Ventricular Septal Defect Closure Research Articles

P200 Lodderomyces elongisporus fungemia in a late post-operative patient with ventricular septal defect: case report

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectivesTo report a case of Lodderomyces elongisporus fungemia in a late post-operative patient with the ventricular septal defect.MethodsInformed consent was obtained from the parents of the child. Clinical history was collected. Routine biochemical tests were conducted. Blood samples were sent to the bacteriology and mycology laboratory for culture. Radiological examination of the head was done to ascertain the cause of neurological manifestations.ResultsAn 11-year-old boy, previously diagnosed as a case of ventricular septal defect (VSD) and severe aortic regurgitation, had undergone VSD closure in December 2010 and aortic valve replacement in January 2011. He was discharged on oral anticoagulants. However, he did not follow up.In August 2018, he presented with fever and right-sided hemiparesis. Hemogram was within normal limits except for decreased hemoglobin. Bacteriological blood culture was sterile, but I.V. antibiotics were administered empirically. However, the patient started to have epileptic attacks and therefore was intubated and antiepileptics were administered. An NCCT of the head revealed a large intraparenchymal bleed. Echocardiography revealed intra-cardiac vegetation measuring 8 × 7 mm and moderate aortic regurgitation.Fungal blood culture inoculated in BACTEC Mycosis IC/F bottle flagged positive after 5 days of incubation. A smear and Gram stain from the same revealed budding yeast cells. Sub-culture was done on Sabouraud dextrose agar and HiCromeTM Candida Differential Agar, and blue-tinged colonies were observed on the latter. The isolate was identified as L. elongisporus when subjected to MALDI-TOF analysis. Identification was confirmed by sequencing the internal transcribed spacer (ITS) region of the ribosomal DNA.Antifungal susceptibility test was performed by broth microdilution as per CLSI guidelines. Antifungal therapy was initiated with liposomal amphotericin B, but he continued to have fever even after 1 week and consequently developed status epilepticus. CT scan of the brain revealed massive intracranial hemorrhage. Parents were advised neurosurgery, but they requested discharge against medical advice. The patient was lost to follow-up.Conclusions Lodderomyces elongisporus is a rare cause of invasive bloodstream infections and should not be ignored as a contaminant when isolated from sterile sites. It is often misidentified as Candida parapsilosis by conventional methods and commercially available systems but can be distinguished from it using chromogenic culture media and MALDI-TOF-MS. The current case report highlights the significance of L. elongisporus as a rare cause of invasive fungal infections, the difficulties faced in the identification of this pathogen, and the importance of newer diagnostic methods in identifying it.

Minimally Invasive Ventricular Septal Defect Closure via Right Thoracotomy: The First Reported Case in Thailand

The present case report concerned a young woman who had a ventricular septal defect (VSD) that was unable to be closed by interventional approach. She had successfully undergone an anterior mini-thoracotomy to close the VSD directly. The thoracotomy approach was chosen as it would give a better cosmetic result for this patient without any subordination in comparison with the standard sternotomy approach. This is the first reported case of minimally invasive VSD closure via the right thoracotomy approach in Thailand. Keywords: Minimally invasive cardiac surgery; Cardiac surgery; Ventricular septal defect; Minimally invasive congenital cardiac surgery; Congenital cardiac surgery

Summary of the Experiences and Results of Transesophageal Ultrasound-Guided Ventricular Septal Defect and Atrial Septal Defect Closure Operation.

Ventricular septal defect (VSD) and atrial septal defect (ASD) are congenital heart diseases. The techniques of transthoracic closure (TC) and percutaneous closure (PC) for the treatment of VSD and ASD have continuously improved and matured. This study aimed to retrospectively analyze the therapeutic effects of TC and PC on VSD and ASD patients. We retrospectively reviewed 928 patients (552 VSD and 376 ASD) who had undergone TC or PC guided by transesophageal ultrasound at the Department of Cardiac Macrovascular Surgery of the First Affiliated Hospital of Nanchang University between August 2010 and August 2020. We collected and evaluated the clinical data of the patients, including age, gender, weight, inlet and outlet diameters of defect, and the operation results of TC and PC. Descriptive statistics were used to analyze means and standard deviations (SD), and the Chi-square test was used to evaluate the difference between groups. Among the 928 patients who were treated with the closure operation, there were no casualties, with 907 patients (97.7%) showing successful closure. Among the 552 VSD patients who were treated with TC, 540 showed successful close, while 12 cases required extracorporeal circulation after the failure of TC. Among the 376 patients with ASD, 256 patients were treated with TC, of which 251 were successful, and five were failures, including three shedding cases. In addition, among the 120 patients who were treated with PC, 116 were successful, and four were failures, including two shedding cases. Postoperative follow up for patients with successful closure operations demonstrated that the complications of aortic and tricuspid regurgitation, hydro-pericardium, III° atrioventricular block, shedding of closure umbrella, hemolysis, and thrombosis had not occurred. Closure operation of VSD and ASD by esophageal ultrasound has the advantages of lower trauma and blood loss, shorter hospital stay, simple operation, fewer postoperative complications, and significant therapeutic efficacy.

Utility of thromboelastogram in cardiac surgery in Jacobsen syndrome associated with platelet dysfunction: a case report

BackgroundJacobsen syndrome is a rare genetic disorder with multiple congenital anomalies and platelet abnormalities caused by chromosome 11 deletion.Case presentationA 7-month-old boy with thrombocytopenia underwent ventricular septal defect closure. At the beginning of surgery, the platelet count was 168 × 103/μL, and heparinized kaolin with heparinase reaction time (HKH-R), which represents clot formation time, was prolonged at 30.4 min. Platelet transfusion was continued, and at the end of surgery, the platelet count and HKH-R values improved to 215 × 103/μL and 15 min, respectively.ConclusionsAs anesthetic management of patients with abnormal platelet function, the viscoelasticity test might be useful in evaluating hemostatic capacity.

Percutaneous closure of ventricular septal defect with the KONAR-MF device

Percutaneous closure of ventricular septal defect with the KONAR-MF device

Three years of interventional pediatric cardiology experience in a newly built city hospital

Aim: The importance of interventional methods in the treatment of congenital heart disease (CHD) is increasing. In this article, we retrospectively evaluated our angiography experience for the diagnosis and treatment of congenital heart diseases in the newly built Kayseri City Hospital for 3 years.
 Material and Method: The demographic data of the patients, their diagnoses and information about interventions were evaluated retrospectively.
 Results: In our center, 291 interventional procedures were performed in a 36-month period. 71 (24%) procedures were for diagnostic evaluation and 220 (76%) procedures were for treatment. 74 (25%) atrial septal defect (ASD) closure procedures, 9 (3%) ventricular septal defect (VSD) closure procedures and 62 (21.3%) patent ductus arteriosus (PDA) closure procedures were performed via percutaneous technique. Eleven of the patients who underwent PDA closure were

Mitral and aortic valve regurgitation following surgical and transcatheter perimembranous ventricular septal defect closure in children and adolescents: midterm outcomes

BackgroundClosure of perimembranous ventricular septal defects (pmVSD), either surgical or percutaneous, might improve or cause new-onset mitral regurgitation (MR) and aortic regurgitation (AR). We aimed to evaluate the changes in MR and AR after pmVSD closure by these two methods.Material and methodWe performed a comparative retrospective data review of all pediatric patients with pmVSDs treated at our institution with surgical or antegrade percutaneous methods from 2014 to 2019 and 146 consecutive patients under 18 years were enrolled. We closely looked at the mitral and aortic valve function after repair. Included patients had no or lower than moderate aortic valve prolapse and baseline normal mitral or aortic valve function or less than moderate MR or AR.ResultsOut of 146 patients, 83 (57%) pmVSDs were closed percutaneously, and 63 (43%) pmVSDs were closed surgically. 80 and 62 patients were included for MR evaluation, and 81 and 62 patients for AR evaluation in percutaneous and surgical groups. The mean follow-up time was 40.48 ± 21.59 months in the surgery group and 20.44 ± 18.66 months in the transcatheter group. Mild to moderate degrees of MR and AR did not change or decreased in most patients. In detail, MR of 70% and AR of 50% of the valves were resolved or decreased in both groups. 13% of patients with no MR developed trivial to mild MR, and 10% of patients with no AR showed mild to moderate AR after pmVSD closure in both methods. There was no significant difference between the two methods regarding emerging new regurgitation or change in the severity of the previous regurgitation.ConclusionpmVSD closure usually improves mild to moderate MR and AR to a nearly similar extent in both percutaneous and surgical methods among children and adolescents. It might lead to the onset of new MR or AR in cases with no regurgitation.

Navigation guidance for ventricular septal defect closure in heart phantoms.

Transesophageal echocardiography (TEE) is the preferred imaging modality in a hybrid procedure used to close ventricular septal defects (VSDs). However, the limited field of view of TEE hinders the maneuvering of surgical instruments inside the beating heart. This study evaluates the accuracy of a method that aims to support navigation guidance in the hybrid procedure. A cardiologist maneuvered a needle to puncture the patient's heart and to access a VSD, guided by information displayed in a virtual environment. The information displayed included a model of the patient's heart and a virtual needle that reproduced the position and orientation of the real needle in real time. The physical and the virtual worlds were calibrated with a landmark registration and an iterative closest point algorithms, using an electromagnetic measurement system (EMS). For experiments, we developed a setup that included heart phantoms representing the patient's heart. Experimental results from two pediatric cases studied suggested that the information provided for guidance was accurate enough when the landmark registration algorithm was fed with coordinates of seven points clearly identified on the surfaces of the physical and virtual hearts. Indeed, with a registration error of 2.28 mm RMS, it was possible to successfully access two VSDs (6.2 mm and 6.3 mm in diameter) in all the attempts with a needle (5 attempts) and a guidewire (7 attempts). We found that information provided in a virtual environment facilitates guidance in the hybrid procedure for VSD closure. A clear identification of anatomical details in the heart surfaces is key to the accuracy of the procedure.

Safety and Efficacy of Percutaneous Transcatheter Closure of Perimembranous Ventricular Septal Defects With Nit Occlud® Lê VSD coil: A Single Center Experience

Safety and Efficacy of Percutaneous Transcatheter Closure of Perimembranous Ventricular Septal Defects With Nit Occlud® Lê VSD coil: A Single Center Experience

Three centers experience with device closure of congenital Gerbode-type perimembranous ventricular septal defects.

We aim to evaluate our experience with interventional closure of Gerbode-type perimembranous ventricular septal defects (pmVSDs). 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. 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. 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.

Early and long-term results of ventricular septal defect repair in children with severe pulmonary hypertension and elevated pulmonary vascular resistance by the double or traditional patch technique.

In upper-income countries, infants undergo low-risk ventricular septal defect (VSD) repair. Children in low- and middle-income countries frequently present at older ages with elevated pulmonary vascular resistance (PVR) and pulmonary arterial hypertension (PAH). Expensive interventions for pulmonary hypertensive crisis are not available, and children are often denied an operation due to the mortality risk. We report our early and late experiences with these patients who underwent VSD closure by traditional patch (TP) or double patch (DP) techniques. We extracted data from patients with VSD and PAH who underwent VSD closure operations from 1996 to 2016. Information regarding cardiac catheterizations, operations, time in the intensive care unit and follow-up information was found. We identified 129 children and analysed the differences between the TP (89/129) and the DP (40/129) in unidirectional groups. After 2005, the patients were pretreated with sildenafil 3 months before catheterization. The TP group was younger (P < 0.001). Hospital mortality (2.5%, DP; 10.1%,TP) was not significantly different (P = 0.17) between the 2 groups despite significant differences in baseline PVR, PVR/systemic vascular resistance and the number of children with a saturation less than 90%. The long-term survival and regression of PAH were better in the DP group (survival over 97% vs 93% in the TP group). Moreover, 61% of children with DP and 75% of those with TP had normal to mild elevations in pulmonary artery pressures at the last follow-up examination (P = 0.046). The DP operation is a low-risk procedure. Moreover, the long-term outcome with the use of this technique in high-risk patients with VSD and high PVR and PAH is favourable with respect to survival and showed a decrease in PAH at the last follow-up.

Single-stage off-pump repair of coarctation of the aorta and ventricular septal defects in children.

OBJECTIVESThe appropriate approach for surgical repair of coarctation of the aorta with a ventricular septal defect (VSD) remains controversial. This study evaluated the outcomes of primary repair of VSDs with periventricular device closure without cardiopulmonary bypass through a left thoracotomy in patients without arch hypoplasia.METHODSWe selected 21 patients aged <1 year, including 7 neonates, who underwent repair of coarctation of the aorta with periventricular device closure of a VSD.RESULTSThe median occluder size was 6 (range, 5–8) mm. The median mechanical ventilation time was 14 (range, 2–68) h, and the median duration of hospital stay was 11 (range, 7–16) days. No reoperations were required to correct VSD shunting, and the median residual shunt size was 1 (range, 1–2) mm. The median follow-up period was 13 (range, 4–31) months. No late deaths were reported, and no haemodynamically significant pressure gradient at the anastomotic site was observed. The median distal aortic arch z-score was 0.39 (range, −0.1–to 0.9). Only 1 patient had a permanent pacemaker implanted towards the end of the follow-up period.CONCLUSIONSPeriventricular device closure can be used safely for closure of VSD in children with coarctation of the aorta without a hypoplastic aortic arch, even in neonates, to reduce the risk of prolonged cardiopulmonary bypass. This hybrid approach can be performed with a low incidence of rhythm disturbances and residual shunting. However, a meticulous assessment of the VSD anatomy is essential to avoid any unfavourable events.

Early and mid-term results of transcatheter closure of perimembranous ventricular septal defect using Amplatzer Ductal Occluder type 1

Objectives: To study the early and midterm results of transcatheter closure of perimembranous VSD using Amplatzer Ductal Occluder type 1.&#x0D; Methods: Prospective study of one hundred thirteen patients with perimembranous VSD (PMVSD) who referred to catheterization laboratory and underwent transcatheter closure of their defects by using Amplatzer Ductal Occluder type 1 device. Routine right and left heart catheterization was performed with evaluation of the pulmonary and systemic pressure. All the procedures were done under fluoroscopy and transthoracic echocardiography guide. Follow up evaluations were done between 1 month and 12 months after discharge (mean 4.5 ± 1.13 months) with transthoracic echocardiography and 12 lead electrocardiography.&#x0D; Results: The age of patients range from 2 to 34 years at procedure (mean 10.60 ± 7.31 years), weight range from 10 to 85 kg (mean 32.38 ± 19.70 kg). The mean echocardiographic defect size was 5.69 ± 1.63 mm and the mean angiographic size was 5.89 ± 1.70 mm. The devices size used range from 6/4 – 16/14 mm. The most common device used was 10/8. The ADOs were successfully implanted in 108 patients (95.6 %). The VSD occlusion rate was 85.2% at completion of the procedure, rising up to 90.7 % next day at discharge, 93.5% at one month and 97.2% at 6 months during follow-up. Two patients (1.9%) developed CAVB, one case within 24 hours and the other case after 2 days of the procedure, they were admitted in hospital treated by temporary pacemaker implantation, steroids and NSAIDs (high dose aspirin) with complete remission within 5 days. Conclusion: Transcatheter closure of PMVSD with ADO1 in children is a safe and effective treatment associated with excellent success and closure rates and with no significant adverse events, but long-term follow-up in a large number of patients would be warranted.

Paediatric Cardiac Anaesthesia at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria: The Hurdles, Struggles, and Successes

Background: Open-heart surgery started at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife, Nigeria, 5 years ago through partnership with foreign partners. This paper reviewed the difficulties facing the development of paediatric cardiac anaesthesia, the pattern, and the outcome of cases managed.&#x0D; Methods: A review of the infrastructure, equipment, manpower and operational setup for open-heart surgery at OAUTHC was done. A retrospective study of all patients that were operated on from April 2016 to March 2021 was performed. Extracted data were analysed with Statistical Packages for the Social Scientists using descriptive statistics.&#x0D; Results: A total of 102 patients had open-heart surgeries during the period under review by the various teams in a shared facility of the hospital's main theatre. Challenges with manpower, infrastructure, and supplies were major limitations to service delivery. Most of the patients (75.5%) were aged &lt; 5 years. The commonest procedures performed were ventricular septal defect closure (31.4%), total correction of tetralogy of Fallot (26.5%), and atrial septal defect closure (9.8%). Fast-tracked anaesthesia was used always except where it was contraindicated. Most (76.7%) of the cases were extubated within 24 hours after surgery; the mean (SD) duration of ventilation in the ICU was 0.99 (1.2) days and the average length of ICU stay was 3 days. The overall mortality rate was 20.6%.&#x0D; Conclusion: Numerous challenges confront the provision of sustainable paediatric cardiac anaesthesia services in resource-constrained settings like ours. Much can be achieved with appropriate investment in material and manpower, and partnership with experienced teams.&#x0D; Authors&#x0D; A T Adenekan 1, A M Owojuyigbe 1, O I Aaron 1, O O Ojo 2

Heart Function and Ventricular Recovery After Percutaneous Closure of Perimembranous Ventricular Septal Defect in Children: A Cross-sectional Study

Background: Perimembranous ventricular septal defect (VSD) is the most common congenital heart defect. There is a trend for percutaneous VSD closure. However, little evidence is available for the effect of this method on ventricular remodeling. Objectives: This study aimed to investigate the effect of percutaneous closure of perimembranous VSD on cardiac function and ventricular recovery. Methods: A total of 46 pediatric patients (32 males vs. 14 females) who underwent transcatheter closure of perimembranous VSD from 2010 to 2020 were randomly included in the study. Data regarding the demographic profile, angiographic records, and follow-up echocardiography were extracted from their files and recorded in questionnaire templates. The echocardiographic parameters were recorded and compared with published Z-scores for the corresponding age groups. Results: The mean duration of follow-up was 15.76 ± 12.20 months. In M-mode echocardiography, 84.6% had interventricular septum diastolic diameter Z-score ≥ 2; 23.8% had interventricular septum systolic diameter Z-score ≥ 2; 38.5% had left ventricular internal diameter in diastole Z-score ≥ 2; 34.6% had left ventricular internal diameter in systole Z-score ≥ 2; and 65.4% had left ventricular posterior wall in diastole Z-score ≥ 2. In the evaluation of Doppler and tissue Doppler, 36.4% of the patients had a Z-score ≥ 2 for E/Ea of tricuspid. Also, VSD size had a positive correlation with interventricular septal diameter in systole Z-score (P = 0.015, r = 0.537). Conclusions: In the midterm follow-up after percutaneous perimembranous VSD closure, left ventricular dilation and hypertrophy persisted in a significant number of patients. However, early closure of the VSD, especially in patients with lower weight could affect ventricular hemodynamics and remodeling.

Late Aortic Insufficiency After Ventricular Device Closure: A Case Report

Device closure of isolated ventricular septal defect is taking precedence over surgical closure in current era. However, device closure in perimembranous and subarterial VSD is complicated by procedural acute aortic regurgitation. In this report we found late aortic regurgitation after four years of device closure of ventricular septal defect. This incident needs one to reconsider the choice of device in patients with perimembranous or subarterial ventricular septal defect as the rim of the occluder device is near the aortic cusp. Early intervention after the development of significant aortic regurgitation is beneficial for the patient.

Long-Term Outcomes of Left Ventricular Restoration in Patients Ineligible for Concomitant Coronary Artery Bypass Grafting.

The prognosis of severe coronary artery disease (CAD) patients undergoing left ventricular restoration (LVR) and ineligible for concomitant coronary artery bypass grafting (CABG) is unclear. This study illustrates the clinical characteristics and the long-term survival of these patients in a retrospective cohort. From January 1999 to March 2021, a total of 78 patients underwent surgical left ventricular restoration without concomitant CABG at our center. The primary endpoint was the major adverse cardiovascular and cerebrovascular events (MACCE). Kaplan-Meier analysis was performed to calculate survival, and compared by log-rank test, followed by multiple adjustments using Cox regression. The mean age was 55.3 ± 11.4 years. There were 76 (97.4%) true and 2 (2.6%) pseudo-aneurysms. Forty-six (59.0%) patients presented NYHA functional class III or IV. The mean EuroSCORE was 10.6 ± 3.2. Concomitant surgeries included mitral valve repair (N = 3), mitral valve replacement (N = 2), tricuspid valve repair (N = 2), ventricular septal defect closure (N = 18), maze procedure (N = 1), and appendage ligation (N = 1). Reoperation for bleeding was performed in one patient (1.3%). Prolonged ventilation was observed in 21 (26.9%) patients. Fourteen (17.9%) patients presented with low cardiac output and were supported with IABP. Operative death occurred in one (1.3%) patient. The median duration of echocardiographic follow-up was 53 months (interquartile range, 81.5) and was obtained in 46 (59.0%) patients. Left ventricular ejection fraction (LVEF) improved from 41.1% ± 10.5% to 45.6% ± 7.9% (P < 0.001), and the left ventricular end-diastolic dimension (LVEDD) fell from 57.8 ± 6.6 mm to 52.0 ± 6.2 mm (P < 0.001). The median patient follow-up time was 79.5 months (interquartile range, 53.5). Overall, 1-, 5-, and 10-year survival rates were 98.7%, 95.5% and 82.3%, respectively. Patients with severe CAD and ineligible for concomitant CABG are in critical condition, and LVR could be a reliable approach to improving cardiac function with satisfactory early and long-term outcomes.

Aortic Valve Endocarditis Post Ventricular Septal Defect Device Closure: Case Report

Ventricular septal defect (VSD) is a common congenital heart disease (CHD) in childhood, and its incidence is about 20% of CHD. Surgical closure or repair is safe with acceptable results. Transcatheter VSD closure offers excellent results. Coil system is developed for transcatheter VSD occlusion. Infective endocarditis (IE) post device implantation is very rare; however, it is possible. IE represents a surgical challenge associated with perioperative mortality

Transcatheter closure of perimembranous ventricular septal defects by using the amplatzer ductal occluder type I

Background: - A ventricular septal defect is a hole or a defect in the septum that divides the 2 lower chambers of the heart, resulting in communication between the left and right ventricular cavities. Objectives: -To evaluate the efficacy and safety of percutaneous transcatheter closure of perimembranous VSD by using Amplatzer Ductal Occluder type I. Method: This is a prospective study. Total numbers of 216 patients with perimembranous VSD were enrolled for transcatheter closure of the defect by using Amplatzer Ductal Occluder type I (ADO I). The inclusion criteria of the study were: the VSD diameter ranged from 4mm to 12 mm, the VSD distance (rim) at least 2mm from atrioventricular and semilunar valves, and the systolic pulmonary atrial pressure ranged (20-75 mm Hg) with mean pulmonary atrial pressure (40 mm Hg). The patients with malalignment type of VSD were excluded from the study.

Doubly committed ventricular septal defect closure using an eccentric occluder via minimal incision in the anterior median sternum through the left parasternal third intercostal space.

Doubly committed ventricular septal defect closure using an eccentric occluder via minimal incision in the anterior median sternum through the left parasternal third intercostal space.