Mini-invasive transthoracic intervention for compound congenital cardiac anomalies in children

Abstract

Objective To evaluate the efficacy of mini-invasive transthoracic intervention for compound congenital cardiac anomalies in children. Methods From March 2015 to May 2017, a total of 11 children with compound congenital cardiac anomalies were recruited.There were 9 boys and 2 girls with an average age of (12.3±8.4)(4-30) months and an average weight of (7.9±2.6)(5.0-12.5) kg.There were 5 cases with atrial septal defect (ASD)+ ventricular septal defect (VSD) (n=5), VSD+ patent ductus arteriosus (PDA) (n=1), ASD+ PDA (n=2), VSD+ pulmonary stenosis (PS)(n=2) and ASD+ PS (n=1). A 1.5 to 2 cm incision was made in lower media sternotomy or third intercostal left parasternal.The sequences of interventional therapy were performed under the guidance of transesophageal echocardiography (TEE). Transthoracic echocardiography, fluoroscopy and electrocardiography were scheduled before discharge and 3 months later. Results All 11 cases underwent simultaneous interventional therapy successfully.The lower media sternotomy incision (n=9) and third intercostal left parasternal incision (n=2) were made in 2 cases.The average procedure time was (81±14) (58-100) min and the average amount of intraoperative blood loss (24±12) (10-50) ml.In 8 patients complicated with secundum ASD, the average diameter of occlude was (7.5±1.2) (6-14) mm.In 8 VSD-complicated patients, subarterial eccentric (n=1) and membranous symmetric (n=7) occludes were applied.The average diameter of occlude was (6.2±1.0)(5-9) mm.In 3 PDA-complicated cases, the size of occlude was 4-6, 6-8 and 6-8 mm respectively.Postoperative TEE indicated that all devices were successfully positioned without any residual shunt or impingement of atrioventricular valves.In 3 PS cases, balloon dilation decreased systolic pressure across pulmonary valve to a postoperative level of under 30 mmHg.No adverse complications occurred before discharge and 3 months later. Conclusions Mini-invasive transthoracic intervention is both safe and effective for compound congenital cardiac anomalies in children. Key words: Congenital heart disease; Compound cardiac anomaly; Minimally Invasive Transthoracic intervention