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Chin CY, Chen CA, Fu CM, Hsu JY, Lin HC, Chiu SN, Chang YM, Lu CW, Chou HW, Huang SC, Chen YS, Wu MH, Wang JK, Lin MT. Risk Factors of Long-Term Sequelae After Transcatheter Closure of Perimembranous Ventricular Septal Defect in Young Children. Circ J 2024; 88:663-671. [PMID: 38325819 DOI: 10.1253/circj.cj-23-0891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Complications arising from transcatheter closure of perimembranous ventricular septal defects (pmVSD) in children, such as residual shunts and aortic regurgitation (AR), have been observed. However, the associated risk factors remain unclear. This study identified risk factors linked with residual shunts and AR following transcatheter closure of pmVSD in children aged 2-12 years.Methods and Results: The medical records of 63 children with pmVSD and a pulmonary-to-systemic blood flow ratio <2.0 who underwent transcatheter closure between 2011 and 2018 were analyzed with a minimum 3-year follow-up. The success rate of transcatheter closure was 98.4%, with no emergency surgery, permanent high-degree atrioventricular block, or mortality. Defects ≥4.5 mm had significantly higher odds of persistent residual shunt (odds ratio [OR] 6.85; P=0.03). The use of an oversize device (≥1.5 mm) showed a trend towards reducing residual shunts (OR 0.23; P=0.06). Age <4 years (OR 27.38; 95% confidence interval [CI] 2.33-321.68) and perimembranous outlet-type VSD (OR 11.94, 95% CI 1.10-129.81) were independent risk factors for AR progression after closure. CONCLUSIONS Careful attention is crucial for pmVSDs ≥4.5 mm to prevent persistent residual shunts in transcatheter closure. Assessing AR risk, particularly in children aged <4 years, is essential while considering the benefits of pmVSD closure.
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Affiliation(s)
- Chia-Yi Chin
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine
- Department of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Chun-Min Fu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Jui-Yu Hsu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Hsin-Chia Lin
- Department of Pediatrics, National Taiwan University Hospital Yunlin Branch
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Ya-Mei Chang
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Heng-Wen Chou
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Shu-Chien Huang
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Yih-Sharng Chen
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
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Adilbekova A, Marassulov S, Baigenzhin A, Kozhakhmetov S, Nurkeyev B, Kerimkulov A, Murzabayeva S, Maiorov R, Kenzhebayeva A. Hybrid versus traditional method closure of ventricular septal defects in children. JTCVS Tech 2024; 24:137-144. [PMID: 38835571 PMCID: PMC11145337 DOI: 10.1016/j.xjtc.2024.01.015] [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: 11/12/2023] [Revised: 12/23/2023] [Accepted: 01/12/2024] [Indexed: 06/06/2024] Open
Abstract
Objective The aim of our study was to evaluate the safety and effectiveness of the hybrid method off-pump for closure of isolated ventricular septal defect (VSD) compared with the traditional method of on-pump of children. Methods This research was a retrospective cohort study. Data were collected from 500 patients with isolated VSD (or residual VSD after a previous repair) who underwent surgery at the National Scientific Medical Center from May 2016 to December 2020. Patients were operated with 1 of 2 methods of surgery: the traditional method of on-pump or the hybrid method of off-pump. This study assessed the safety and efficacy of the hybrid method by comparing it with the traditional method for the treatment of patients with isolated VSD. Results The procedural success rate reached 93.2% in the hybrid method, with a 6.4% conversion rate to the traditional method and 0.4% hospital mortality. The mean operation time was 84 minutes (31; 160 minutes) in the hybrid group (n = 250) and 168 minutes (70; 300 minutes) in the traditional group (n = 250) (P = .000). Hospital mortality was 0.43% in the first group and 1.5% in the second group (P = .000). Conclusions The hybrid method of VSD closure is safe and effective in a selected group of patients. The advantages of the hybrid method are improved cosmetics and shorter operation time and overall hospital stay.
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Affiliation(s)
- Akkerbez Adilbekova
- Department of Pediatric Cardiac Surgery, National Scientific Medical Center, Astana City, Republic of Kazakhstan
- Department of Surgical Diseases Named Tsoi, Аstana Medical University, Astana City, Republic of Kazakhstan
| | - Shukhrat Marassulov
- Department of Pediatric Cardiac Surgery, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Abay Baigenzhin
- Department of Pediatric Cardiac Surgery, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Saken Kozhakhmetov
- Department of Surgical Diseases Named Tsoi, Аstana Medical University, Astana City, Republic of Kazakhstan
| | - Bakhytzhan Nurkeyev
- Department of Pediatric Cardiac Surgery, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Amangeldy Kerimkulov
- Department of Pediatric Anesthesiology, Reanimation and Intensive Care, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Saniya Murzabayeva
- Department of Pediatric Anesthesiology, Reanimation and Intensive Care, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Rinat Maiorov
- Department of Pediatric Interventional Cardiology, Endovascular X-ray Surgery and Functional Diagnostics, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Arailym Kenzhebayeva
- Department of Pediatric Cardiac Surgery, National Scientific Medical Center, Astana City, Republic of Kazakhstan
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Leong MC, Hoo XY, Alwi M. Preliminary experience with transcatheter closure of wind-sock-like perimembranous ventricular septal defects using Amplatzer Vascular Plug IV devices. Cardiol Young 2024; 34:228-231. [PMID: 38073568 DOI: 10.1017/s1047951123004055] [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: 01/19/2024]
Abstract
Amplatzer Vascular Plug IV (Abbott, USA) is usually used for the occlusion of abnormal tortuous vessels and has not been tried for the transcatheter closure of perimembranous ventricular septal defects with wind-sock morphology. Here, we report on three successful cases of perimembranous ventricular septal defect transcatheter closure using Amplatzer Vascular Plug IV. We did not observe residual shunting or new onset of complications during follow up. These preliminary positive results advocate the application and suitability of Amplatzer Vascular Plug IV for closing wind-sock-like perimembranous ventricular septal defects.
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Affiliation(s)
- Ming Chern Leong
- Paediatric & Congenital Heart Centre, Institute Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia
| | - Xin Yi Hoo
- Paediatric & Congenital Heart Centre, Institute Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia
| | - Mazeni Alwi
- Paediatric & Congenital Heart Centre, Institute Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia
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Elmarsafawy H, Hafez M, Alsawah GA, Bakr A, Rakha S. Long-term outcomes of percutaneous closure of ventricular septal defects in children using different devices: A single centre experience from Egypt. BMC Pediatr 2023; 23:381. [PMID: 37525132 PMCID: PMC10392015 DOI: 10.1186/s12887-023-04194-9] [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] [Received: 03/06/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND The feasibility of percutaneous closure ventricular septal defects (VSD) in children has been previously proven. However, data on long-term outcomes are limited. We aim to evaluate the long-term outcome of our experience with percutaneous closure of VSD using various occluders. METHODS Retrospective institutional analysis of children who underwent transcatheter closure of perimembranous and muscular VSDs between September 2012 and February 2020. Patient demographics, procedural, and long-term follow-up data were comprehensively analyzed. Patients who lost to follow-up within two years post-procedure were excluded. RESULTS We identified 75 patients (54.7% males) with a median of 66 months (IQR, 46-96). The closure success rate at one year was 95.7%. Complete heart block was detected in two patients early post-procedure and resolved with steroids. The VSDs were perimembranous (52%), muscular (33.33%), and residual (14.67%). Implanted devices were Pfm Nit-Occlud LeˆVSD Coil (42.7%), HyperionTM VSD Muscular Occluder (28%), Amplatzer VSD muscular occluder (10.7%), Amplatzer Duct Occluder (14.7%), Occlutech Muscular VSD Occluder (2.7%), and Amplatzer Duct Occluder II (1.3%). No new arrhythmia or valve regurgitation was detected after two years post-procedure. Persisted complications on long-term follow-up included: residual shunting in 3(4%), mild tricuspid regurgitation in 2(2.7%), and aortic regurgitation in 2(2.7%), with one immediate post-catheterization mild aortic regurgitation worsened during follow-up, requiring surgical repair of VSD three years after device implantation. No deaths were reported. CONCLUSION Long-term outcomes of pediatric transcatheter VSD closure using different devices are satisfactory. Post-procedural adverse events are limited, but long-term surveillance is necessary to monitor their progression.
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Affiliation(s)
- Hala Elmarsafawy
- Pediatric Cardiology Unit, Pediatrics Department, Mansoura University Faculty of Medicine, El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
- Faculty of Medicine, New Mansoura University, New Mansoura City, Egypt
| | - Mona Hafez
- Pediatric Cardiology Unit, Pediatrics Department, Mansoura University Faculty of Medicine, El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
| | - Gehan A Alsawah
- Pediatric Cardiology Unit, Pediatrics Department, Mansoura University Faculty of Medicine, El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
| | - Asmaa Bakr
- Pediatric Cardiology Unit, Pediatrics Department, Mansoura University Faculty of Medicine, El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
| | - Shaimaa Rakha
- Pediatric Cardiology Unit, Pediatrics Department, Mansoura University Faculty of Medicine, El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt.
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Alshahrani D, Linnane N, McCrossan B, Oslizlok P, McMahon CJ, Walsh KP, Kenny DP. Transfemoral Perimembranous Ventricular Septal Defect Device Closure in Infants Weighing ≤ 10 kg. Pediatr Cardiol 2023; 44:1176-1182. [PMID: 36698044 PMCID: PMC10224829 DOI: 10.1007/s00246-023-03100-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Abstract
Transcatheter closure of Perimembranous VSDs (PMVSD) remains challenging particularly in infants. The aim of this study is to evaluate the efficacy and safety of transfemoral PMVSD device closure in infants weighing ≤ 10 kg in a single centre. Retrospective review of departmental databases and medical charts to define patient cohort and collect demographic, procedural and follow-up data. Between July 2014 and March 2021, 16 patients underwent attempted transfemoral PMVSD device closure (12 retrograde) at a median age of 11 months (interquartile range [IQR] 9-15.5) and a median weight of 8.3 kg (IQR 7.2-9.5). All patients were either symptomatic, had progressive left heart dilation or had VSD associated valve regurgitation. Median defect size on pre-procedural transoesophageal echocardiography was 6.8 mm (IQR 6-8.5). Median device waist size was 6 mm (IQR 4.5-8). Successful device placement was achieved in 14 patients (88%). One patient developed moderate aortic and tricuspid valve regurgitation upon retrograde and antegrade device deployment, respectively, and subsequently underwent surgical closure. The second patient developed progressive aortic regurgitation (AR) 2 days post procedure, and also underwent surgical removal with no residual AR. There was no cases of device embolization and no femoral arterial compromise. On median follow-up of 40.5 months (IQR 25-64), none of the patients developed complete heart block. Three patients (18.75%) had small residual shunts at latest follow-up which have not required any further intervention. Device closure of PMVSD's in children weighing ≤ 10 kg is feasible and safe with good procedural success rates. Use of both the antegrade and retrograde approaches may be necessary depending on anatomical variances.
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Affiliation(s)
- Dhafer Alshahrani
- Department of Pediatric Cardiology, Children's Health Ireland at Crumlin, Dublin 12, Republic of Ireland
- Section of Pediatric Cardiology, Department of Cardiac Sciences, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Niall Linnane
- Department of Pediatric Cardiology, Children's Health Ireland at Crumlin, Dublin 12, Republic of Ireland
| | - Brian McCrossan
- Department of Pediatric Cardiology, Children's Health Ireland at Crumlin, Dublin 12, Republic of Ireland
- Department of Pediatric Cardiology, Royal Belfast Hospital of Sick Children, Belfast, UK
| | - Paul Oslizlok
- Department of Pediatric Cardiology, Children's Health Ireland at Crumlin, Dublin 12, Republic of Ireland
| | - Colin J McMahon
- Department of Pediatric Cardiology, Children's Health Ireland at Crumlin, Dublin 12, Republic of Ireland
| | - Kevin P Walsh
- Department of Pediatric Cardiology, Children's Health Ireland at Crumlin, Dublin 12, Republic of Ireland
| | - Damien P Kenny
- Department of Pediatric Cardiology, Children's Health Ireland at Crumlin, Dublin 12, Republic of Ireland.
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Wang S, Li Z, Wang Y, Zhao T, Mo X, Fan T, Li J, You T, Deng R, Ouyang W, Wang W, Zhang C, Butera G, Hijazi ZM, Pang K, Zhu D, Jiang S, Zhang G, Hu X, Xie Y, Zhang F, Fang F, Sun J, Li P, Chen J, Luo Z, Pan X. Transcatheter closure of perimembranous ventricular septal defect using a novel fully bioabsorbable occluder: multicenter randomized controlled trial. Sci Bull (Beijing) 2023; 68:1051-1059. [PMID: 37179234 DOI: 10.1016/j.scib.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/21/2023] [Accepted: 04/14/2023] [Indexed: 05/15/2023]
Abstract
Although the use of bioabsorbable occluder is expected to reduce the risk of metal occluder-related complications, it has not been approved due to incomplete degradation and new complications. Novel fully bioabsorbable occluders were designed to overcome such limitations. The aim of this study was to investigate the efficacy and safety of a fully biodegradable occluder in patients with ventricular septal defects. 125 patients with perimembranous ventricular septal defect (VSD) larger than 3 mm were screened from April 2019 to January 2020 in seven centers. 108 patients were enrolled and randomized into the bioabsorbable occluder group (n = 54 patients) and nitinol occluder group (n = 54). A non-inferiority design was utilized and all patients underwent transcatheter device occlusion. Outcomes were analyzed with a 24-month follow-up. All patients were successfully implanted and completed the trial. No residual shunt >2 mm was observed during follow-up. Transthoracic echocardiography showed a hyperechoic area corresponding to the bioabsorbable occluder which decreased primarily during the first year after implantation and disappeared within 24 months. Postprocedural arrhythmia was the only occluder-related complication with an incidence of 5.56% and 14.81% for the bioabsorbable and nitinol groups, respectively (P = 0.112). The incidence of sustained conduction block was lower in the bioabsorbable occluder group (0/54 vs. 6/54, P = 0.036) at 24-month follow-up. In conclusion, the novel fully bioabsorbable occluder can be successfully and safely implanted under echocardiography guidance and reduce the incidence of sustained postprocedural arrythmia. The efficacy and safety of this fully biodegradable occluder are non-inferior to that of a traditional nitinol one.
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Affiliation(s)
- Shouzheng Wang
- Department of Structural Heart Disease, Fuwai Hospital & National Center for Cardiovascular Disease, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences & Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, National Clinical Research Center for Cardiovascular Diseases, Beijing 100037, China
| | - Zefu Li
- Department of Structural Heart Disease, Fuwai Hospital & National Center for Cardiovascular Disease, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences & Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, National Clinical Research Center for Cardiovascular Diseases, Beijing 100037, China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Tianli Zhao
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Xuming Mo
- Department of Cardiovascular Surgery, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Taibing Fan
- Department of Cardiovascular Surgery, Fuwai Central China Cardiovascular Hospital, Zhengzhou 451464, China
| | - Jianhua Li
- Department of Cardiovascular Surgery, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Tao You
- Department of Cardiovascular Surgery, Gansu Province Hospital, Lanzhou 730000, China
| | - Rundi Deng
- Department of Structural Heart Disease, Fuwai Hospital & National Center for Cardiovascular Disease, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences & Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, National Clinical Research Center for Cardiovascular Diseases, Beijing 100037, China
| | - Wenbin Ouyang
- Department of Structural Heart Disease, Fuwai Hospital & National Center for Cardiovascular Disease, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences & Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, National Clinical Research Center for Cardiovascular Diseases, Beijing 100037, China
| | - Weiwei Wang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin 300192, China
| | - Chuangnian Zhang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin 300192, China
| | - Gianfranco Butera
- Department of Pediatric and Adult Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Ziyad M Hijazi
- Department of Pediatrics, Sidra Heart Center, Sidra Medical & Research Center, Doha 999043, Qatar
| | - Kunjing Pang
- Department of Echocardiography, Fuwai Hospital & National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, National Clinical Research Center for Cardiovascular Diseases, Beijing 100037, China
| | - Da Zhu
- Department of Structural Heart Disease, Fuwai Yunnan Cardiovascular Hospital, Kunming 650102, China
| | - Shiliang Jiang
- Department of Structural Heart Disease, Fuwai Hospital & National Center for Cardiovascular Disease, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences & Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, National Clinical Research Center for Cardiovascular Diseases, Beijing 100037, China
| | - Gejun Zhang
- Department of Structural Heart Disease, Fuwai Hospital & National Center for Cardiovascular Disease, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences & Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, National Clinical Research Center for Cardiovascular Diseases, Beijing 100037, China
| | - Xiaopeng Hu
- Department of Structural Heart Disease, Fuwai Hospital & National Center for Cardiovascular Disease, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences & Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, National Clinical Research Center for Cardiovascular Diseases, Beijing 100037, China
| | - Yongquan Xie
- Department of Structural Heart Disease, Fuwai Hospital & National Center for Cardiovascular Disease, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences & Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, National Clinical Research Center for Cardiovascular Diseases, Beijing 100037, China
| | - Fengwen Zhang
- Department of Structural Heart Disease, Fuwai Hospital & National Center for Cardiovascular Disease, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences & Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, National Clinical Research Center for Cardiovascular Diseases, Beijing 100037, China
| | - Fang Fang
- Department of Structural Heart Disease, Fuwai Hospital & National Center for Cardiovascular Disease, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences & Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, National Clinical Research Center for Cardiovascular Diseases, Beijing 100037, China
| | - Jingping Sun
- Cardiology Department, The Clinic Cleveland Foundation, Cleveland 44195, USA
| | - Ping Li
- Cardiology Department, Fuwai Hospital & National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, National Clinical Research Center for Cardiovascular Diseases, Beijing 100037, China
| | - Juan Chen
- Department of Cardiovascular Surgery, Hefei High-Tech Cardiovascular Hospital, Hefei 230088, China
| | - Zhiling Luo
- Department of Echocardiography, Fuwai Yunnan Cardiovascular Hospital, Kunming 650102, China.
| | - Xiangbin Pan
- Department of Structural Heart Disease, Fuwai Hospital & National Center for Cardiovascular Disease, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences & Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, National Clinical Research Center for Cardiovascular Diseases, Beijing 100037, China.
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Lozier JS, Sati M, Cheifetz IM, Bocks ML. Update on percutaneous and perventricular device closure of congenital ventricular septal defect. Expert Rev Cardiovasc Ther 2023; 21:337-345. [PMID: 37096558 DOI: 10.1080/14779072.2023.2206566] [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: 04/26/2023]
Abstract
INTRODUCTION Ventricular septal defect is the most common congenital heart defect. Surgical repair has been standard therapy for symptomatic ventricular septal defects since the 1950's. Catheter-based device closure of ventricular septal defects emerged in the 1980's and has become a safe and effective alternative in select patients. AREAS COVERED This review focuses on patient selection and procedural techniques for device closure of ventricular septal defects, including percutaneous and hybrid perventricular approaches. The available devices used for these procedures, and outcomes of their use, are reviewed. EXPERT OPINION Percutaneous and perventricular device closure of ventricular septal defects is safe and effective in select patients. However, the majority of ventricular septal defects requiring closure continue to be managed with conventional surgery. Further development and investigation of transcatheter and hybrid surgical approaches for closing ventricular septal defects is required.
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Affiliation(s)
- John S Lozier
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Maram Sati
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ira M Cheifetz
- Divisions of Pediatric Cardiac Critical Care and Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Martin L Bocks
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
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8
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Haddad RN, Boudjemline Y, Combes N, Hadeed K, Karsenty C, Saliba Z. Three centers experience with device closure of congenital Gerbode-type perimembranous ventricular septal defects. J Card Surg 2022; 37:2714-2724. [PMID: 35771212 DOI: 10.1111/jocs.16713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/21/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES We aim to evaluate our experience with interventional closure of Gerbode-type perimembranous ventricular septal defects (pmVSDs). METHODS We performed three-center retrospective data review of patients with congenital indirect Gerbode-type pmVSDs treated percutaneously between August 2017 and May 2021. Standard safety and latest follow-up outcomes were assessed. RESULTS Ten patients (six females) were identified with a median age of 6.8 years (range: 2.5-54) and a median weight of 26.5 kg (range: 12-88). The median left ventricular defect size was 10 mm (range: 3-15.5). On baseline ultrasound, 6 patients had absent subaortic rim , 6 patients had trivial aortic regurgitation, and 3 patients had tear-drop-type (small) aortic cusp prolapse. The tricuspid regurgitation was graded II (n = 5) and III (n = 5). Five Lifetech Konar-Multifunctional occluders, four Amplatzer duct occluders II and one Amplatzer duct occluder I were implanted. The median fluoroscopy time was 10.4 min (range: 4.3-20.2). Pre-existing aortic regurgitations remained identical. One new aortic regurgitation was identified before discharge and remained trivial after 48 months of follow-up. No heart block or tricuspid stenosis was observed on a median follow-up of 17 months (range: 3-48). All patients are symptom-free with complete shunt closure and significant regression or resolution of tricuspid regurgitation. CONCLUSIONS Despite anatomical challenges, interventional closure of congenital indirect Gerbode-type pmVSD appears to be feasible, safe, and most importantly clinically effective using different commercially available devices. Amplatzer duct occluder II and Lifetech Konar-Multifunctional occluder offer interesting specifications to retrogradely target this specific defect with success.
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Affiliation(s)
- Raymond N Haddad
- Department of Pediatric Cardiology, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon
| | | | - Nicolas Combes
- Pediatric and Adult Congenital Heart Disease Department, Clinique Pasteur, Toulouse, France
| | - Khaled Hadeed
- Pediatric Cardiology Unit, Department of Pediatrics, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - Clement Karsenty
- Pediatric Cardiology Unit, Department of Pediatrics, Children's Hospital, Toulouse University Hospital, Toulouse, France.,Institut Des Maladies Métaboliques Et Cardiovasculaires, Université de Toulouse, Toulouse, France
| | - Zakhia Saliba
- Department of Pediatric Cardiology, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon
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Transcatheter Closure of Perimembranous Ventricular Septal Defect Using the Lifetech Konar-Multi Functional Occluder: Early to Midterm Results of the Indonesian Multicenter Study. Glob Heart 2022; 17:15. [PMID: 35342698 PMCID: PMC8877696 DOI: 10.5334/gh.1106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background: The alternative device to close perimembranous ventricular septal defect (pmVSD) has been searched for better result, less complications and applicable for infants. However, the ideal device is still unavailable. We aimed to evaluate the effectiveness and outcome of transcatheter pmVSD closure using the KONAR-multi functional occluder (MFO). Methods: Clinical, procedural, follow-up data of pmVSD patients with symptom of heart failure or evidence of significant left to right shunt, growth failure, recurrent respiratory tract infection, and history of endocarditis who underwent transcatheter closure using the MFO were prospectively evaluated. Results: Between January 2016 and December 2017, there were complete records of 132 pmVSD children closed using MFO from eleven centers in Indonesia. The median of age was 4.5 (0.3–17.4) years; weight 14.8 (3.5–57) kg, defect size at the smallest part 3.4 (1.0–8.1) mm, flow ratio 1.6 (1.3–4.9), mean pulmonary artery pressure 18 (7–79) mmHg, fluoroscopy time 18 (3.8–91) and procedural time 75 (26–290) minutes. A retrograde approach was done in 41 (31%) patients. Procedures succeeded in first attempt in 126 (95.4%), failed in three and migration in three patients. Six of eight infants with congestive heart failure were closed successfully. Of 126 patients with successful VSD closure, 12 months follow-up were completed in all patients. The rate of complete occlusion at 1 month, 3 months, 6 months and 12 months after intervention were 95.2%, 97.6%, 99.2%, and 99.2%, respectively. New-onset aortic regurgitation and moderate tricuspid regurgitation developed only in five and three patients. Neither complete atrioventricular block, nor other complications occurred. Conclusion: Transcatheter closure of pmVSD using the MFO is safe, effective, and feasible in infants and children.
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Lei YQ, Lin WH, Lin SH, Xie WP, Liu JF, Chen Q, Cao H. Influence of percutaneous catheter intervention for congenital perimembranous ventricular septal defects in children on the cardiac conduction system and associated risk factors: a meta-analysis. J Cardiothorac Surg 2022; 17:19. [PMID: 35172864 PMCID: PMC8851805 DOI: 10.1186/s13019-022-01751-8] [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: 01/08/2021] [Accepted: 12/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to investigate adverse outcomes and risk factors for the cardiac conduction system in children with perimembranous ventricular septal defects (pmVSDs) who had been treated by catheter intervention. Method PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for studies in English on interventional treatment of pmVSDs in pediatric patients published up to the end of October 15, 2020. We used random- or fixed-effect models to obtain pooled estimates of the success rate and postoperative complications. Results A total of 1650 pediatric patients from 8 publications were included, with a mean age ranging from 3.44 to 8.67 years old. The pooled estimate of successful implantation was 98.2% (95% CI 97.1–99.4%, I2 = 69.4%; P < 0.001), and the incidence of cardiac conduction system complications was 17.4% (95% CI 8.4–26.4%, I2 = 96.1%; P < 0.001), among which the incidence of heart block was 14.8% (95% CI 6.4–23.3%, I2 = 96.9%; P = 0.001). The incidence of impulse formation disorders was 4.1% (95% CI 0.7–7.6%, I2 = 91.7%; P = 0.019), and the incidence of complete atrioventricular block was 0.8% (95% CI 0.3–13%, I2 = 0.0%; P = 0.001). Risk factors for newly emerging arrhythmias included the VSD size MD = 0.89 (95% CI 0.46–1.32, I2 = 0%; P < 0.0001) and device size MD = 1.26 (95% CI 0.78–1.73, I2 = 0%; P < 0.00001). Conclusions Percutaneous catheter intervention is safe and effective in treating pediatric patients with pmVSD, and the risk factors leading to arrhythmias include the sizes of the pmVSD and device.
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Affiliation(s)
- Yu-Qing Lei
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Wen-Hao Lin
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Shi-Hao Lin
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Wen-Peng Xie
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Jian-Feng Liu
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China. .,Fujian Children's Hospital, Fuzhou, China. .,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China. .,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.
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Lin L, Liu J, Guo X, Chen H, Huang Y, Zheng H, Chen W, Chen L, Chen L, Chen Z. Risk factors for atrioventricular block after occlusion for perimembranous ventricular septal defect. Heart Rhythm 2021; 19:389-396. [PMID: 34843969 DOI: 10.1016/j.hrthm.2021.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The risk factors for complete atrioventricular block (CAVB) after device closure of perimembranous ventricular septal defect (pmVSD) remain unclear. OBJECTIVE The purpose of this study was to analyze the incidence and risk factors for CAVB after device closure for pmVSD. METHODS We reviewed 1884 patients with pmVSD who had undergone successful device occlusion between June 2005 and January 2020. Permanent CAVB was defined as CAVB requiring implantation of a permanent pacemaker (PPM) or extraction of the occluder. RESULTS In total, 14 patients (0.7%) developed permanent CAVB. Of these patients, 10 (0.5%) required PPM implantation. Four permanent CAVB occurred within 7 days after the procedure (acute), 2 between 7 and 30 days (subacute), 3 between 30 days and 1 year (late), and 5 more than 1 year (very late). None of the subacute, late, and very late CAVB recovered normal conduction with medication and eventually required device removal or PPM implantation. Four patients with acute CAVB and 1 with subacute CAVB underwent device removal, and 4 (80%) recovered normal conduction. Multivariate regression revealed that the ratio of device to defect size was the only independent risk factor for permanent CAVB (odds ratio 3.027; 95% confidence interval 1.476-6.209; P = .003). CONCLUSION The incidences of permanent CAVB after occlusion for pmVSD and PPM implantation were 0.7% and 0.5%, respectively. The ratio of device to defect size was the only independent risk factor for permanent CAVB. Device removal is an effective therapeutic modality for recovering normal conduction in acute and subacute CAVB patients.
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Affiliation(s)
- Li Lin
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Jianwen Liu
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Xiufen Guo
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Hang Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Yu Huang
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Huiying Zheng
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Wanhua Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Lianglong Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Liangwan Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Zhaoyang Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China.
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Tan H, Huang E, Deng X, Li D, Ouyang S. Effects of minimally invasive and traditional surgeries on the quality of life of children with congenital heart disease: a retrospective propensity score-matched study. BMC Pediatr 2021; 21:522. [PMID: 34819045 PMCID: PMC8611858 DOI: 10.1186/s12887-021-02978-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The focus of clinical care after treating congenital heart disease (CHD) has shifted from saving patients' lives to improving their quality of life. This study aimed to examine the influence of minimally invasive and traditional surgeries on the quality of life of children with CHD. METHODS This was a retrospective cross-sectional study. A total of 459 children aged 2-18 years with CHD treated at Second Xiangya Hospital of Central South University from July 2016 to June 2017 were enrolled, among whom 219 underwent minimally invasive surgery and 240 traditional surgery. The quality of life of children with CHD after surgery was reported by the patients' parents. We applied propensity score matching to correct for confounding factors and conducted multiple linear regression analysis to examine the related effects of minimally invasive and traditional surgeries on the quality of life of children with CHD. RESULTS The scores of problems related to perceived physical appearance in children undergoing minimally invasive surgery was higher than those in those undergoing traditional surgery (p = 0.004). Different treatment modes were independent influencing factors for problems related to perceived physical appearance in children with CHD. There was no significant difference in average treatment effect scores of children undergoing different surgical procedures in other quality of life dimensions (problems related to cardiac symptoms and their treatment, drug treatment, anxiety regarding treatment, cognitive psychology, and communication), suggesting that different operation modes were not independent influencing factors for these related problems. CONCLUSION Compared with traditional surgery, minimally invasive surgery can significantly improve the physical appearance perception scores of children with CHD after surgery. Therefore, minimally invasive surgery can improve the quality of life of children with CHD.
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Affiliation(s)
- Hui Tan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Cardiovascular Surgery and Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital Central South University, 139 Middle Renmin Road, Changsha, 410011, China
| | - Erjia Huang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Cardiovascular Surgery and Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital Central South University, 139 Middle Renmin Road, Changsha, 410011, China
| | - Xicheng Deng
- Heart Center, Hunan Children's Hospital, Changsha, 410007, China
| | - Dongping Li
- Department of Cardiovascular Surgery and Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital Central South University, 139 Middle Renmin Road, Changsha, 410011, China
| | - Shayuan Ouyang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China. .,Department of Cardiovascular Surgery and Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital Central South University, 139 Middle Renmin Road, Changsha, 410011, China.
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13
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Aal AA, Hassan HM, Ezzeldin D, El Sayed M. Impact of percutaneous ventricular septal defect closure on left ventricular remodeling and function. Egypt Heart J 2021; 73:86. [PMID: 34637037 PMCID: PMC8511205 DOI: 10.1186/s43044-021-00215-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Ventricular septal defect (VSD) is the most common congenital heart disease. In patients with large VSD, left side chambers are subjected to volume overload with subsequent chambers dilatation and eccentric left ventricular hypertrophy. Percutaneous closure of VSD has been shown to be an effective method with equal safety and efficacy when compared to surgery. The effect of VSD closure on LV remodeling has been mainly assessed in patients treated with surgery and to date published data remain scarce. Therefore, we aim to evaluate the effect of percutaneous VSD closure on different LV parameters. Results Seventeen patients (median age 6 years (IQR 4.75–8 years), 70.6% females) who underwent percutaneous VSD closure were enrolled in the study. Sixteen patients (94%) had perimembranous VSD, and one patient had muscular VSD. The procedure was successful in all patients with no major complications. Nit Occlud® Lê coil device was implanted in 16 patients (94%), and one patient received Amplatzer PDA duct occlude device. At 6-months follow-up, there was a significant reduction in indexed LV dimensions [LVEDD/BSA (median 46.5 mm/m2 vs. 42.9 mm/m2, p = 0.03), LVESD/BSA (median 31.7 mm/m2 vs. 26.7 mm/m2, p = 0.02)], indexed LV volumes [LVEDV/BSA (median 52.6 ml/m2 vs. 37.3 ml/m2, p = 0.02), LVESV/BSA (median 31.7 ml/m2 vs. 23.3 ml/m2, p = 0.02)] and indexed LV mass (median 62.4 gm/m2 vs. 57.9 ml/m2, p = 0.01). There was a significant reduction in LVEDD Z-score (p = 0.01) and LVESD Z-score (p = 0.04). There was no significant change in LV EF. Conclusions Percutaneous VSD closure is associated with improvement of various LV parameters with consequential favorable LV remodeling and function.
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Affiliation(s)
- Amr Abdel Aal
- Cardiology Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
| | - Housam M Hassan
- Cardiology Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Dina Ezzeldin
- Cardiology Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Maiy El Sayed
- Cardiology Department, Faculty of Medicine, Helwan University, Cairo, Egypt
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Transcatheter Closure of Perimembranous and Intracristal Ventricular Septal Defects Using Amplatzer Duct Occluder II in Children. J Interv Cardiol 2021; 2021:4091888. [PMID: 34621141 PMCID: PMC8452420 DOI: 10.1155/2021/4091888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/01/2021] [Accepted: 08/24/2021] [Indexed: 12/29/2022] Open
Abstract
Background Transcatheter closure of aneurysmal perimembranous ventricular septal defect (pmVSD), pmVSD near the aortic valve, and intracristal VSD (icVSD) with symmetrical or asymmetrical ventricular septal defect occluders still presents significant challenges. We report our experience with transcatheter closure of pmVSD and icVSD using Amplatzer duct occluder II (ADO II) in children. Method We retrospectively analyzed all children, who presented to our hospital consecutively between March 2014 and June 2020 for attempted transcatheter closure of pmVSD or icVSD with the ADO II device. Standard safety and last-follow-up outcomes were assessed and compared. Results In total, 41 patients underwent transcatheter closure of VSD with the ADO II (28 in pmVSD and 13 in icVSD groups) with a median age of 3.5 years (total range: 0.9 to 12 years) and median weight of 15.0 kg (total range: 10.0 to 43.0 kg). Implantation was successful in 40/41 patients (97.5%, 27/28 in pmVSD group, 13/13 in icVSD group). One patient with mild aortic valve prolapse in pmVSD group developed new-onset moderate aortic regurgitation after a 4/4 mm ADO II was deployed; however, this resolved after the device was retrieved and successfully replaced with a 5 mm zero eccentric VSD occluder. There was no procedure-related mortality. After a median follow-up of six months (total range: 6 to 72 months), complete closure rates were 85.1% and 76.9% among pmVSD and icVSD groups, respectively. In the pmVSD group, one case of new-onset moderate tricuspid regurgitation was observed at six months, and there was one case of severe tricuspid regurgitation that had progressed from mild tricuspid regurgitation at 12 months. No serious complications were noted in the icVSD group. Conclusion ADO II provides a safe and reproducible alternative for the closure of perimembranous and intracristal ventricular septal defects with a diameter less than 5 mm in young children.
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15
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O'Byrne ML, Glatz AC. Managing confounding and effect modification in pediatric/congenital interventional cardiology research. Catheter Cardiovasc Interv 2021; 98:1159-1166. [PMID: 34420250 DOI: 10.1002/ccd.29925] [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] [Received: 05/20/2021] [Revised: 07/27/2021] [Accepted: 08/01/2021] [Indexed: 11/08/2022]
Abstract
Measuring the effect of a treatment on outcomes is an important goal for research in pediatric/congenital interventional cardiology. The breadth of anatomic and physiologic variations, patient ages, and genetic syndromes and noncardiac comorbid conditions all represent sources of potential confounding and effect modification that are major obstacles to this goal. If not accounted for, these factors can obscure the "true" treatment effect and lead to spurious conclusions about the relative efficacy and/or safety of therapies. In this review, we discuss the importance of confounding and effect modification in pediatric/congenital interventional cardiology research. We define these terms and discuss strategies (both in study design and data analysis) to mitigate error introduced by confounding and effect modification. The importance of confounding by indication in pediatric/congenital cardiology is discussed along with specific methods to address it.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute and Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew C Glatz
- Division of Cardiology and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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Xie WP, Liu JF, Lei YQ, Cao H, Chen Q. Effects of WeChat follow-up management of infants who underwent ventricular septal defect repair on parents' disease knowledge and quality of life: A prospective randomized controlled study. J Card Surg 2021; 36:3690-3697. [PMID: 34318543 DOI: 10.1111/jocs.15848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effect of WeChat follow-up management of infants who underwent ventricular septal defect (VSD) repair on parents' disease knowledge and quality of life. METHODS Participants were randomly assigned to an intervention group (n = 40) or a control group (n = 40). The intervention group was followed up with WeChat, while the control group was followed up using a traditional method. The disease knowledge, mental state, and quality of life of the two groups of parents were analyzed and compared. RESULTS During the 3-month follow-up period, the PedSQL (PedsQL family impact module) results showed that the overall score in the intervention group was significantly higher than that in the control group. The parents in the intervention group were better at managing "emotion control," "worry," and "family communication" than those in the control group. The results of the LKQCHD (Leuven congenital heart disease knowledge questionnaire) showed that the parents in the intervention group had a higher mastery of "basic knowledge and treatment of congenital heart disease," "related complications," and "postoperative rehabilitation" than those in the control group. CONCLUSION Knowledge education and psychological counseling for parents of children who underwent VSD repair through WeChat follow-up management can effectively improve parents' knowledge, relieve their anxiety and sadness, and improve their quality of life.
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Affiliation(s)
- Wen-Peng Xie
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Jian-Feng Liu
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Yu-Qing Lei
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
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Metabolomic analysis to discriminate drug-induced liver injury (DILI) phenotypes. Arch Toxicol 2021; 95:3049-3062. [PMID: 34274980 PMCID: PMC8380240 DOI: 10.1007/s00204-021-03114-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/29/2021] [Indexed: 12/19/2022]
Abstract
Drug-induced liver injury (DILI) is an adverse toxic hepatic clinical reaction associated to the administration of a drug that can occur both at early clinical stages of drug development, as well after normal clinical usage of approved drugs. Because of its unpredictability and clinical relevance, it is of medical concern. Three DILI phenotypes (hepatocellular, cholestatic, and mixed) are currently recognized, based on serum alanine aminotransferase (ALT) and alkaline phosphatase (ALP) values. However, this classification lacks accuracy to distinguish among the many intermediate mixed types, or even to estimate the magnitude and progression of the injury. It was found desirable to have additional elements for better evaluation criteria of DILI. With this aim, we have examined the serum metabolomic changes occurring in 79 DILI patients recruited and monitored using established clinical criteria, along the course of the disease and until recovery. Results revealed that free and conjugated bile acids, and glycerophospholipids were among the most relevant metabolite classes for DILI phenotype characterization. Using an ensemble of PLS-DA models, metabolomic information was integrated into a ternary diagram to display the disease phenotype, the severity of the liver damage, and its progression. The modeling implemented and the use of such compiled information in an easily understandable and visual manner facilitates a straightforward DILI phenotyping and allow to monitor its progression and recovery prediction, usefully complementing the concise information drawn out by the ALT and ALP classification.
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Solana-Gracia R, Mendoza Soto A, Carrasco Moreno JI, del Cerro Marín MJ, Gutiérrez-Larraya Aguado F, Coserría Sánchez JF, Blanco Mata R, Prada Martínez FH, Pan Álvarez-Ossorio M, Jiménez Montañés L, Pérez de Prado A, Rodríguez Vázquez del Rey MDM, Gutiérrez García H, Velasco Bayón JM, Zunzunegui Martínez JL. Registro español de cierre percutáneo de comunicación interventricular con dispositivo NitOcclud Lê VSD-Coil. Experiencia tras más de 100 implantes. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Jiang D, Han B, Zhao L, Yi Y, Zhang J, Fan Y, Lv J, Wang J, Wang Y. Transcatheter Device Closure of Perimembranous and Intracristal Ventricular Septal Defects in Children: Medium- and Long-Term Results. J Am Heart Assoc 2021; 10:e020417. [PMID: 33998288 PMCID: PMC8483536 DOI: 10.1161/jaha.120.020417] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background In children, the practice of transcatheter closure of intracristal ventricular septal defect (icVSD) has been limited. Currently, there is a lack of comparison between device closure of perimembranous ventricular septal defect (pmVSD) and icVSD, and long‐term clinical outcomes are rare. Methods and Results This study included a total of 633 children (39 with icVSD and 594 with pmVSD), aged 18 months to 16 years, who underwent transcatheter closure of ventricular septal defect between January 2014 and December 2018. All patients were followed up until September 2020, with a median follow‐up of 46 months in the pmVSD group and 52 months in the icVSD group. The procedural success rate was 96.3% and 84.6% in pmVSD and icVSD groups, respectively (P=0.002). The median of age, weight, procedure time, fluoroscopic time, and radiation dose were greater in the icVSD group compared with the pmVSD group. More eccentric ventricular septal defect occluders were used in the icVSD group. Most adverse events were minor without any intervention, with cardiac rhythm/conduction abnormalities being the most common. In the pmVSD group, 2 patients experienced complete atrioventricular block, with one implanting a permanent pacemaker and the other dying of cardiac arrest secondary to reversible complete atrioventricular block 40 days postprocedure. Complete left bundle‐branch block occurred in 14 patients, and 12 cases were transient. In the icVSD group, no complete atrioventricular block or death occurred, and one patient developed transient complete left bundle‐branch block. Conclusions In selected patients, transcatheter device closure of pmVSD and icVSD can be performed safely and successfully, with excellent medium‐ and long‐term results in children.
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Affiliation(s)
- Diandong Jiang
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Bo Han
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Lijian Zhao
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Yingchun Yi
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Jianjun Zhang
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Youfei Fan
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Jianli Lv
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Jing Wang
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Yan Wang
- Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
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20
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Abstract
BACKGROUND Medical advancements have encouraged minimally invasive surgical repair of congenital heart defects such as ventricular septal defects (VSDs), and the diagnostic process can now be carried out using non-traditional techniques such as pulse oximetry. This, in turn, has improved clinical outcomes with reduced complication rates post-surgery. However, the variations in type of VSDs, age of patient, comorbidities, and access to closure devices may limit the efficacy of surgical advancements. METHODS Articles were identified amongst Scopus, MEDLINE, and PubMed using various relevant search strings using PRISMA guidelines. Of the 115 articles initially extracted, 10 were eventually reviewed after duplicates and irrelevant studies were removed. RESULTS Of the 24 eligible articles, 10 papers were selected for analysis. Minimally invasive approaches to VSD repair was associated with satisfactory short-term outcomes when compared to open repair. For diagnosis of congenital VSD, whilst recent advances such as pulse oximetry method and genome analysis are more sensitive, the limited availability and access to such investigatory methods must be recognised. CONCLUSION Pulse oximetry and fetal echocardiography are established non-invasive diagnostic tools for VSD. The recent advances in minimally invasive treatment options including periventricular approach and transcatheter techniques have improved patient outcomes, yet at the expense of higher residual rates. Careful patient selection for each technique and follow-up should be planned through multidisciplinary team meetings.
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21
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Sarkislali K, Kalangos A. Late Tricuspid Regurgitation after Percutaneous Transcatheter Closure of Ventricular Septal Defect: an Educational Presentation. Braz J Cardiovasc Surg 2021; 36:253-256. [PMID: 33577256 PMCID: PMC8163272 DOI: 10.21470/1678-9741-2020-0172] [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] [Indexed: 11/04/2022] Open
Abstract
Transcatheter closure of ventricular septal defects (VSD) is not out of complications. Late complications are rare, but important, and sometimes require surgical correction. Herein, we report a case of tricuspid regurgitation as a complication of transcatheter VSD closure. The patient underwent successful surgery. Postoperative course was satisfactory. Echocardiographic examination revealed well-functioning tricuspid valve. We present this case since valve regurgitation after transcatheter procedure requiring surgery is an uncommon but significant complication due to heart failure risk. Even in the absence of any clinical finding, post-procedural close follow-up is important for early diagnosis of the problem to prevent the aforementioned risk.
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Affiliation(s)
- Kamil Sarkislali
- Department of Cardiac and Vascular Surgery, Istanbul Education Research Hospital, Istanbul, Turkey
| | - Afksendyios Kalangos
- Department of Cardiac and Vascular Surgery, Koc University Medical Faculty, Istanbul, Turkey
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22
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Singhi AK, Sivakumar K. Echocardiographic Classification of Perimembranous Ventricular Septal Defect Guides Selection of the Occluder Design for Their Transcatheter Device Closure. J Cardiovasc Imaging 2021; 29:316-326. [PMID: 34080335 PMCID: PMC8592680 DOI: 10.4250/jcvi.2020.0218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/31/2021] [Accepted: 02/14/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Perimembranous ventricular septal defects (VSDs) has proximate relation to the aortic and tricuspid valves as well as the conduction tissues. Transcatheter closure utilizes various off-label device designs. METHODS Perimembranous VSD without aortic margin were classified as group A, with thick aortic margin as group B, with membranous septal aneurysm as group C and defects restricted by tricuspid valve attachments as group D. The proposed ideal design was asymmetric device in group A; duct occluder I (ADOI) and muscular ventricular septal occluder (MVSO) in group B; thin profile duct occluder II (ADOII) in group C and ADOI in group D. Device was 0-2 mm larger than the defect. RESULTS Eighty patients with VSD measuring 6.83 ± 2.87mm underwent successful closure. Device was retrieved before release in one group A and one group C patient due to aortic regurgitation. Asymmetric device was used in 16 group A defects. Among group B defects, ADOI was used in 5, ADOII in 5, MVSO in one and asymmetric device in 3. Group C defects were closed with ADOI in 7, ADOII in 10 and asymmetric device in 3. Three patients with multiple exits had 2 ADOII devices. Group D defects were closed using ADOI in 20 and ADOII in 10 patients. There was no late aortic regurgitation or heart block on a follow-up exceeding 7 years. CONCLUSIONS This echocardiographic classification helps device selection in every single patient. While asymmetric device is uniquely suited for group A defects, different designs are appropriate in the other groups.
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Affiliation(s)
- Anil Kumar Singhi
- Department of Pediatric Cardiology, Medica Super Specialty Hospital, Kolkata, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India.
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23
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Procedural and short-term outcomes of transcatheter closure of ventricular septal defect using lifetech multifunctional occluder: initial experience. Cardiol Young 2021; 31:435-445. [PMID: 33292894 DOI: 10.1017/s1047951120004229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The Lifetech Multifunctional occluder is a versatile device with an improved delivery and flexibility that reduces the risk of atrioventricular block. This is a retrospective, descriptive, pilot study done in 25 patients who underwent transcatheter closure of ventricular septal defect using Lifetech Multifunctional occluder from February 2017 to January 2018.The average age was 9.32 ± 7.20 years, with a range from 1 to 32 years. Procedural success was 100% with no case needing a change of device size. Closure rate on follow up was at 42% (10/24), 52% (12/23), and 81% (17/21) at 1 day, 1 month, and 6 months, respectively. At 6-month follow up, pre-procedure tricuspid regurgitation disappeared by 38%. However, the incidence of new onset tricuspid regurgitation to trace was 16% (2) and mild 8% (1). Pre-procedure mild aortic regurgitation remained the same status throughout the 6-month follow up. Closure of the defect did not improve or worsen the aortic regurgitation. Post-transcatheter closure of ventricular septal defect with mild infundibular hypertrophy, the 1-year-old patient had resolution of the infundibular hypertrophy after 6 months but our 9-year-old patient had persistence of the mild infundibular hypertrophy even after 6 months. One patient (4%) developed transient widened QRS complexes post-transcatheter closure that resolved after 1 month. In total, 92% of the patients had no periprocedural complications. While one patient each had an inadvertent urinary bladder puncture and device embolisation.Our retrospective review of the procedural and short-term outcomes of transcatheter closure of ventricular septal defect sizes 2-10 mm, using the Lifetech Multifunctional occluder, appears to be safe and effective. However, long-term follow up is warranted.
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24
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Kuswiyanto RB, Rahayuningsih SE, Apandi PR, Hilmanto D, Bashari MH. Transcatheter closure of doubly committed subarterial ventricular septal defect: Early to one-year outcome. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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25
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Zhang W, Wang C, Zhou L, Li J, Shi J, Xie Y, Qian M, Wang S, Zhang Z. Morphology and Function of the Aortic Valve after Transcatheter Closure of Ventricular Septal Defect with Aortic Valve Prolapse. CONGENIT HEART DIS 2021. [DOI: 10.32604/chd.2021.015527] [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: 03/06/2023]
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26
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Bergmann M, Germann CP, Nordmeyer J, Peters B, Berger F, Schubert S. Short- and Long-term Outcome After Interventional VSD Closure: A Single-Center Experience in Pediatric and Adult Patients. Pediatr Cardiol 2021; 42:78-88. [PMID: 33009919 PMCID: PMC7864847 DOI: 10.1007/s00246-020-02456-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022]
Abstract
Interventional closure of congenital ventricular septal defects (VSD) is recording a continuous rise in acceptance. Complete atrioventricular block (cAVB) and residual shunting are major concerns during follow-up, but long-term data for both are still limited. We retrospectively evaluated the outcome of patients with interventional VSD closure and focused on long-term results (> 1 year follow-up). Transcatheter VSD closures were performed between 1993 and 2015, in 149 patients requiring 155 procedures (104 perimembranous, 29 muscular, 19 residual post-surgical VSDs, and 3 with multiple defects). The following devices were used: 65 × Amplatzer™ Membranous VSD Occluder, 33 × Duct Occluder II, 27 × Muscular VSD Occluder, 3 × Duct Occluder I, 24 × PFM-Nit-Occlud®, and 3 × Rashkind-Occluder. The median age at time of implantation was 6.2 (0.01-66.1) years, median height 117 (49-188) cm, and median weight 20.9 (3.2-117) kg. Median follow-up time was 6.2 (1.1-21.3) years and closure rate was 86.2% at last follow-up. Complications resulting in device explantation include one case of cAVB with a Membranous VSD occluder 7 days after implantation and four cases due to residual shunt/malposition. Six (4%) deaths occurred during follow-up with only one procedural related death from a hybrid VSD closure. Overall, our reported results of interventional VSD closure show favorable outcomes with only one (0.7%) episode of cAVB. Interventional closure offers a good alternative to surgical closure and shows improved performance by using softer devices. However, prospective long-term data in the current era with different devices are still mandatory to assess the effectiveness and safety of this procedure.
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Affiliation(s)
- M. Bergmann
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - C. P. Germann
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - J. Nordmeyer
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - B. Peters
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - F. Berger
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - S. Schubert
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.418457.b0000 0001 0723 8327Clinic for Pediatric Cardiology and Congenital Heart Defects, Herz- Und Diabeteszentrum NRW, Ruhr University of Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
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27
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Yang P, Wu Z, Liu Z, Zhang J, Zhou H, Ji X, Yi Q, Li M. Unplanned Surgery After Transcatheter Closure of Ventricular Septal Defect in Children: Causes and Risk Factors. Front Pediatr 2021; 9:772138. [PMID: 34917563 PMCID: PMC8670304 DOI: 10.3389/fped.2021.772138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate the causes and risk factors of unplanned surgery after transcatheter closure of ventricular septal defect (VSD) in children. Methods: A total of 773 patients with VSD who had the devices transcatheter released between January 2013 and December 2018 in our institution were retrospectively reviewed. Univariate and multivariate analyses were used to identify the risk factors for unplanned surgery. Results: Twenty four patients (3.1%) underwent unplanned surgery after transcatheter closure of VSD. The most common cause for unplanned surgery was new-onset or worsening aortic regurgitation (14/24; 58.3%), followed by occluder migration (4/24; 16.7%), complete atrioventricular block (2/24; 8.3%), severe hemolysis (2/24; 8.3%), residual shunt (1/24; 4.2%), and occluder edge near the tricuspid valve chordae (1/24; 4.2%). Logistic regression analysis revealed that primary aortic valve prolapse (OR: 5.507, 95%CI: 1.673-18.123, P = 0.005); intracristal VSD (OR: 8.731, 95%CI: 2.274-33.527, P = 0.002); eccentric occluder (OR: 4.191, 95%CI: 1.233-14.246, P = 0.022); larger occluder size (OR: 1.645, 95%CI: 1.331-2.033, P < 0.001); and pulmonary artery systolic pressure ≥45 mmHg (OR: 4.003, 95%CI: 1.073-14.941, P = 0.039) were risk factors for unplanned surgery. Conclusions: New-onset or worsening aortic regurgitation was the primary cause for unplanned surgery after transcatheter closure of VSD in children. Primary aortic valve prolapse, intracristal VSD, eccentric occluder, larger occluder size, pulmonary artery systolic pressure ≥45 mmHg could increase the risk of unplanned surgery.
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Affiliation(s)
- Penghui Yang
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhijun Wu
- Department of Pediatrics, Chongqing Iron and Steel General Hospital, Chongqing, China
| | - Zhiyuan Liu
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jing Zhang
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hao Zhou
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaojuan Ji
- National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Department of Ultrasound Investigations, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qijian Yi
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Mi Li
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
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28
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Maidman SD, Eberly LM, Greenbaum AB, Guyton RA, Wells BJ. Postinfarction Ventricular Septal Rupture and Hemopericardium with Tamponade Physiology. ACTA ACUST UNITED AC 2020; 5:48-50. [PMID: 33644514 PMCID: PMC7887524 DOI: 10.1016/j.case.2020.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ventricular septal rupture and hemopericardium are rare postinfarction complications. Contrast[HYPHEN]enhanced echocardiography can help identify pericardial effusion etiologies. Transcaval percutaneous ventricular assist device implantation is a viable strategy.
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Affiliation(s)
- Samuel D Maidman
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Logan M Eberly
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Adam B Greenbaum
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Robert A Guyton
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Bryan J Wells
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
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29
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Khoshhal SQ, Al-Mutairi MB, Alnajjar AA, Morsy MM, Salem SS, Al-Muhaya M, El-Harbi KM, Abo-Haded HM. Transcatheter device closure of ventricular septal defects in children: a retrospective study at a single cardiac center. Ann Saudi Med 2020; 40:396-402. [PMID: 33007168 PMCID: PMC7532053 DOI: 10.5144/0256-4947.2020.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Ventricular septal defect (VSD) is the most common congenital heart disease in the pediatric population. Nowadays, trans-catheter closure is considered a feasible method of therapy for most muscular and some perimembranous types of VSDs. OBJECTIVE Assess the safety, efficacy and outcome of percutaneous transcatheter closure of VSDs in children. DESIGN Retrospective, single center study. SETTING Madinah Cardiac Center, Madinah, Saudi Arabia. PATIENTS AND METHODS The study included all consecutive children who underwent transcatheter closure of isolated VSD during the period from December 2014 to January 2019. The data were collected from hospital database medical records. Transthoracic echocardiography (TTE) and an electrocardiogram (ECG) were done before and after the procedure in all the patients. The device was implanted by the retrograde or antegrade approach. All patients were subjected to follow-up evaluation at 1, 3, 6, 12 months, and annually thereafter with TTE and ECG. MAIN OUTCOME MEASURES Procedure success rate, clinical follow-up, TTE. SAMPLE SIZE 70 children. RESULTS The mean (standard deviation) age of patients was 10.2 (4.1) years (range: 2-18 years), and their mean body weight was 30.9 (13.9) kg (range: 7.0-57.7 kg). Forty-eight (68.6%) children had muscular VSD (mVSD), and 22 (31.4%) children had perimembranous VSD (pmVSD). The majority of defects were closed via the retrograde approach using the Amplatzer muscular occluder device. At 24 hours after the procedure, the success rate was 90%. Only four (5.7%) cases had major adverse events including complete atrioventricular block, hemolysis, and thrombus formation. CONCLUSION Transcatheter closure is a safe and feasible procedure in VSDs of various morphologies, with a low adverse event rate. LIMITATIONS Retrospective design, single-center study, absence of control group. CONFLICT OF INTEREST None.
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Affiliation(s)
- Saad Q Khoshhal
- From the Department of Pediatrics, Faculty of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Mansour B Al-Mutairi
- From the Department of Pediatrics, Madinah Cardiac Center, Madinah, Saudi Arabia
| | | | - Mohamed M Morsy
- From the Department of Pediatrics, Madinah Cardiac Center, Madinah, Saudi Arabia.,From the Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Sherif S Salem
- From the Department of Pediatrics, Madinah Cardiac Center, Madinah, Saudi Arabia.,From the Department of Pediatrics, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt
| | - Mustafa Al-Muhaya
- From the Department of Pediatrics, Madinah Cardiac Center, Madinah, Saudi Arabia
| | - Khaled M El-Harbi
- From the Department of Pediatrics, Faculty of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Hany M Abo-Haded
- From the Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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30
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Solana-Gracia R, Mendoza Soto A, Carrasco Moreno JI, Del Cerro Marín MJ, Gutiérrez-Larraya Aguado F, Coserría Sánchez JF, Blanco Mata R, Prada Martínez FH, Pan Álvarez-Ossorio M, Jiménez Montañés L, Pérez de Prado A, Rodríguez Vázquez Del Rey MDM, Gutiérrez García H, Velasco Bayón JM, Zunzunegui Martínez JL. Spanish registry of percutaneous VSD closure with NitOcclud Lê VSD Coil device: lessons learned after more than a hundred implants. ACTA ACUST UNITED AC 2020; 74:591-601. [PMID: 32830074 DOI: 10.1016/j.rec.2020.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 05/19/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES The NitOcclud Lê VSD Coil was specifically designed for transcatheter occlusion of ventricular septal defects (VSD) and became available for this purpose in August 2010. Our objective was to describe the Spanish experience of this technique and analyze its reliability and short- to mid-term efficacy. METHODS National multicenter observational study, which retrospectively recruited all patients (of any age) with VSD (of any location or type) who underwent percutaneous NitOcclud occlusion, using an intention-to-treat analysis, until January 2019. RESULTS A total of 117 attempts were made to implant at least 1 NitOcclud in 116 patients in 13 institutions. The median [range] age and weight was 8.6 [0.4-69] years and 27 [5.8-97] kg, respectively. In 99 patients (85%), the VSD was an isolated congenital defect. The location was perimembranous in 95 (81%), and 74 (63%) of them were aneurysmatic. The mean fluoroscopy time was 34 [11.4-124] minutes. Of the 117 attempts, 104 were successful (89%) with a follow-up of 31.4 [0.6-59] months. At the last review, final complete occlusion of the defect without residual shunt or with only a minimal shunt was achieved in 92.3% (no shunt, n=73; trivial shunt, n=23). Four patients required a second procedure for residual shunt occlusion. Two devices had to be surgically explanted due to severe hemolysis. There were no deaths or other major complications. CONCLUSIONS The NitOcclud device can be used successfully for a wide anatomical spectrum of VSD. The main issue is residual shunt, but its incidence decreases over time. The incidence of hemolysis was very low and no permanent changes were detected in atrioventricular conduction.
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Affiliation(s)
- Ruth Solana-Gracia
- Unidad de Cardiología Infantil, Hospital Universitario Infanta Leonor, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Alberto Mendoza Soto
- Instituto Pediátrico del Corazón, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | | | - Roberto Blanco Mata
- Servicio de Cardiología, Hospital Universitario de Cruces, Bilbao, Vizcaya, Spain
| | | | | | | | | | | | | | | | - José Luis Zunzunegui Martínez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Unidad de Cardiología Infantil, Hospital Universitario Gregorio Marañón, Madrid, Spain
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31
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Yosy DS, Djer MM, Putra ST. Comparison of complications between transcatheter and surgical ventricle septal defect closure: a single-center cohort study. MEDICAL JOURNAL OF INDONESIA 2020. [DOI: 10.13181/mji.oa.203837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Some ventricular septal defects (VSDs) require an interventional procedure for closure. Transcatheter and surgical closures of VSD have similar effectiveness, but transcatheter VSD closure is considered associated with less complication than surgical closure. This study aimed to compare mid-term or long-term complications of transcatheter and surgical VSD closures.
METHODS This was a retrospective cohort study compared the complication rates of transcatheter and surgical VSD closures performed in Cipto Mangunkusumo Hospital from January 1, 2010, to April 30, 2017, with 34 subjects in each group. The inclusion criteria were as follows: single lesion outlet perimembranous or doubly committed subarterial VSD, age 218 years, body weight >8 kg, and no arrhythmia. Electrocardiography and echocardiography were done to collect primary data. Other data were collected from medical records. Mid-term complications occurred 124 months after interventional closure. Long-term complications occurred 24 months after interventional closure. Complications were arrhythmia, valve regurgitation, and residual shunt. Data were analyzed by chi-square test.
RESULTS The rate of worsening valve regurgitation was higher in the transcatheter group than in the surgical group (16 versus 11, p = 0.322). The number of patients with residual shunts were similar between the transcatheter group and surgical group (5 versus 5; p = 1.000). Both complications were found in mid- and long-term. Arrhythmia as a long-term complication occurred in five and seven patients in the transcatheter and surgical groups, respectively (p = 0.752).
CONCLUSIONS Transcatheter and surgical VSD closures have similar mid or long-term complications.
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Fong LCW, Ford TJ, da Costa BR, Jüni P, Berry C. Bias and Loss to Follow-Up in Cardiovascular Randomized Trials: A Systematic Review. J Am Heart Assoc 2020; 9:e015361. [PMID: 32646264 PMCID: PMC7660731 DOI: 10.1161/jaha.119.015361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Loss to follow-up (LTFU) is common in randomized controlled trials. However, its potential impact on primary outcomes from cardiovascular randomized controlled trials is not known. Methods and Results We conducted a prospective systematic review (PROSPERO: CRD42019121959) for randomized controlled trials published in 8 leading journals over 5 years from January 2014 to December 2018. Extent, reporting, and handling of LTFU data were recorded, and the proportion of a trial's primary outcome results that lose statistical significance was calculated after making plausible assumptions for the intervention and control arms. These assumptions could drive differential treatment effects between the groups considering relative event incidence between LTFU participants and those included in the primary outcome. We identified 117 randomized controlled trials of which 91 (78%) trials reported LTFU, 23 (20%) reported no LTFU, and 3 (3%) trials did not report on whether LTFU occurred. The median percentage of study participants lost to follow-up was 2% (interquartile range, 0.33%-5.3%). Only 10 trials (9%) had a low cluster of risk factors for impairment in trial quality. The percentage of trials losing statistical significance varied from 2% when the relative event incidence for LTFU between the randomized groups was 1 for the intervention arm and 1.5 for the control arm to 16% when the relative event incidence was 3 for the intervention arm and 1 for the control arm. Conclusions Almost 1 in 6 (16%) cardiovascular randomized trials published in leading journals may have a change in the primary outcome if plausible assumptions are made about differential event rates of participants lost to follow up. There is scope for improvement arising from LTFU in randomized trials in cardiovascular medicine. Registration URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42019121959.
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Affiliation(s)
- Lucas Chun Wah Fong
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Glasgow Scotland.,British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow United Kingdom
| | - Thomas J Ford
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow United Kingdom.,Department of Cardiology Gosford Hospital Gosford NSW Australia.,Faculty of Medicine University of Newcastle Callaghan NSW Australia
| | - Bruno R da Costa
- Institute of Health Policy, Management, and Evaluation Dalla Lana School of Public Health University of Toronto.,Applied Health Research Center (AHRC) Li Ka Shing Knowledge Institute, St Michael's Hospital Toronto Ontario Canada.,Institute of Primary Health Care (BIHAM) University of Bern Bern Switzerland
| | - Peter Jüni
- Department of Medicine University of Toronto Canada
| | - Colin Berry
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Glasgow Scotland.,British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow United Kingdom
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Chen CA, Wang JK, Lin MT, Chiu HH, Hsu JY, Lin SM, Chang YM, Chiu SN, Lu CW, Wu MH, Yang MC. Exercise Capacity and Ventricular Remodeling After Transcatheter Ventricular Septal Defect Closure in Asymptomatic or Minimally Symptomatic Adolescents and Adults. Circ Cardiovasc Interv 2020; 13:e008813. [PMID: 32519889 DOI: 10.1161/circinterventions.119.008813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transcatheter ventricular septal defect (VSD) closure is a safe and efficacious alternative to surgery. However, its benefits in asymptomatic or minimally symptomatic patients remain unknown. METHODS Sixty patients with VSD aged 12 to 60 years underwent cardiopulmonary exercise test and echocardiography 1 day before transcatheter VSD closure and 6 months after intervention (closure group). Thirty patients who did not receive the intervention underwent the same evaluations over 6 months (observation group). RESULTS No significant change in exercise function was observed after VSD closure, except for increased peak oxygen (O2) pulse (absolute increase: 0.4±1.4 mL/beat). Left ventricular end-diastolic dimension and mitral peak early filling velocity-to-early diastolic annular velocity ratio decreased (absolute decrease: 0.3±0.6 cm and 0.7±1.9, respectively). Despite unchanged overall peak O2 consumption, 33% of closure group patients exhibited clinically significant improvements in peak O2 consumption (>10% increase relative to baseline). This was not related to the pulmonary flow-to-systemic flow ratio or baseline exercise capacity. By contrast, all exercise function parameters deteriorated significantly in the observation group. Subgroup analysis revealed that patients with a baseline left ventricular end-diastolic dimension Z score of >2 exhibited a significantly greater improvement in peak O2 consumption, peak O2 pulse, and oxygen uptake efficiency slope than did the observation group. CONCLUSIONS Compared with conservative management, transcatheter VSD closure prevents deterioration in exercise capacity and promotes left ventricular reverse remodeling in asymptomatic or minimally symptomatic patients. These benefits are most prominent in patients whose left ventricular end-diastolic dimension Z score before intervention is >2, irrespective of baseline peak O2 consumption and pulmonary flow/systemic flow ratio. Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT03127748.
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Affiliation(s)
- Chun-An Chen
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.).,Department of Pediatrics, College of Medicine, National Taiwan University, Taipei (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.)
| | - Jou-Kou Wang
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.).,Department of Pediatrics, College of Medicine, National Taiwan University, Taipei (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.)
| | - Ming-Tai Lin
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.).,Department of Pediatrics, Taipei Tzu Chi Hospital, New Taipei City, Taiwan (H.-H.C.)
| | - Hsin-Hui Chiu
- Department of Pediatrics, Taipei Tzu Chi Hospital, New Taipei City, Taiwan (H.-H.C.)
| | - Jui-Yu Hsu
- Dianthus MFM clinic, Taipei, Taiwan (J.-Y.H., Y.-M.C.)
| | - Shu-Man Lin
- Department of Anesthesiology, National Yang-Ming University, Taipei, Taiwan (S.-M.L.)
| | - Ya-Mei Chang
- Dianthus MFM clinic, Taipei, Taiwan (J.-Y.H., Y.-M.C.)
| | - Shuenn-Nan Chiu
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.).,Department of Pediatrics, College of Medicine, National Taiwan University, Taipei (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.)
| | - Chun-Wei Lu
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.).,Department of Pediatrics, College of Medicine, National Taiwan University, Taipei (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.)
| | - Mei-Hwan Wu
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.).,Department of Pediatrics, College of Medicine, National Taiwan University, Taipei (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.)
| | - Ming-Chun Yang
- Department of Pediatrics, E-DA Hospital, Kaoshiung, Taiwan (M.-C.Y.).,College of Medicine, I-SHOU University, Kaohsiung, Taiwan (M.-C.Y.)
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Outcomes of infants and children undergoing surgical repair of ventricular septal defect: a review of the literature and implications for research with an emphasis on pulmonary artery hypertension. Cardiol Young 2020; 30:799-806. [PMID: 32431266 DOI: 10.1017/s1047951120001146] [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 Pulmonary vascular disease resulting from CHDs may be the most preventable cause of pulmonary artery hypertension worldwide. Many children in developing countries still do not have access to early closure of clinically significant defects, and the long-term outcomes after corrective surgery remain unclear. Focused on long-term results after isolated ventricular septal defect repair, our review sought to determine the most effective medical therapy for the pre-operative management of elevated left-to-right shunts in patients with an isolated ventricular septal defect. METHODS We identified articles specific to the surgical repair of isolated ventricular septal defects. Specific parameters included the pathophysiology and pre-operative medical management of pulmonary over-circulation and outcomes. RESULTS Studies most commonly focused on histologic changes to the pulmonary vasculature and levels of thromboxanes, prostaglandins, nitric oxide, endothelin, and matrix metalloproteinases. Only 2/44 studies mentioned targeted pharmacologic management to any of these systems related to ventricular septal defect repair; no study offered evidence-based guidelines to manage pulmonary over-circulation with ventricular septal defects. Most studies with long-term data indicated a measurable frequency of pulmonary artery hypertension or diminished exercise capacity late after ventricular septal defect repair. CONCLUSION Long-term pulmonary vascular and respiratory changes can occur in children after ventricular septal defect repair. Research should be directed at providing an evidenced-based approach to the medical management of infants and children with ventricular septal defects (and naturally all CHDs) to minimise consequences of pulmonary artery hypertension, particularly as defect repair may occur late in underprivileged societies.
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Effect of transcatheter closure by Amplatzer TM Duct Occluder II in patients with small ventricular septal defect. Cardiovasc Interv Ther 2020; 36:375-383. [PMID: 32462466 DOI: 10.1007/s12928-020-00677-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/20/2020] [Indexed: 12/19/2022]
Abstract
Transcatheter closure of ventricular septal defect (VSD) is an alternative treatment of surgery. However, because of the potential risk of the complete atrioventricular block (AVB) and the lack of available dedicated devices for VSD, this procedure rarely used most centers. Recently in Thailand, with distinct device design that may cause less clamp force and radial force, the AmplatzerTMDuct Occluder (ADO) II has become available for the closure of small VSDs. This is a retrospective review of 49 patients who underwent transcatheter VSD closure using ADO II at Songklanagarind hospital and Queen Sirikit National Institute of Child Health between January 2014 and December 2016 with an intention to report procedural success rate and 12-months-outcomes. Twenty-six cases were female. The median age and weight at treatment were 7.8 year (ranged from 1.9 to 25 year) and 25.1 kg (ranged from 11 and 57 kg). The majority (65.3%) of the VSD was a perimembranous defect. The mean diameter of LV entry was 5.2 ± 2.5 mm and the mean RV exit was 3.2 ± 0.8 mm. Four patients had more than 1 exit at RV orifice. The mean length of the VSD was 5.3 ± 1.8 mm. The mean aortic valve-VSD distance was 3.9 ± 2.0 mm. The mean tricuspid valve-VSD distance was 3.8 ± 2.5 mm. The procedural success achieved in all patients (100%), most of the implantations were performed in a retrograde approach (53.1%). The ADO II was successfully implanted in 2 cases (5%) who failed other devices in the first attempts. There were no major complications. There were no changes in the severity of tricuspid and aortic valve regurgitation immediate after implantation and at 12 months' follow-up. Three patients (6%) had tiny to small residual shunt at 12 months' follow-up. None of the patients had a complete heart block. However, new-onset of left bundle branch block and right bundle branch block occurred in 2 (5%) cases and 5 (10%) cases, respectively. With symmetrical double-disc design and softness of the device, the ADO II can be safely and effectively used for closure of the VSDs with the defect size less than 6 mm.
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Li D, Zhou X, Li M, An Q. Comparisons of perventricular device closure, conventional surgical repair, and transcatheter device closure in patients with perimembranous ventricular septal defects: a network meta-analysis. BMC Surg 2020; 20:115. [PMID: 32456641 PMCID: PMC7249310 DOI: 10.1186/s12893-020-00777-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 05/18/2020] [Indexed: 02/08/2023] Open
Abstract
Background Treatments for perimembranous ventricular septal defects (pmVSD) mainly include conventional surgical repair (CSR), transcatheter device closure (TDC), and perventricular device closure (PDC). We aimed to perform a network meta-analysis to compare the three approaches in patients with pmVSD. Methods We searched for comparative studies on device closure and conventional repair for pmVSD to April 2020. A network meta-analysis was performed under the frequentist frame with risk ratio and 95% confidence interval. The main outcome was the procedural success rate. Additional outcomes were postoperative complications, including residual shunt, intra-cardiac conduction block, valvular insufficiency, incision infection, and pericardial effusion. Results Twenty-four studies of 8113 patients were included in the comparisons. The pooled estimates of success rate favored the CSR compared with the PDC. No significant differences of success rate were found in the TDC versus CSR and the PDC versus TDC. The pooled estimates of incidences of the residual shunt, new tricuspid regurgitation, incision infection, and pericardial effusion favored the PDC compared with the CSR. There were no significant differences between the PDC and TDC approaches in all outcomes except new aortic regurgitation. Conclusion The PDC technique not only reduces the risk of significant complications compared with the CSR, but also produces not inferior results compared with the TDC in selected pmVSD patients. PROSPERO registration number CRD42019125257.
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Affiliation(s)
- Dongxu Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, P.R. China.
| | - Xu Zhou
- Evidence-based Medicine Research Center, School of Basic Medical Sciences, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, P.R. China
| | - Mengsi Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Qi An
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, P.R. China
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Liao Z, Chen H, Lin L, Chen Q, Chen L, Chen Z. Long-term outcomes after conventional surgical repair versus perventricular device occlusion for doubly committed subarterial ventricular septal defects: a propensity score matched study. Eur J Cardiothorac Surg 2020; 57:929-936. [PMID: 32163571 DOI: 10.1093/ejcts/ezaa020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/09/2019] [Accepted: 11/17/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the long-term outcomes of perventricular device occlusion and surgical repair for doubly committed subarterial ventricular septal defect using propensity score matched analysis because previous comparative studies were limited by differences in the baseline characteristics. METHODS We reviewed inpatients with isolated doubly committed subarterial ventricular septal defect aged <18 years who underwent surgical repair or device occlusion between January 2011 and December 2017. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics. RESULTS A total of 336 patients underwent surgical repair; 99 underwent device occlusion. After matching, the repair group included 164 patients, whereas the device group had 91 patients. There were no significant differences in the baseline characteristics. The median follow-up periods were 46 and 58 months for the device and repair groups, respectively. No significant difference was noted in the rates of cumulative adverse events in the 2 groups (7.9% vs 5.5%; P = 0.61). The repair group required longer periods of hospitalization (P = 0.002) and mechanical ventilation (P = 0.016). No grade 3 or higher valvular regurgitation or high-degree atrioventricular block events were observed. All patients were in sinus rhythm at the last follow-up examination. CONCLUSIONS In selected patients with doubly committed subarterial ventricular septal defect, compared with conventional repair, perventricular device occlusion has comparable efficacy and safety, less invasiveness in terms of time in the hospital and on mechanical ventilation and avoidance of cardiopulmonary bypass.
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Affiliation(s)
- ZhenMei Liao
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Hang Chen
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Li Lin
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
| | - LiangLong Chen
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
| | - ZhaoYang Chen
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
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Tang C, Zhou K, Hua Y, Wang C. Very late-onset endocarditis complicated by non-significant aortic regurgitation after device closure of perimembranous ventricular septal defect. Medicine (Baltimore) 2020; 99:e20120. [PMID: 32384490 PMCID: PMC7220634 DOI: 10.1097/md.0000000000020120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Aortic regurgitation (AR) was recognized as a major, but rare complication after device closure for perimembranous ventricular septal defects (PmVSD). Most of them are temporary and non-significant. Infectious endocarditis (IE) is another extremely rare post-procedure complication of PmVSD. Theoretically, AR could increase risk for post-interventional IE. However, no cases have been documented thus far. We firstly described a case of very late-onset IE associated with non-significant AR after transcatheter closure of PmVSD with modified symmetrical double-disk device, underscoring the need for reassessing long-term prognostic implications of non-significant post-procedure AR after PmVSD occlusion and the most appropriate treatment strategy. PATIENT CONCERNS A 15-year old male received transcatheter closure of a 6.4 mm sized PmVSD with a 9-mm modified symmetric double-disk occluder (SHAMA) 11 years ago in our hospital. A new-onset mild eccentric AR was noted on transthoracic echocardiography (TTE) examination 1-year post procedure, without progression and heart enlargement. At this time, the child was admitted with a complaint of persistent fever for 16 days and nonresponse to 2-weeks course of amoxicillin and cefoxitin. DIAGNOSIS The diagnosis of post-procedure IE was established since a vegetation (14 × 4 mm) was found to be attached to the tricuspid valve, an anechoic area (8 × 7 mm) on left upper side of ventricular septum and below right aortic sinus, and severe eccentric AR as well as the isolation of Staphylococcus aureus from all three-blood cultures. INTERVENTIONS Treatment with vancomycin was initially adopted. However, surgical interventions including removal of vegetation, abscess and occluder, closure of VSD with a pericardial patch, tricuspid valvuloplasty, and aortic valvuloplasty were ultimately performed because of recurrent fever and a new-onset complete atrioventricular block 12-days later. The child continued with antibiotic therapy up to six weeks post operation. OUTCOMES The child's temperature gradually returned to normal with alleviation of AR (mild) and heart block (first degree). The following course was uneventful. CONCLUSION Late-onset IE could occur following device closure of PmVSD and be associated with post-procedure AR. For non-significant AR after device closure of PmVSD, early surgical intervention could be an alternative for reducing the aggravation of aortic valve damage and the risk of associated IE.
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Affiliation(s)
- Changqing Tang
- Department of Pediatric Cardiology
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Pediatric Cardiology
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Pediatric Cardiology
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuan Wang
- Department of Pediatric Cardiology
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Aortic regurgitation after closure of ventricular septal defect by transcatheter device: the long-term complication. Cardiol Young 2020; 30:577-579. [PMID: 32102719 DOI: 10.1017/s1047951120000414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ventricular septal defect is the most common type of CHD, and transcatheter ventricular septal defect closure has been shown to be an alternative to surgical closure with acceptable mortality and morbidity as well as encouraging results. Short-term and mid-term follow-ups have indicated the safety and efficacy of transcatheter closure, but long-term follow-up results were rare. In this report, we first found that aortic regurgitation occurred in patients 9-12 years following transcatheter closure and regurgitation were gradually increased. The findings indicate that the long-term outcome of transcatheter closure of ventricular septal defect may not be as satisfied as expected.
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40
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Li D, Zhang Z, Li M. Comparisons of periventricular device closure, conventional surgical repair, and transcatheter device closure in patients with congenital ventricular septal defects: A Protocol for Systematic Review. Medicine (Baltimore) 2020; 99:e18901. [PMID: 31977902 PMCID: PMC7004670 DOI: 10.1097/md.0000000000018901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Surgical treatments for ventricular septal defects (VSDs) mainly include 3 approaches: conventional surgical repair (CSR), transcatheter device closure (TDC), and perventricualr device closure (PDC). PDC has been introduced in over 10 years, although there remain concerns about adverse events. This network meta-analysis is to compare PDC, CSR, and TDC in the treatment of congenital VSD. METHODS We will search MEDLINE, EMBASE, Clinical Trials, Cochrane Library, and China National Knowledge Infrastructure databases for comparative studies on device closure and conventional repair for congenital VSDs to August 2019. A network meta-analysis with frequentist frame will be performed to compare the 3 approaches involving the success rate, in-hospital indexes, and incidences of complications, using risk ratio with 95% confidence intervals. RESULTS This study will be submitted to a peer-reviewed journal for publication. CONCLUSION This network meta-analysis will assess the safety and efficacy of PDC, CSR, and TDC in the treatment of congenital VSDs, and provide more evidence-based guidance in clinical practice. PROSPERO REGISTRATION NUMBER CRD42019125257.
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Affiliation(s)
- Dongxu Li
- Department of Cardiovascular Surgery
| | | | - Mengsi Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, PR China
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Karangelis D, Loggos S, Tzifa A, Mitropoulos F. Evaluation of Three Different Techniques for the Closure of Ventricular Septal Defects. J INVEST SURG 2019; 34:473-476. [PMID: 31588823 DOI: 10.1080/08941939.2019.1665152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Dimos Karangelis
- Department of Cardiac Surgery, Mitera Hospital, Marousi, Athens, Greece
| | - Spiros Loggos
- Department of Cardiac Surgery, Mitera Hospital, Marousi, Athens, Greece
| | - Aphrodite Tzifa
- Department of Congenital Cardiology, Mitera Hospital, Marousi, Athens, Greece
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El-Kadeem S, El Nemr S, El Amrousy D, Zoair A. Comparison of transcatheter versus surgical closure of perimembranous ventricular septal defect in pediatric patients: A systematic review and meta-analysis. J Saudi Heart Assoc 2019; 31:188-197. [PMID: 31337945 PMCID: PMC6625968 DOI: 10.1016/j.jsha.2019.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/28/2019] [Accepted: 06/18/2019] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Perimembranous ventricular septal defect (pmVSD) is a common congenital heart disease (CHD) usually treated with either catheter or surgical closure. Superiority of one procedure over the other in children is still a matter of debate. We performed this meta-analysis to compare the clinical outcomes and cost of transcatheter and surgical closure of pmVSD in children. MATERIALS AND METHODS We searched seven databases (MEDLINE, PubMed, EMBASE, Google Scholar, CENTRAL, CINHAL, and Cochrane library) and literature references for articles published in the past 10 years (between January 2008 and January 2018) comparing closure of pmVSD by both procedures in children. The outcomes of interest were success rate, residual shunt, need for blood transfusion, complications especially complete atrioventricular block, length of hospital stay, and cost. RESULTS A total of 1750 articles were identified. However, only five studies fulfilled the inclusion criteria. As regards success rate, no significant difference was found between surgical and catheter closure. Residual shunt was significantly lower in catheter closure than surgical closure [risk ratio (RR) = 0.44; 95% confidence interval (CI), 0.23-0.83, p = 0.01). The need for blood transfusion and the length of hospital stay were significantly lower in the catheter closure compared to surgical closure (RR = 0.02; 95% CI, 0.01-0.08; p < 0.00001), (RR = -4.81; 95% CI, -7.76 to -1.86; p = 0.001), respectively. However, overall complications, complete atrioventricular block, and the cost were comparable in both procedures. CONCLUSION Transcatheter closure of pmVSD in children was as effective as surgical closure with a lower residual shunt and need for blood transfusion, and shorter hospital stay.
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Affiliation(s)
- Sahar El-Kadeem
- Pediatric Department, Faculty of Medicine, Tanta University, Tanta, EgyptaEgypt
- Tanta University Hospital, Tanta, EgyptbEgypt
| | - Shaymaa El Nemr
- Pediatric Department, Faculty of Medicine, Tanta University, Tanta, EgyptaEgypt
- Tanta University Hospital, Tanta, EgyptbEgypt
| | - Doaa El Amrousy
- Pediatric Department, Faculty of Medicine, Tanta University, Tanta, EgyptaEgypt
- Tanta University Hospital, Tanta, EgyptbEgypt
- Corresponding author at: Faculty of Medicine, Tanta University Hospital, 6 El Motasem Street, Tanta, Egypt.
| | - Amr Zoair
- Pediatric Department, Faculty of Medicine, Tanta University, Tanta, EgyptaEgypt
- Tanta University Hospital, Tanta, EgyptbEgypt
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Shao S, Luo C, Zhou K, Hua Y, Wang C. What is the best management option for non-significant residual shunt after device closure of perimembranous ventricular septal defect: A case report based on the lessons from post-procedure endocarditis. Medicine (Baltimore) 2019; 98:e17347. [PMID: 31626092 PMCID: PMC6824650 DOI: 10.1097/md.0000000000017347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Non-significant residual shunt is a relatively common complication after device closure of perimembranous ventricular septal defects (Pm-VSD). Lifelong antibiotic prophylaxis has been recommended in guidelines to avoid infectious endocarditis (IE) if residual shunt remains. Clinicians, however, rarely follow it in their practice and regular follow-up was the most common option since post-procedure IE after transcatheter closure of PmVSD is rarely reported. We firstly described a case of IE after transcatheter closure of PmVSD with modified symmetrical double-disk device with a residual shunt, highlighting the need for reassessing the prognostic implications of post-procedure non-significant residual shunt and the most appropriate treatment strategy. PATIENT CONCERNS A 3-year old female received transcatheter closure of PmVSD sized 5.0 mm on left ventricular angiography with an 8-mm modified symmetric double-disk occluder (SHAMA) owing to a history of recurrent lower respiratory tract infections. Post-procedure echocardiography documented a non-significant residual shunt, but no additional interventions were performed. Two months post procedure, the child was re-admitted into our department with a complaint of persistent fever up to 41°C for 11 days and nonresponse to 1-week course of amoxicillin. DIAGNOSES The diagnosis of post procedure IE was established since a vegetation (13 × 9 mm) was found to be attached to the tricuspid valve and the occluder, and Staphylococcus aureus was isolated from all three-blood cultures. INTERVENTIONS After 6 weeks of vancomycin treatment, the vegetation disappeared with no sign of valvular dysfunction. Three weeks after discharge, a second device was implanted to abolish persistent residual flow. OUTCOMES Unfortunately, the child was ultimately transferred to surgical department due to severe hemolysis after the second device implantation. The occluders were removed and the VSD was closed with a pericardial patch. Tricuspid valvuloplasty was also performed and the following course was uneventful. LESSONS For non-significant residual shunt after device closure of PmVSD, implantation of a second device or surgical repair may be a better and more satisfactory alternative compared with lifelong antibiotic prophylaxis or no interventions, since associated IE can indeed occur despite its rarity and the risk of antibiotic-associated adverse events may outweigh the benefits.
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Affiliation(s)
- Shuran Shao
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University
| | - Chunyan Luo
- Department of Radiology, West China Hospital, Sichuan University
| | - Kaiyu Zhou
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Yang M, Su J, Liu A, Fan X, Li G, Li B, Liu Y. Correction of simple congenital heart defects by right axillary thoracotomy in adults. J Card Surg 2019; 34:1172-1177. [PMID: 31475401 DOI: 10.1111/jocs.14172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Right axillary thoracotomy has been performed for open-heart procedures as a more aesthetic alternative to standard median sternotomy. This study aimed to evaluate the efficacy and safety of right axillary thoracotomy for the correction of simple congenital heart defects in adults. METHODS Between January 2014 and December 2017, the clinical data of 180 adults who underwent right axillary thoracotomy for simple congenital heart defects were compared with the data of a paired group of 192 adults who underwent median sternotomy. RESULTS Compared with the median sternotomy group, the right thoracotomy group showed shorter operative time, postoperative mechanical ventilation time, and postoperative hospitalization duration, as well as less drainage and transfusion volumes (P < .05). Aortic cross-clamping time, cardiopulmonary bypass time, and length of intensive care unit stay were similar between groups. No mortality or significant residual defects were reported in either group during follow-up. In total, 172 patients (95.6%) in the right thoracotomy group and 134 patients (69.8%) in the median sternotomy group were satisfied with their cosmetic results (P < .01). CONCLUSIONS A right axillary thoracotomy is as safe and effective as a median sternotomy for the correction of simple congenital heart defects in adults. With lower trauma and better cosmetic results, this procedure provides a good alternative to the standard median sternotomy.
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Affiliation(s)
- Ming Yang
- Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junwu Su
- Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Aijun Liu
- Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiangming Fan
- Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Gang Li
- Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Bin Li
- Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yinglong Liu
- Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Ali YA, Hassan MA, El Fiky AA. Assessment of left ventricular systolic function after VSD transcatheter device closure using speckle tracking echocardiography. Egypt Heart J 2019; 71:1. [PMID: 31659511 PMCID: PMC6821406 DOI: 10.1186/s43044-019-0001-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 06/21/2019] [Indexed: 11/18/2022] Open
Abstract
Background This is a case-control study conducted on 30 children, 15 with VSD who performed VSD transcatheter device closure (group A) and 15 controls of matching age and gender (group B), in the period between September 2015 and February 2018. We aimed to assess the global left ventricular (LV) systolic function by 2D speckle tracking before and after ventricular septal defect (VSD) transcatheter closure, in comparison to normal controls. All patients were subjected to full history taking; general and cardiac examination; ECG; CXR; full transthoracic echocardiographic examination, including VSD number, size, and site; LV dimensions and volumes; estimated pulmonary artery pressure; right ventricular size and function; left ventricular circumferential; and radial strain imaging by 2D speckle tracking. Patients who had ventricular septal defect closed were reassessed by transthoracic echocardiography after 3 months. Results The study included 15 children with VSD: 3 males and 12 females; their age ranged from 2 to 13 years; all had subaortic VSD except for 1 who had apical muscular VSD: VSD size ranged from 3 to 8 mm; PFM coil was used to close defect in all patients except for 2 patients who had an Amplatzer duct occlude I (ADOI) device, and 1 patient needed an additional vascular plug after significant hemolysis. Pre-procedurally, group A had a significantly higher LVEDD, LVESD, and LVEDV than group B. Mean circumferential strain was significantly higher (more negative) in group A than that in group B either pre- or post-procedure. Post-procedurally, there was a significant decrease in circumferential strain (less negative) and a significant increase in radial strain (more positive). Conclusion Following transcatheter VSD closure, there is a significant decrease in LV circumferential strain and a significant increase in LV radial strain, which conclude a decrease in LV volume overload with the improvement of its contractility.
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Wang C, Zhou K, Luo C, Shao S, Shi X, Li Y, Wei L, Yan S, Liu X, Hua Y. Complete Left Bundle Branch Block After Transcatheter Closure of Perimembranous Ventricular Septal Defect. JACC Cardiovasc Interv 2019; 12:1631-1633. [DOI: 10.1016/j.jcin.2019.04.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/15/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
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Haddad RN, Daou L, Saliba Z. Device Closure of Perimembranous Ventricular Septal Defect: Choosing Between Amplatzer Occluders. Front Pediatr 2019; 7:300. [PMID: 31475122 PMCID: PMC6707042 DOI: 10.3389/fped.2019.00300] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/08/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Off-label device closure of perimembranous ventricular septal defect (pmVSD) is well reported in the literature with encouraging results. However, technical challenges may be encountered. Objectives: To evaluate and compare feasibility, technical aspects, procedural outcomes, and mid-term follow-up of pmVSD closure using Amplatzer™ occluders. Patients and Methods: From July 2015 to July 2018, patients in whom pmVSD closure was attempted using an Amplatzer occluder were retrospectively identified from our institution's database. Device selection was made according to the defect anatomy that was obtained via ventriculography and trans-esophageal echocardiography. Follow-up evaluations were done at discharge, then at 1, 3, 6, and 12 months and yearly thereafter with transthoracic echocardiography and electrocardiogram. Results: In total, 8 Amplatzer Duct Occluder (ADO), 27 ADO II, and 17 Amplatzer Muscular VSD Occluder (AMO) were used in 51 patients with a mean age of 7.4 ± 6.9 years and a mean weight of 25.4 ± 19.8 kg. Implantation was successful in 50/51 patients (98.0%). There was no procedure related mortality. One ADO accidentally embolized to the aorta after release and was surgically recaptured from the iliac artery. All ADO II were delivered retrogradely with the least amount of time (p = 0.002) and the lowest radiation exposure (p < 0.001). Minor valvular disturbances occurred in 8/49 patients (16.3%), including five tricuspid regurgitation (three with ADOII and two with AMO) and three trivial aortic regurgitations (two with ADO and one with ADOII). On a median follow-up of 194 days (range, 60-895 days), no surgical device removal was necessary. At 6 months of follow-up, trivial residual shunt was present in 5/49 patients (10.2%), among which none occurred with ADO. One complete atrioventricular block was detected 18 months after ADO implantation and required permanent pacing. Conclusions: Transcatheter closure of PmVSD using Amplatzer occluders is feasible, safe and efficacious in properly selected patients. The major key factor behind high procedural success rate is proper device selection. ADOII is remarkably superior in terms of device softness, flexibility and faster implantation process. Yet, its use is limited to small defects with particular anatomy.
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Affiliation(s)
- Raymond N Haddad
- Department of Pediatrics, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon
| | - Linda Daou
- Department of Pediatric Cardiology, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon
| | - Zakhia Saliba
- Department of Pediatric Cardiology, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon
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Esmaeili A, Behnke-Hall K, Schrewe R, Schranz D. Percutaneous closure of perimembranous ventricular septal defects utilizing almost ideal Amplatzer Duct Occluder II: Why limitation in sizes? CONGENIT HEART DIS 2018; 14:389-395. [PMID: 30561883 DOI: 10.1111/chd.12731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/27/2018] [Accepted: 11/26/2018] [Indexed: 11/28/2022]
Abstract
AIM The purpose of this study is to describe the special aspects of perimembranous ventricular septal defects (pmVSD) closure by utilizing Amplatzer Duct Occluder II (ADO II) devices with a rational request for bigger ADO-II sizes, based on our experience in transcatheter device closure of pmVSD. METHODS AND RESULTS At our institution, placement of an ADO II device was used in 15 patients with pmVSD; the patients' age ranged between 6 months and 20 years. The indications for closure were CHF (n = 4), hemodynamically significant shunt (n = 7), tricuspid regurgitation (n = 3), and high risk for infective endocarditis (n = 2), respectively. The location of the VSD was infracristal in 13 patients, supracristal in 1, and a postsurgical Gerbode VSD in another one. Implantation of the device was successfully performed without embolization, any evidence of an AV block, or other conductance abnormalities during implantation and follow-up in the mean of 2.5 years (range 2 months-6.5 years). CONCLUSIONS Transcatheter closure of a pmVSD with ADO II is feasible in all pediatric and young adult age groups, by considering the device diameter limitations. The off-label use of ADO II implantation seems to be safe for VSDs closure up to 6 mm of size and feasible for various locations including unusual morphology such as postsurgical Gerbode defect.
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Affiliation(s)
- Anoosh Esmaeili
- Pediatric Heart Center of Hessen, Goethe University, Frankfurt am Main, Germany
| | - Kachina Behnke-Hall
- Pediatric Heart Center of Hessen, Goethe University, Frankfurt am Main, Germany
| | - Roland Schrewe
- Pediatric Heart Center of Hessen, Goethe University, Frankfurt am Main, Germany
| | - Dietmar Schranz
- Pediatric Heart Center of Hessen, Goethe University, Frankfurt am Main, Germany
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Ling Y, Wang Y, Fan Q, Qian Y. Combined perventricular closure of ventricular septal defect and atrial septal defect via lower ministernotomy. J Cardiothorac Surg 2018; 13:125. [PMID: 30541582 PMCID: PMC6292104 DOI: 10.1186/s13019-018-0815-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/03/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Minimally invasive approaches such as perventricular closure of ventricular septal defects (VSD) have been applied for the surgical correction of congenital heart defects in order to avoid disadvantages related to median sternotomy with a cardiopulmonary bypass (CPB). However, reports remain scarce regarding combined perventricular closure of VSD and atrial septal defects (ASD) via minimally invasive approaches, such as lower ministernotomy. RESULTS The authors have operated on 5 patients who were diagnosed with VSD in association with ASD, successfully realizing perventricular closure via lower ministernotomy. CONCLUSION The proposed technique proved to be safe and effective.
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Affiliation(s)
- Yunfei Ling
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxuexiang 37th, 610041, Chengdu, Sichuan, People's Republic of China
| | - Yue Wang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxuexiang 37th, 610041, Chengdu, Sichuan, People's Republic of China
| | - Qiang Fan
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxuexiang 37th, 610041, Chengdu, Sichuan, People's Republic of China
| | - Yongjun Qian
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxuexiang 37th, 610041, Chengdu, Sichuan, People's Republic of China.
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He L, Cheng GS, Zhang YS, He XM, Wang XY, Du YJ. Transcatheter Closure of Perimembranous Ventricular Septal Defects in Children using a Wire-Drifting Technique. Clinics (Sao Paulo) 2018; 73:e371. [PMID: 30517278 PMCID: PMC6238823 DOI: 10.6061/clinics/2018/e371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 07/04/2018] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Explore the feasibility and safety of transcatheter closure of perimembranous ventricular septal defects using a wire-drifting technique (WT) in children. METHODS We retrospectively analyzed 121 pediatric patients diagnosed with perimembranous ventricular septal defects who underwent interventional treatment at the First Affiliated Hospital of Xi'an Jiaotong University from Dec 2011 to Dec 2014. Based on the method used for arteriovenous loop establishment during the procedure, the patients were divided into a conventional technique (CT) group and a WT group. RESULTS In total, 51 of the 53 patients (96.2%) in the CT group and 66 of the 68 patients (97.1%) in the WT group achieved procedural success, with no significant difference between the two groups (p>0.05). The CT group showed a nonsignificantly higher one-time success rate of arteriovenous loop establishment (94.3% vs. 91.2%, p>0.05). The procedure time was 46.0 (14.0) min and 46.5 (10.0) min in the CT and WT groups, respectively. The CT procedure was discontinued in the 2 cases (3.8%) of intraprocedural atrioventricular block in the CT group. In the one case (1.9%) of postprocedural atrioventricular block in the CT group, a permanent pacemaker was implanted to resolve third-degree atrioventricular block three months after the procedure. In the WT group, no cases of intraprocedural atrioventricular block occurred, and one case (1.5%) of postprocedural atrioventricular block occurred. In this case, intravenous dexamethasone injection for three days returned the sinus rhythm to normal. Aggravated mild to moderate tricuspid regurgitation was observed in 2 patients (3.8%) in the CT group during the 2-year follow-up period; aggravated tricuspid regurgitation was not observed in the WT group. During the 2-year follow-up period, there was no evidence of residual shunting in either group. CONCLUSION Transcatheter closure of perimembranous ventricular septal defects with the WT is safe and effective in children.
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Affiliation(s)
- Lu He
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China
| | - Ge-Sheng Cheng
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China
| | - Yu-Shun Zhang
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China
- *Corresponding author. E-mail:
| | - Xu-Mei He
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China
| | - Xing-Ye Wang
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China
| | - Ya-Juan Du
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China
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