Closure Of Defect Research Articles

Kiosk 2R-FB-11 - Left Ventricular Hemodynamics Recover After Closure of Atrial Septal Defect in Children

Kiosk 2R-FB-11 - Left Ventricular Hemodynamics Recover After Closure of Atrial Septal Defect in Children

Assessment of right heart size in children after percutaneous closure of secundum atrial septal defect with amplatzer septal occluder

Assessment of right heart size in children after percutaneous closure of secundum atrial septal defect with amplatzer septal occluder

Progress in Transthoracic or Percutaneous Device Closure of Ventricular Septal Defect Guided by Transesophageal Echocardiography

Progress in Transthoracic or Percutaneous Device Closure of Ventricular Septal Defect Guided by Transesophageal Echocardiography

Single-channel endoscopic closure of a mucosal defect after endoscopic submucosal dissection using a disposable endoloop and a retrievable clip.

Endoscopic submucosal dissection (ESD) is a treatment with high rate of en bloc resection. It has been suggested that mucosal suture of post-ESD ulcers may reduce the incidence of delayed accidents. Suturing method for the ulcers and deep tears that use a single-channel scope and a reusable endoloop (Olympus, Tokyo, Japan) and ones that use a double-channel scope have been reported. Notably, due to difficulties in using a a reusable loop, we devised a suturing method that uses a single-channel scope, a disposable endoloop, and a SureClip (Micro-tech Endoscopy, Nanjing, China). The SureClip was inserted into the forceps hole and withdrawn from the tip. The loop portion of the endoloop was grasped with the SureClip while the disposable endoloop was halfway out and then delivered into the lumen outside the endoscope. After reaching the target site, the SureClip was opened and secured to one of the mucosa ends. The first clip was placed as far away from the sheath as possible. The use of the SureClip was then continued, for fixation at multiple sites, and the endoloop was tightened and sutured. No complications, such as bleeding or perforation, were observed.

Atrial septal defect and zero positive end-expiratory pressure: A case report

This case report aims to investigate the impact of zero Positive End-Expiratory Pressure (PEEP) on the respiratory parameters of a patient following atrial septal defect repair who requires mechanical ventilation. We present the case of a 33-year-old patient who had been experiencing recurrent chest infections accompanied by copious cough with greenish sputum since 2009, without experiencing shortness of breath. The patient had no significant childhood illnesses and had initially been treated with frequent antibiotics at a local health center, which did not lead to symptom improvement. Subsequently, the patient was referred to a tertiary level University Hospital and underwent a series of diagnostic investigations. Transesophageal echocardiography revealed a defect in the superior and posterior location of the interatrial septum, measuring approximately 16mm with left-to-right flow. This defect was situated at the insertion of the superior vena cava, consistent with a superior sinus venosus atrial septal defect. The examination also revealed a moderately dilated right atrium and mild-to-moderate tricuspid regurgitation. Consequently, the patient underwent intracardiac repair of the atrial septal defect on cardiopulmonary bypass. In light of the ongoing increase in symptoms, right ventricle remodeling, and pulmonary artery pressure as the patient ages, it is essential to consider recommencing atrial septal defect closure early after diagnosis, regardless of the presence of symptoms..

Combined surgeries for secondary chest wall lesions

The authors present treatment of rhabdomyosarcoma of the gluteal region with secondary lesion of the lung and chest wall. Features of chest wall defect closure are analyzed.

Cardiopulmonary Rehabilitation along with Inspiratory Muscle Training to Improve Aerobic Capacity in Athletic Patient Following Atrial Septal Defect Closure: A Case Report

Cardiopulmonary Rehabilitation along with Inspiratory Muscle Training to Improve Aerobic Capacity in Athletic Patient Following Atrial Septal Defect Closure: A Case Report

Different mechanisms for persistent and residual left-to-right shunt after transcatheter sinus venosus defect closure and their management.

Transcatheter closure of superior vena cava (SVC) form of sinus venosus defects (SVDs) using covered stents is emerging as an alternative to surgery in the current decade. A covered stent placed in the cavoatrial junction creates a roof for the right upper pulmonary vein (RUPV) that stops the left-to-right shunt and redirects the vein to the left atrium. While surgical literature has clearly documented the incidence of stenosis of SVC and RUPV, sinus nodal dysfunction, and persistent residual shunts following surgical correction, it is imperative to have similar data after this new transcatheter intervention on the incidence of complications and follow-up outcomes. Since patients with pretricuspid shunts are often clinically asymptomatic, correction is primarily performed to prevent a persistent right heart volume overload and allow remodeling of the heart chambers. Any residual left-to-right shunt after a correction will result in persistent right heart dilatation. Residual flows can result from various mechanisms, including lack of apposition of the covered stent to the free edge of the SVD, fabric breach, and persistent anomalous drainage of additional right-sided pulmonary veins that drain very high in the SVC or can be due to a coexistent defect in the oval fossa. This review analyzes the different mechanisms, explains the transesophageal and angiographic images for each one, and offers solutions tailored for various reasons. Different mechanisms warrant different treatment principles. A solution for residual shunt from one mechanism may not be appropriate for residual flow through another mechanism. A thorough understanding would aid the operator in effective interventions for these SVDs.

Pushing boundaries in cardiac surgery: minimally invasive mitral valve repair combined with tricuspid valve repair and/or other concomitant procedures.

Minimally invasive mitral valve repair/replacement has emerged as a widely accepted surgical approach for managing mitral valve disorders. Continuous technological progress has contributed to the refinement of this procedure, leading to improved safety, decreased surgical trauma, and faster recovery times. Despite these advancements, there remains a scarcity of data concerning minimally invasive complex mitral valve repair surgeries when combined with additional procedures. Between November 2008 and December 2022, 153 patients underwent an operation using a minimally invasive technique. All patients underwent mitral valve surgery for severe mitral valve insufficiency/stenosis in combination with at least one additional procedure for tricuspid valve repair (n = 52, 34%), patent foramen ovale or atrial septal defect closure (n = 34, 22.2%), left atrial appendage occlusion (n = 25, 16.3%), or electrophysiological procedure (n = 101, 66.0%). Two concomitant procedures were conducted in 98 patients (64.1%), three concomitant procedures in 49 patients (32%), and four concomitant procedures in 6 patients (3.9%). Surgical success was achieved in 99.3% of the patients (n = 152), one patient required a revision of the mitral valve repair on the first postoperative day due to systolic anterior motion phenomenon. Mitral valve repair was performed in 136 patients (88.9%), while 15 patients (9.8%) received a mitral valve replacement as per a preoperative decision due to severe mitral valve stenosis, and two patients (1.3%) underwent other mitral valve procedures. Therapeutic success in treating atrial fibrillation was achieved in 86 patients (85.1%) of the 101 who received an additional maze-procedure. The 30-day mortality rate was 0.7%, with one patient succumbing to respiratory failure. Neurological complications occurred in 7 patients (4.6%). Freedom from reoperation was calculated as 98% at 5-year follow-up and 96.5% at 10-year follow-up. Minimally invasive mitral valve surgery, even when performed alongside concomitant procedures, stands out as a reproducible and safe technique with outstanding outcomes. It is imperative to advance towards the next frontier in minimally invasive surgery, encouraging experienced surgeons to undertake more complex procedures using minimally invasive approaches. These results help envision extending the boundaries of minimally invasive surgery by performing complex mitral valve procedures and associated interventions entirely through endoscopic means in suitable patients.

The Risk Factors of Mitral Regurgitation Deterioration After Secundum Atrial Septal Defect Closure.

Association between secundum Atrial Septal Defect (ASD) and mitral valve (MV) disease has been recognized for decades. Secundum ASD closure can reduce mitral regurgitation (MR) degree. However, in some patients, deterioration of MR after ASD closure has been observed. We aimed to identify the risk factors of MR deterioration after ASD closure. This was an observational retrospective cohort study. Data were collected from the registry and echocardiogram report. We evaluated all patients with ASD closure by surgery and transcatheterization without MR intervention from January 2012 until June 2021 at Dr. Sardjito General Hospital, Yogyakarta. We excluded patients with multiple ASD and ASD with severe MR requiring MV intervention. Risk factors for MR deterioration were evaluated using multivariate logistic regression. A total of 242 patients who underwent post-secundum ASD closure were included. In multivariate analysis, ASD closure by surgery, large left atrial (LA) diameter (>40 mm), low left ventricular ejection fraction (LVEF; <55%), and MV regurgitation degree were significant risk factors for MR worsening after ASD closure, with OR of 2.103 (95% CI 1.124-3.937); 2.871 (95% CI 1.032-7.985); 5.531 (95% CI 1.368-22.366); and 2.490 (95% CI 1.339-4.630) respectively. ASD closure by surgery, large LA diameter (>40 mm), low LVEF (<55%), and MV regurgitation degree are independent significant risk factors for MR deterioration in post-secundum ASD closure patients. In adult ASD patients with reduced LV function, it is recommended to perform balloon testing and consider fenestrated closure, as low LVEF <55% has the highest risk of causing new or deteriorating MR.

Usage of Padlock Over-the-Scope-Clip in Difficult-to-Control Recurrent Gastrointestinal Bleeding Due to a Gastric Dieulafoy Lesion.

Dieulafoy's lesions (DLs) are a rare cause of acute gastrointestinal bleeds (GIBs). Here we describe Over-the-Scope Clip Padlock System (OTSC-P) use to treat a gastric fundus DL with recurrent bleeding despite other interventions. The OTSC-P was created for full-thickness defect closure in the event of a perforation, but use has expanded to treatment of GIB. They consist of metal clips mounted on transparent caps, delivered via endoscope. Their size allows control of larger bleeding lesions, provides enhanced tissue stability and the firmer clip grasp reduces rebleeding or clip dislodgement.

Impact of Atrial Septal Defect Closure on Mortality in Older Patients

Impact of Atrial Septal Defect Closure on Mortality in Older Patients

Transcatheter Device Closure of Atrial Septal Defects

Transcatheter Device Closure of Atrial Septal Defects

Modeling the Evolution of Casting Defect Closure in Ingots through Radial Shear Rolling Processing

This paper investigates the behavior of transverse defects under significant total strain in conditions of complex vortex metal flow implemented through the radial shear rolling (RSR) method. The aim of this study is to assess the applicability of RSR processing for the in-depth transformation of small ingots of special steel into bars, particularly for the manufacturing of structural elements in specialized construction projects such as nuclear power plants. Although a substantial total strain is anticipated to enhance the steel structure and contribute to defect closure, the question of the development or closure of potential casting defects remains unclear. To address this issue, model tests were conducted to simulate the implementation of RSR processing. Defect behavior data under very complex vortex metal flow and high strain conditions were obtained for the first time and have scientific merit. A small steel ingot with a 32 mm diameter, containing a simulated artificial defect in the form of a transverse through-hole with a 5 mm diameter, was employed. During rolling, the workpiece diameter was progressively reduced by 2 mm with each subsequent pass, reaching a final diameter of 20 mm. Additionally, to provide a more detailed visualization of the defect evolution process, the same defect was modeled in an aluminum bar over six passes, and changes in defect volume and shape were analyzed after each pass. A highly detailed 3D visualization of the actual defect evolution was achieved based on cross-sections from experimental workpieces. These data corresponded to the total strain levels obtained by finite element method (FEM) simulation. Notably, a consistent similarity was observed between the test results for both metals, revealing a reduction in defect volume of up to 67.7%. The deformational welding of defects in the outer sections, encompassing one-third of the rod’s radius, occurred in the initial passes. However, defects in the axial zone of the rods remained unclosed, lengthening and gradually decreasing proportionally to the elongation of the rod, akin to conventional rolling. Consequently, the radial shear rolling (RSR) method is unsuitable for ingots with substantial discontinuities in the axial zone post-casting. Nevertheless, the method ensures the total welding of defects located in the outer zones of the ingots, even with minor applied deformations and a slight decrease in the diameter of the deformed ingot. Such data were obtained for the first time and should contribute to future investigations in this field.

Outcomes Following Closure of Secundum Atrial Septal Defect in Children ≤ 15 kg in a French Tertiary Centre.

Secundum atrial septal defects (sASDs) are common congenital cardiac defects mostly treated using a transcatheter approach. However, small children (<15 kg) are still undergoing surgical sASD closure in many centres. Although both options have been proved to have excellent results in children, comparative data of the two techniques are missing for patients ≤ 15 kg. The medical records of children ≤ 15 kg who underwent sASD surgical (group A) and transcatheter (group B) closure between 2010 and 2023 were reviewed retrospectively. Twenty-five children in group A and twenty-two in group B were included (mean weight 8.9 kg in group A and 10.3 kg in group B). The main indications for closure were right heart enlargement and failure to thrive. Major complications occurred in two patients in group A and none in group B. Minor complications occurred in eight patients in group A and one in group B. At last follow-up, symptoms resolved completely or improved significantly for all infants, with the exception of failure to thrive in the sub-population of children with extra-cardiac comorbidities. sASD closure can be performed safely in symptomatic infants ≤ 15 kg, even in the presence of comorbidity, and should not be postponed. However, in patients with extra-cardiac comorbidities, the only indication of growth retardation must be carefully evaluated.

Infective Endocarditis After Percutaneous Device Closure of Atrial Septal Defects: Incidence, Diagnosis, and Treatment. Case Report and Literature Review.

Infective endocarditis (IE) on atrial septal defect (ASD) closure devices, while extremely rare, has been reported to be more frequent early after the procedure. We describe a case of late IE after percutaneous closure of patent foramen ovale (PFO). We also performed a literature review on this subject. We reviewed a total of 42,365 patients who were treated with percutaneous devices: 13,916 for ostium secundum (OS) (32%), 24,726 for PFO (58%) and 3,723 for OS+PFO (8%). Among these patients, we identified 50 cases of IE after atrial septal defect device closure (0.001%). In contrast to previous reports, nearly 66% of IE in this setting occurred late, after at least 6 months from the procedure (33/50 patients). A statistical analysis clearly showed that the mean time from the procedure to IE increased in the last five years, probably associated with a change in antiplatelet therapy after ASD closure. Management of IE on an ASD occluder should always be discussed in the setting of a multidisciplinary heart team that includes a cardiologist, cardiac surgeon, and anesthetist. While surgical strategies gave excellent results, conservative management might be considered in cases of small IE vegetations and for patients in good general condition. However, in these cases, the patient must be closely observed with repeated blood and instrumental tests.

THE PROBLEM OF TRANSCATHETER CLOSURE OF MULTIPLE ATRIAL SEPTAL DEFECTS: INTERVENTIONAL APPROACHES AND RESULTS. LITERATURE REVIEW

HighlightsThe article presents a review of the literature and the results of endovascular correction of multiple atrial septal defects, methods of occluder implantation. Indications for transcatheter closure and possible complications of the procedure are given. AbstractOver the past few decades, the treatment strategy for the second atrial septal defect has changed significantly. Due to the improvement of device technology and procedural techniques, transcatheter closure of atrial septal defects is currently considered to be the method of choice in most patients with secondary types of defects. The latest generation devices provide a simple and safe implantation. The use of biocompatible occluder materials contributes to endothelization and reduction of traumatization of nearby structures. Most of the currently available devices demonstrate excellent efficiency and comparable results with their own advantages and disadvantages. In addition to improving the properties and performance of the device, there was a clear improvement in the procedural technique because of numerous experiments with closing of the device. A difficult problem for an endovascular surgeon is the procedure for closing multiple defects, due to their shapes, locations on the septum, the lack of a sufficient amount of tissue edge on the septum, as well as difficulties with choosing the type of device, their number and relative location.

Spontaneous closure of perimembranous ventricular septal defect in a cat

We discuss the case of a 5-month-old male British Shorthair referred to our hospital following the detection of a heart murmur during a routine vaccination appointment. Two-dimensional echocardiography revealed a 1.18 mm ventricular septal defect (VSD) located immediately below the aortic valve, without signs of secondary cardiac remodeling. Given the absence of cardiac dysfunction, no treatment was administered, and the cat was periodically monitored over the next 2 years. Echocardiography at 29 months of age revealed no signs of the VSD. Future studies are needed to increase the evidence base for spontaneous VSD closure in small animals.

PLASTIC SURGERY OF WOUND DEFECTS WITH FREE GRAFTS AFTER MALIGNANT SKIN TUMORS EXCISION: A PILOT STUDY.

To evaluate the effectiveness of applying negative pressure bandages (VAC bandage) in patients with malignant skin tumors after closing defects with free skin grafts and to compare it with fixation of skin grafts by the ordinary ointment bandages. 61 patients with malignant skin tumors who underwent surgical treatment at the National Cancer Institute from 2019 to 2023 were included in the study. For the wound defects closure, the split skin grafts were applied in all patients. At the time of surgery, after closing a wound defect by a split skin graft, a negative pressure dressing (VAC bandage) was applied in 41 patients for 7 days (group 1). In 20 patients, a transplanted skin graft was fixed after surgery by an ordinary ointment pressure bandage (group 2). The immediate results were evaluated one week after surgery. Complete engraftment of the flap in group 1 was observed in 53.7 ± 7.8% cases, in group 2 this result was achieved in 5.0 ± 4.8% patients (p = 0.002). The complete graft necrosis occurred in 1 case in group 1 vs. 2 cases in group 2 (p = 0.496). The results of the engraftment in postoperative wounds were significantly better in the VAC-bandage group in terms of the number of the complete engraftments compared to the conventional pressure ointment bandage group.

Minimally Invasive Extended Totally Extraperitoneal Versus Transabdominal Retromuscular Ventral Hernia Mesh Repair: Systematic Review and Meta-Analysis.

Introduction: Minimally invasive surgery for ventral hernia repair (MIS-VHR) with mesh in retromuscular plane can be performed by either transabdominally (TA-RM) or via enhanced view totally extraperitoneal approach (eTEP). Although both techniques offer the mesh extension in the best anatomical space, closure of hernia defect, avoidance of traumatic fixation, the superiority of one approach over another is not established. This systematic review and meta-analysis were set up to analyze safety and efficacy of eTEP in comparison with TA-RM. Materials and Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) framework was used as guideline to conduct systematic search of literature. Studies that provided comparative data of MIS-VHR using eTEP versus TA-RM were identified. Primary outcomes were major complications. These were defined as grade III-IV according to Clavien-Dindo classification. Secondary outcomes included: surgical site infection (SSI) rates, seroma rates, surgical site occurrence requiring procedural intervention (SSOPI), minor complications (Clavien-Dindo grade I-II), intraoperative complications, recurrence rate, postoperative ileus, duration of surgery, postoperative pain. Random- and fixed-effects models of statistical analysis were used. Risk difference (RD) was computated for binary outcomes (major and minor complications, SSI, seroma, SSOPI, recurrence, ileus) with 95% confidence intervals. I2 test was used to assess statistical heterogeneity. Risk of bias assessment was performed using Newcastle-Ottawa framework. Results: There were 3 observational studies that enrolled 370 participants. In the eTEP group there were 166 patients and, in the TA-RM group there were 204 patients. There was no significant RD with regard to major complications (RD -0.02 [-0.06 to 0.02], test for overall effect: Z = 0.86 [P = .39]). There was no significant RD in occurrence of minor complications, SSI, seroma, SSOPI, recurrence, ileus. Conclusions: Both eTEP and TA-RM were found to have equal safety profile. Further high-quality studies evaluating patient reported outcomes and late recurrence may be useful. PROSPERO registration number: CRD42023429160.