Large Muscular Ventricular Septal Defects Research Articles

Transcatheter Closure of a Large Muscular Ventricular Septal Defect (VSD) in a Child Weighing Five Kilogram with Severe Pulmonary Arterial Hypertension

Ventricular septal defect (VSD) is the commonest congenial heart lesion which may close spontaneously in significant number of cases. Muscular VSD has better chance of spontaneous closure. Some of the large muscular VSDs may cause severe complications like pulmonary hypertension and intractable heart failure. Closing VSD in young infant is challenging specially with devices as delivery systems are too large comparing to size of femoral vessels. Some centre prefers hybrid procedure of per ventricular device closure as surgical closure is high risk in young infants with complications. Here a case of large muscular VSD with severe pulmonary hypertension is reported in a ten month old girl which was closed successfully with a Konar- MFTM device and patient was discharged after 24 hours. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 84-86

21 Decision-making using multimodality imaging in complex muscular ventricular septal defects post pulmonary artery banding

Large muscular ventricular septal defects below the moderator band are an interesting entity as these lesions can be surgical challenging. The conventional approach is to do pulmonary artery banding to control heart failure and allow child to grow with view to close later using interventional approach if the lesion remains significant. Hybrid approach with pulmonary artery debanding and per-ventricular VSD closure has been attempted in few centres. Current advances in multimodality imaging helps us to understand the anatomy better and help us to plan the interventional and surgical procedure well. We present 3 cases of muscular ventricular septal defects post pulmonary artery banding. The VSDs in these patients had multiple exits in right ventricle aspect extending above and below the moderator band. Assessment of ventricular septal defect using transthoracic echocardiography, 3D echocardiography, conventional angiogram and CT angiogram added more information. However along with 3D modelling and printing in these selected cases helped to preempt challenges and plan according to avoid complications. We demonstrate the use of multimodality imaging and 3D modelling in these case series.

Coronary fistula with ventricular septal defect following chest trauma

We report on a 51-year-old male who developed traumatic ventricular septal defect and coronary artery fistula after an industrial accident involving injury to his chest. The defects were initially haemodynamically non-significant but he progressively developed symptoms of heart failure with associated dilatation of left atrium and ventricle. The ventricular septal defect was diagnosed by echocardiography and the coronary artery fistula was identified by pre-operative angiography. Both defects were surgically repaired more than one year after the injury. A large muscular ventricular septal defect was patched and the coronary artery fistula was closed from within the right ventricle.

A Minimally Invasive Technique for Occluding Large Muscular Ventricular Septal Defects in Infants

Objective: This study investigated the feasibility, timing and indications for closure of large muscular ventricular septal defects (VSDs) in infants without use of a cardiopulmonary bypass. Methods: A total of 9 infants with large muscular VSDs ranging in size from 7 to 15 mm were treated by minimally invasive closure without cardiopulmonary bypass between April 2010 and February 2013. Results: All surgeries were successful without resulting in uncontrolled systemic infection, a pulmonary hypertensive crisis or a severely low cardiac output, and with an apparently shorter operation time and postoperative tracheal cannula. Conclusions: VSD closure without cardiopulmonary bypass can improve the efficacy and prognosis of infants with large muscular VSDs and concurrent pulmonary infections or respiratory failure.

Ventricular Septal Defect after Blunt Trauma in a Case of Preexisting Prosthetic Mitral Valve

We present a case of an isolated large ventricular septal defect (VSD) following blunt chest trauma in a motor vehicle accident in the patient with preexisting mechanical mitral valve. Transthoracic echocardiography revealed a large muscular VSD with significant left to right shunt along with septal edema. Surgical repair was performed in view of Qp:Qs of 2.5 with significant hemodynamic instability despite intra-aortic balloon pump. The ventricular septal defect was found in apical muscular portion of the interventricular septum, which was closed through left ventriculotomy. We here discuss the possible mechanisms of damage and importance of timely surgery. To conclude, minor looking external injury might contain devastating damage inside, especially with patients on anti-coagulant therapy.

Unusual Cardiac Gunshot Injury Causing Traumatic Ventricular Septal Defect

Cardiac gunshot injuries are frequently fatal with poor outcome. We report the very unusual survival from cardiac gunshot injuries at multiple sites including the left atrium, left ventricle, right ventricle apex, right ventricular outflow tract and the inter-ventricular septum, creating a large muscular ventricular septal defect (VSD). It shows how rapid transport, proper resuscitation and emergent surgery can improve survival in patients who sustain life threatening cardiac gunshot injuries.

Perventricular device closure of isolated muscular ventricular septal defect in infants: A single centre experience

ObjectivesTo evaluate prospective single centre experience of mid-term safety and efficacy of perventricular device closure of isolated large muscular ventricular septal defect (mVSD) in high-risk infants. BackgroundSurgical closures of large mVSD in infants represent a challenge with significant morbidity. MethodsBetween August 2008–2010, perventricular closure was attempted in 24 infants of 6.01 ± 2.37 months age and 4.27 ± 0.56 kg weight under TEE guidance. ResultsThe device was successfully deployed in 21/24 infants. Size of mVSD was 8.42 ± 1.46 mm (6.1–12 mm). Mean procedure time was 28.8 ± 11.7 min. The closure rate was 84% immediately and 100% at 6 months. Four patients suffered major complications: 2-died, 1-esophageal perforation, 1-persistent CHB. At 26.23 ± 6.63 months follow-up two patients were symptomatic: 1-required device retrieval, 1-died of severe gastroenteritis. ConclusionPerventricular device closure of isolated mVSD appears feasible option at mid-term follow-up and may either substitute or complement the conventional surgical technique in selected cases depending on institutional paediatric cardiac surgery performance.

Identification of complex chromosome 18 rearrangements by FISH and array CGH in two patients with apparent isochromosome 18q

Identification of complex chromosome 18 rearrangements by FISH and array CGH in two patients with apparent isochromosome 18q

Initial results of primary device closure of large muscular ventricular septal defects in early infancy using perventricular access

To report our experience with the use of the Amplatzer muscular ventricular septal defect (VSD) occluder, using direct right ventricle free wall puncture for primary closure of muscular VSDs in infants. Young infants with heart failure due to large or multiple muscular VSDs often require intervention at a stage when percutaneous device closure is impractical due to delivery system limitations. There are considerable benefits to avoiding bypass in these infants. Patients with suitable muscular VSDs, considered too small for transvenous closure, underwent periventricular muscular VSD closure under transesophageal echo (TEE) guidance. Eight infants underwent the procedure. The median age was 14 weeks (2-41) with median weight of 4 kg (3-6.6). Four patients had additional VSDs and one patient had previous repair of coarctation. One patient had dextrocardia and severe left ventricular impairment due to an associated cardiomyopathy. The median VSD size was 8 mm (range, 4-10 mm). A single device (6-12 mm) was deployed in each patient, the size chosen being 1-2 mm larger than the TEE measurement. Two patients had subsequent pulmonary artery banding, with absorbable bands, because of moderate residual shunting through additional VSDs. The latest echo study at a median of 7.2 weeks (0.5-66) post device implantation revealed no patients with a hemodynamically significant shunt. Perventricular muscular VSD closure can be safely and effectively undertaken in small infants with suitable muscular defects, and this strategy can avoid the need for bypass.

Definitive Diagnosis of Obstructed Total Anomalous Pulmonary Venous Drainage in a Critically Ill Newborn With High-Resolution Computed Tomography

Anewborn infant (39 weeks’ gestation, birth weight 2.9 kg) was transferred urgently to our hospital with a transcutaneous oxygen saturation of 40% and a clinical suspicion of obstructed pulmonary venous return. Detailed cardiac ultrasound showed several large muscular ventricular septal defects with right to left shunting and a collecting vein behind the left atrium; however, the pulmonary venous anatomy was not clearly delineated. In particular, both the superior and inferior caval veins were enlarged, …

Retrograde use of the Cardioseal/Starflex occluder device

The Cardioseal/Starflex septal occluder is usually deployed through a long transvenous sheath for closure of atrial septal defects, persistent foramen ovale, and, less commonly, ventricular septal defects. We describe two patients with residual left-to-right shunting after surgical palliation of congenital heart defects and illustrate the successful use of the double-umbrella device in these situations using a retrograde transarterial approach. This is exemplified by two previously not described interventions: retrograde closure of a large muscular ventricular septal defect in a patient after a palliative Mustard operation and a transcatheter closure of a Waterston-Cooley anastomosis. Effective and safe closure of left-to-right shunting can be achieved by retrograde use of the Cardioseal/Starflex device in selected adolescents and grown-ups with congenital heart disease.

Intraoperative transoesophageal echocardiography for paediatric cardiac surgery--an audit of 200 cases.

We report out initial experience with intraoperative transoesophageal echocardiography (TOE) in 200 patients undergoing repair of congenital heart disease. Complications associated with probe insertion precluded a full study in 11 patients (5.5%) and included airway obstruction (n = 6), inability to pass the probe (n = 4) and vascular compression (n = 1). The preoperative diagnosis was confirmed by TOE in 176 of 189 cases (93%) with minor variances in 12 (6.3%) and one major variance (additional large muscular ventricular septal defect (VSD)). Unexpected abnormalities not diagnosed preoperatively were found at surgery in four cases (2%) and were all of trivial operative significance. Postoperative studies showed no residual defect in 96 (51%) and trivial or mild residual defects in 72 patients (38%). There were moderate or severe residual defects in 21 cases (11%). Ten cases (5.3%) returned to bypass for further surgery, with eight achieving complete or adequate amelioration. In six of the 10 cases, return to bypass was prompted by the TOE examination alone. There was one re-operation in the postoperative period for a VSD patch dehiscence. Routine TOE offers significant advantages in the management of patients undergoing repair of congenital heart disease, particularly in postoperative assessment. Careful monitoring of perfusion and ventilation is required, particularly during probe insertion in children weighing 5 kg or less.

Repair of large muscular ventricular septal defects in infants employing left ventriculotomy

The approach to muscular ventricular septal defect has been controversial. Traditional approaches have included pulmonary artery banding or right ventriculotomy. Left vcntriculotomy has been employed in older children because of the ease of exposure in the absence of trabeculations, but concern has been raised regarding potential loss of left ventricular function. Four infants less than 4 months of age underwent repair of a large muscular ventricular septal defect by left ventriculotomy. One infant had no associated defects; 2 had undergone previous coarctation repair (1 with pulmonary artery banding); and 1 had a large secundum atrial septal defect. All had congestive heart failure refractory to maximal medical management. All patients survived, and there was no myocardial dysfunction. Echocardiographic indices of ventricular function 3 to 24 months postoperatively were normal (mean shortening fraction, 32.5%). Left ventriculotomy with patch closure of the ventricular septal defect provides a simple approach to a large muscular ventricular septal defect in infants with heart failure.