Multiple Ventricular Septal Defects Research Articles

Apical Left Ventriculotomy is Safe in Infants and Young Children Requiring Cardiac Surgery

Incisions in the left ventricle have previously been associated with increased mortality and morbidity, particularly in infants. In order to determine whether this assumption is still true in the current era, we reviewed our recent experience with apical left ventriculotomy in neonates and infants. The records of five consecutive patients requiring a left ventriculotomy between 2007 and 2010 were reviewed. Weight and age ranged from 2.6 to 16 kilograms and 5 days to 2 years. The diagnoses were three multiple ventricular septal defects, one rhabdomyoma, and one apical aneurysm. The primary end point was left ventricular ejection fraction, with other end points being intensive care unit length of stay, time to extubation, inotrope requirement, arrhythmias, and mitral valve function. There were no early or late deaths. Although lower than their preoperative values, early postoperative ejection fractions were greater than 50% in all patients. Two patients required no inotropes, and 3 required only minimal support. Hospital length of stay was 9 ± 7 days for multiple ventricular septal defect patients, with intensive care unit stays of 2 to 5 days. There were no postoperative arrhythmias requiring pharmacological therapy, and one patient had a significant reduction in mitral insufficiency postoperatively. Based on our experience, we believe that an apical left ventriculotomy does not significantly impair left ventricular function even in small infants, and is not associated with significant morbidity, based on short-term follow-up. Although the long-term effects are still unknown, early results suggest that a left ventriculotomy may safely be used when alternative approaches are inadequate for complex cardiac defects.

Perventricular Closure of Muscular Ventricular Septal Defects in Infants With Echocardiographic Guidance Only

To report our experience with perventricular closure of muscular (apical) ventricular septal defects (VSDs) in small infants, with echocardiographic guidance only, in a nonhybrid suite. Eight infants with nine large muscular (apical) VSDs underwent perventricular device closure in a nonhybrid operating room, with transesophageal and epicardial echocardiography guidance, at a mean age and weight of 3.07 (0.3-7.28) months and 3.7 (2.5-6.2) kg, respectively. Five patients had multiple VSDs. Four had associated cardiac defects. Nine Amplatzer muscular VSD devices with a mean size of 10 (4-14) mm were deployed. Seven patients were discharged from the intensive care unit with a mean length of stay of 8.6 days. Four patients had minimal postprocedural residual shunt; no one had a residual shunt at six-month follow-up. Mid-term results are excellent. Perventricular closure is feasible under echocardiographic guidance only in small patients, even without hybrid suite. This may be a good approach for very symptomatic low-weight infants with apical VSD and may also be useful, in any center, at any time, and in any operating room, to treat an associated apical VSD, even unexpected.

Transcatheter Closure of Multiple Perimembranous Ventricular Septal Defects With Septal Aneurysm Using Two Overlapping Amplatzer Duct Occluders II

Ventricular septal defect (VSD) is a common congenital heart defect in children. Perimembranous VSD (Pm VSD), a defect involving the membranous septum and the adjacent portion of the muscular septum, accounts for about 70 % of cases. Transcatheter closure of Pm VSDs using the Amplatzer Pm VSD device, although successful in many patients, has been associated with major adverse events. Complete heart block, thromboembolism, and new-onset valvular regurgitations in patients undergoing VSD closure using the Pm VSD occluder have been reported [3]. Recently, a new retrograde approach for transcatheter closure of Pm VSDs using the Amplatzer Duct Occluder II (ADO II) has been described with a 90 % success rate [1]. This report describes a child who had multiple Pm VSDs with septal aneurysm undergoing successful transcatheter closure using two ADO II occluders with relative ease.

Case report: airway and concurrent hemodynamic management in a neonate with oculo‐auriculo‐vertebral (Goldenhar) syndrome, severe cervical scoliosis, interrupted aortic arch, multiple ventricular septal defects, and an unstable cervical spine

We report the challenging case of a 1-week-old, term, 2.4 kg neonate with Goldenhar syndrome (including microcephaly, left microtia, left facial palsy, dextro-scoliosis of the cervical spine, and cervico-thoracic levoscoliosis), multiple ventricular septal defects, a type B interrupted aortic arch, a large patent ductus arteriosis, and radiographic and clinical signs concerning for an unstable cervical spine. Our anesthesia team was consulted for perioperative management of this patient during her surgical repair. This case report describes the use of the Air-Q size 1 laryngeal airway (LA) to assist fiberoptic intubation in an ASA 4 neonate with cardiac disease, an anticipated difficult airway with the addition of an unstable cervical spine, as well as the anesthetic techniques used to maintain hemodynamic stability while the airway was secured.

Palliative Arterial Switch Operation in the Context of Multiple Ventricular Septal Defects, Potentially Biventricular and Univentricular Hearts With Malposed Great Arteries

This study is an examination of our unit's experience with palliative arterial switch in univentricular and potentially biventricular hearts with transposition of the great arteries (TGA). These patients were divided into three groups based on their physiology. (a) Single ventricle physiology (n = 8), in which all the patients had univentricular hearts, TGA, and subaortic stenosis (SAS). (b) Borderline biventricular physiology (n = 4), in which the patients had TGA, ventricular septal defect (VSD), and hypoplastic right ventricle (RV). (c) Biventricular physiology (n = 3), in which the patients had TGA and multiple VSDs. In all, 12 (80%) patients survived. Seven of these have undergone second stage surgery (cavopulmonary shunt, n = 5; biventricular repair, n = 2). Palliative arterial switch is an alternative to Norwood procedure and modifications thereof for managing SAS in single ventricle with malposed great arteries. Palliative switch with adjunctive pulmonary artery band may be a temporizing measure in TGA with multiple VSDs, where the VSDs are judged to be inaccessible through the tricuspid valve or through either of the great arteries. It may also be utilized for TGA and hypoplastic RV instead of committing them to univentricular pathway and keeping the option of biventricular repair.

Long term follow-up of 799 children with isolated ventricular septal defects

We evaluated long-term follow-up results and prognosis of pediatric patients with isolated ventricular septal defects (VSD). The study included 799 patients (368 girls, 431 boys; mean age at diagnosis 24.3±37.4 months; median 6 months) who were monitored by the pediatric cardiology department for VSD. The mean follow-up period was 32.8±30.3 months (median 20 months). The VSDs were classified as perimembranous (n=610, 76.4%), muscular (n=171, 21.4%), doubly committed subarterial (n=10, 1.3%), and multiple (n=8, 1%). Spontaneous closure rates were 42.7%, 13.1%, and 25% in muscular, perimembranous, and multiple VSDs, respectively, which corresponded to a mean age of 18.6±19.9 months (median 12 months) in muscular and 30.2±33.7 months (median 14.5 months) in perimembranous VSDs. Before 2 years of age, 78.1% of muscular and 58.6% of perimembranous VSDs underwent spontaneous closure. Of 256 defects (32%) that required surgical closure, 91.4% were of perimembranous location. The mean age at surgery was 38.8±49.1 months (median 11 months) for muscular, and 43.7±40.9 months (median 24 months) for perimembranous defects. During the follow-up period, the following complications were noted: aortic valve prolapse (0.7%), aortic regurgitation (0.6%), left ventricle-to-right atrium shunt (2.6%), subaortic ridge (3.7%), and infundibular stenosis (1.2%). Aortic regurgitation developed in eight patients (3.7%) after surgical closure. Our data on the natural course and prognosis of VSDs may be of relevance with respect to patients' age, defect type, and complications encountered in the follow-up period.

Long Term Problems from Surgical Patch Closure of Multiple Muscular Ventricular Septal Defects

Long Term Problems from Surgical Patch Closure of Multiple Muscular Ventricular Septal Defects

Left Ventricular Function After Left Ventriculotomy for Surgical Treatment of Multiple Muscular Ventricular Septal Defects

Left Ventricular Function After Left Ventriculotomy for Surgical Treatment of Multiple Muscular Ventricular Septal Defects

333 Transcatheter closure of multiple muscular ventricular septal defects with various Amplatzer devices

333 Transcatheter closure of multiple muscular ventricular septal defects with various Amplatzer devices

Double Aneuploidy: A Case of Trisomy 21 with XYY

Although aneuploidies are common structural chromosomal abnormalities, double aneuploidies involving chromosomes 21 and Y are very rare. Here we report a case of double aneuploidy involving chromosomes 21 and Y in a 5 day old baby with jaundice and polycythemia. The diagnosis was confirmed by karyotype analysis using modified “whole blood” and microtechnique methods followed by Giemsa-Trypsin-Leishman (GTL) banding technique. The patient had typical features of Down syndrome, however, phenotypic features of XYY was not present. In addition, the patient also had atrial septal defect, multiple trabecular small ventricular septal defect, and moderate degree of pulmonary hypertension. Etiological predisposing factor for 48,XYY,+21 is not known. It is difficult to determine the incidence, phenotypic properties, and recurrence risk of 48,XYY,+21.

Left Ventricular Function After Left Ventriculotomy for Surgical Treatment of Multiple Muscular Ventricular Septal Defects

Optimal management of muscular ventricular septal defects (MVSD) is still not determined in the current era. Moreover, long-term left ventricular function after closure of MVSD is not well known. Thus, we investigated surgical outcomes including long-term left ventricular function after closure of MVSD through left ventriculotomy. We conducted a retrospective review of medical records of 20 children who underwent MVSD closure between March 1993 and August 2010. There were 10 boys (50%) and 10 girls (50%). Patient age ranged from 1.6 to 103.4 months (median, 26.4 months), and body weight from 2.8 to 31.5 kg (median, 11.9 kg). Electrocardiogram results were normal sinus rhythm in all except 1 patient with congenital complete atrioventricular block. There were 16 patients who previously had palliative pulmonary artery banding procedures before closure of MVSD. There were 13 patients (65%) with Swiss-cheese type VSD. There was 1 hospital death of a patient with congenital complete atrioventricular block with pacemaker malfunction (5%). There was 1 late death of a patient with del 22q with adenoviral pneumonia. There was no reoperation. Median follow-up duration was 85.9 months (range, 4.7 to 166.7). The location of MVSD was apical portion in 10 patients (50%) and midtrabecular portion in 9 patients (45%). There were 6 Dacron patch closures and 13 direct closures of MVSD through left ventriculotomy. There was no complete atrioventricular block. Last follow-up echocardiographic data showed normal ejection fraction with 65.2% ± 8.2% after closure of MVSDs. There was no leakage in 8 patients; 11 patients had insignificant leakage, which disappeared spontaneously in 4 patients 17.9 months (median value) after operation. Our acceptable long-term results of left ventricular function after left ventriculotomy proved that this technique might be a viable option in the management of MVSD.

Transesophageal Echocardiography Detection of Undiagnosed Multiple Muscular Ventricular Septal Defects with Alteration of Shunt Flow by Right Ventricular Pacing After an Arterial Switch Operation in a Neonate

Transesophageal Echocardiography Detection of Undiagnosed Multiple Muscular Ventricular Septal Defects with Alteration of Shunt Flow by Right Ventricular Pacing After an Arterial Switch Operation in a Neonate

Miniinvasive hybrid closure of multiple muscular ventricular septal defects in a premature infant with novel use of Amplatzer Duct Occluder II – a case report

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Haponiuk I, Chojnicki M, Jaworski R, et al. Miniinvasive hybrid closure of multiple muscular ventricular septal defects in a premature infant with novel use of Amplatzer Duct Occluder II – a case report. Videosurgery and Other Miniinvasive Techniques. 2011;6(1):33-36. doi:10.5114/wiitm.2011.20991. APA Haponiuk, I., Chojnicki, M., Jaworski, R., Steffek, M., Juściński, J., & Sroka, M. et al. (2011). Miniinvasive hybrid closure of multiple muscular ventricular septal defects in a premature infant with novel use of Amplatzer Duct Occluder II – a case report. Videosurgery and Other Miniinvasive Techniques, 6(1), 33-36. https://doi.org/10.5114/wiitm.2011.20991 Chicago Haponiuk, Ireneusz, Maciej Chojnicki, Radosław Jaworski, Mariusz Steffek, Jacek Juściński, Mariusz Sroka, and Lucyna Pałkowska. 2011. "Miniinvasive hybrid closure of multiple muscular ventricular septal defects in a premature infant with novel use of Amplatzer Duct Occluder II – a case report". Videosurgery and Other Miniinvasive Techniques 6 (1): 33-36. doi:10.5114/wiitm.2011.20991. Harvard Haponiuk, I., Chojnicki, M., Jaworski, R., Steffek, M., Juściński, J., Sroka, M., and Pałkowska, L. (2011). Miniinvasive hybrid closure of multiple muscular ventricular septal defects in a premature infant with novel use of Amplatzer Duct Occluder II – a case report. Videosurgery and Other Miniinvasive Techniques, 6(1), pp.33-36. https://doi.org/10.5114/wiitm.2011.20991 MLA Haponiuk, Ireneusz et al. "Miniinvasive hybrid closure of multiple muscular ventricular septal defects in a premature infant with novel use of Amplatzer Duct Occluder II – a case report." Videosurgery and Other Miniinvasive Techniques, vol. 6, no. 1, 2011, pp. 33-36. doi:10.5114/wiitm.2011.20991. Vancouver Haponiuk I, Chojnicki M, Jaworski R, Steffek M, Juściński J, Sroka M et al. Miniinvasive hybrid closure of multiple muscular ventricular septal defects in a premature infant with novel use of Amplatzer Duct Occluder II – a case report. Videosurgery and Other Miniinvasive Techniques. 2011;6(1):33-36. doi:10.5114/wiitm.2011.20991.

Delayed Closure of Multiple Muscular Ventricular Septal Defects in an Infant after Coarctation Repair and a Hybrid Procedure�A Case Report

There are several strategies of surgical approach for the repair of multiple muscular ventricular septal defects (mVSDs), but none leads to a fully predictable, satisfactory therapeutic outcome in infants. We followed a concept of treating multiple mVSDs consisting of a hybrid approach based on intraoperative perventricular implantation of occluding devices. In this report, we describe a 2-step procedure consisting of a final hybrid approach for multiple mVSDs in the infant following initial coarctation repair with pulmonary artery banding in the newborn. At 7 months, sternotomy and debanding were performed, the right ventricle was punctured under transesophageal echocardiographic guidance, and the 8-mm device was implanted into the septal defect. Color Doppler echocardiography results showed complete closure of all VSDs by 11 months after surgery, probably via a mechanism of a localized inflammatory response reaction, ventricular septum growth, and implant endothelization.

Ventricular septal defect closure in a small children with the Amplatzer Duct Occluder II

Transcatheter technique for muscular ventricular septal defect closure remains challenging, particularly in small patients. We report the successful use of the low profile Amplatzer Duct Occluder II for multiple ventricular septal defect closure in an infant with D-transposition of the great arteries, status postpulmonary artery banding. The multiple apical ventricular septal defects were successfully closed with two Amplatzer Duct Occluder II and one Amplatzer Muscular Ventricular Septal Defect Occluder during two interventional catheterizations. The patient subsequently underwent successful surgical repair.

Successful Repair of Multiple Muscular Ventricular Septal Defects Using a Unique Hybrid Procedure

The surgical management of multiple muscular ventricular septal defects (mVSDs) in the infant remains a challenging problem because of the presence of residual shunts and postoperative myocardial dysfunction. We present a case of successful repair of multiple mVSDs with a unique hybrid procedure combining both the perventricular closure and open surgical repair.

Internal Right Ventricular Band for Multiple Ventricular Septal Defects in a Neonate Undergoing Arterial Switch and Aortic Arch Repair

A neonate presented with d-transposition of the great arteries, aortic arch hypoplasia, aortic coarctation, and multiple ventricular septal defects. During the arterial switch procedure and the aortic arch repair, a fenestrated Gore-Tex disk (W.L. Gore & Assoc, Flagstaff, AZ) was sewn into the right ventricular outflow tract to restrict pulmonary blood flow. The internal right ventricular band successfully controlled the pulmonary blood flow, maintaining a systemic oxygen saturation of 88% to 92%, and allowing growth from 3.5 to 10.5 kg. At 8 months of age, the internal band in the patient was removed, and the ventricular septal defects were successfully closed.

Surgical repair of D-TGA with an aortopulmonary window and ventricular septal defects

D-Transposition of great arteries with an aortopulmonary window is a rare congenital anomaly. We describe a case of D-Transposition of great arteries with an aortopulmonary window and multiple ventricular septal defects in a 5-month boy who underwent successful surgical repair.

Posttraumatic Coronary Artery-Right Ventricular Fistula with Multiple Ventricular Septal Defects

The combination of posttraumatic coronary artery-right ventricular fistula and multiple ventricular septal defects is a rare and interesting phenomenon. We describe a case of a 19-year-old male with these findings following a blunt chest trauma after a motorcycle accident.

Spontaneous Closure of a Ventricular Septal Defect in a Horse

Spontaneous Closure of a Ventricular Septal Defect in a Horse