 2014 were reviewed for a comparative investigation between the two procedures. Procedure success was achieved in 36 transfemoral (75 %) and in 36 surgical (100 %) procedures (p = 0.001). Transfemoral patients were older, with a VSD size similar to that of surgical patients (14.5 ± 11.7 vs 4.4 ± 2.9 years, p < 0.001; 4.5 ± 1.5 vs 4.4 ± 1.3 mm, p = 0.577, respectively). No significant difference was observed in complication rates between the two treatment groups (p = 1). No large residual shunt was observed. Small residual shunt was noted in two transfemoral patients and four surgical patients (p = 0.674). All these small residual shunts closed spontaneously during follow-up. The surgical repair costs 26 % less than the device occlusion (Yuan 22063.2 ± 343.9 vs Yuan 29970.1 ± 1335.2, p < 0.001), where most of the cost was attributed to the occluder in the amount of Yuan 19,500. Compared with device occlusion, minimally invasive surgical repair can provide superior efficacy and comparable complication rates. In addition, it is 26 % cheaper than device occlusion. In low-income countries where healthcare resources are limited, medical resources must be judiciously allocated to the treatment that allows for effective treatment of the largest number of patients.
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Zhao Yang C, Hua C, Yuan Ji M, Qiang C, Wen Zhi P, Wan Hua C, Chang X, Lin F, Liang-Long C, Jun Bo G. Transfemoral and Perventricular Device Occlusions and Surgical Repair for Doubly Committed Subarterial Ventricular Septal Defects. Ann Thorac Surg 2015; 99:1664-70. [DOI: 10.1016/j.athoracsur.2015.01.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/30/2014] [Accepted: 01/06/2015] [Indexed: 10/23/2022]
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Devlin PJ, Russell HM, Mongé MC, Patel A, Costello JM, Spicer DE, Anderson RH, Backer CL. Doubly Committed and Juxtaarterial Ventricular Septal Defect: Outcomes of the Aortic and Pulmonary Valves. Ann Thorac Surg 2014; 97:2134-40; discussion 2140-1. [DOI: 10.1016/j.athoracsur.2014.01.059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 12/26/2013] [Accepted: 01/06/2014] [Indexed: 11/26/2022]
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Carotti A, Digilio MC, Piacentini G, Saffirio C, Di Donato RM, Marino B. Cardiac defects and results of cardiac surgery in 22q11.2 deletion syndrome. ACTA ACUST UNITED AC 2008; 14:35-42. [PMID: 18636635 DOI: 10.1002/ddrr.6] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Specific types and subtypes of cardiac defects have been described in children with 22q11.2 deletion syndrome as well as in other genetic syndromes. The conotruncal heart defects occurring in patients with 22q11.2 deletion syndrome include tetralogy of Fallot, pulmonary atresia with ventricular septal defect, truncus arteriosus, interrupted aortic arch, isolated anomalies of the aortic arch, and ventricular septal defect. These conotruncal heart defects are frequently associated in this syndrome with additional cardiovascular anomalies of the aortic arch, pulmonary arteries, infundibular septum, and semilunar valves complicating cardiac anatomy and surgical treatment. In this review we describe the surgical anatomy, the operative treatment, and the prognostic results of the cardiac defects associated with 22q11.2 deletion syndrome. According to the current literature, in patients with tetralogy of Fallot with/without pulmonary atresia and truncus arteriosus, in spite of the complex cardiac anatomy, the presence of 22q11.2 deletion syndrome does not worsen the surgical prognosis. On the contrary in children with pulmonary atresia with ventricular septal defect and probably in those with interrupted aortic arch the association with 22q11.2 deletion syndrome is probably a risk factor for the operative treatment. The complex cardiovascular anatomy in association with depressed immunological status, pulmonary vascular reactivity, neonatal hypocalcemia, bronchomalacia and broncospasm, laryngeal web, and tendency to airway bleeding must be considered at the time of diagnosis and surgical procedure. Specific diagnostic, surgical, and perioperative protocols should be applied in order to provide appropriate treatment and to reduce surgical mortality and morbidity.
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Affiliation(s)
- Adriano Carotti
- Pediatric Cardiac Surgery, Ospedale Pediatrico Bambino Gesù, Rome, Italy
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Frigiola A, Abella RF, Giamberti A. Doubly committed subarterial ventricular septal defect with severe aortic regurgitation: the "two-patch" technique. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2006:161-4. [PMID: 16638562 DOI: 10.1053/j.pcsu.2006.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Doubly committed subarterial ventricular septal defect complicated by severe aortic regurgitation caused by a prolapsed aortic cusp still represents a challenging surgical problem. We report on our "two-patch" technique, were the ventricular septal defect is closed through the aortic valve by a patch anchored to another patch through the prolapsed cusp. This second patch is pulled up with the prolapsed cusp and is then fixed to the aortic wall. Since May 1990, 15 patients with a mean age of 12 years underwent repair of this cardiac malformation with the "two-patch" technique. The aortic regurgitation was severe in all patients. All patients survived. In a mean follow-up of 10 years, two patients were successfully reoperated for progression of the aortic regurgitation. All the remaining patients were in NYHA functional class I. In conclusion, the "two-patch" technique is simple, easily reproducible, and can be a valid surgical option for this complex cardiac malformation.
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Affiliation(s)
- Alessandro Frigiola
- Pediatric Cardiac Surgery Department, Policlinico San Donato, San Donato, Milan, Italy
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Brizard C. Surgical repair of infundibular ventricular septal defect and aortic regurgitation. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2006:153-60. [PMID: 16638561 DOI: 10.1053/j.pcsu.2006.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Interpretation of the anatomy of the defect and the pathophysiology has guided the surgical technique and indications for infundibular ventricular septal defect VSD. Infundibular ventricular septal defects are located in the infundibular septum, between the two commissures of the right coronary cusp. The defect is associated with an anomaly of the right sinus of Valsalva where the transition to cusp tissue occurs higher than normally. There is development of fibrous adherences between the ventricular surface of the right coronary cusp and the crest of the septum. This reduces the height of the cusp and destabilizes the valve. The aim is to reposition the hinge point of the right coronary cusp to restore the normal height of the cusp, hence a normal surface of apposition. This is achieved with a trans-aortic approach. The major difference with other techniques described is the extensive mobilization of the cusp. The procedure is completed by a reduction of the free edge of the right coronary cusp if it is elongated. This technique is indicated in all patients with infundibular ventricular septal defect in whom an aortic regurgitation appears or increases during follow-up. Fifteen patients were operated on with this technique between 1996 and 2005. Thirteen have achieved good results at follow-up. There was one late death.
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Affiliation(s)
- Christian Brizard
- Cardiac Surgery Unit, Royal Children's Hospital, Melbourne, and Department of Pediatrics, The University of Melbourne, Australia.
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Jesús Maître Azcárate M. Comunicación interventricular con insuficiencia aórtica. Un problema no resuelto. Rev Esp Cardiol (Engl Ed) 2002. [DOI: 10.1016/s0300-8932(02)76727-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Schoof PH, Hazekamp MG, Huysmans HA. Pulmonary autograft in ventricular septal defect-aortic insufficiency complex. Ann Thorac Surg 1996; 61:1005-6. [PMID: 8619672 DOI: 10.1016/0003-4975(95)00955-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Pulmonary autograft aortic root replacement in a child with the ventricular septal defect-aortic insufficiency complex is described. It offers all the advantages of the autograft, avoids closure of the ventricular septal defect, and prevents the use of prosthetic material.
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Affiliation(s)
- P H Schoof
- Department of Cardiac Surgery, University Hospital Leiden, Netherlands
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