Treatment Of Ventricular Septal Defect Research Articles

A Case Report of the Repair of Coarctation of the Aorta by Stenting in an Infant with Ventricular Septal Defect Due to Placement of a Large Amplatzer During Ductus Arteriosus

Introduction: Diagnosis and treatment of ventricular septal defect (VSD) during infancy is of great importance in improving the infant’s health. Patent ductus arteriosus (PDA) and coarctation of the aorta are the most common disorders associated with VSD. Patent ductus arteriosus needs to be closed using surgical or non-surgical procedures. This article aims to present a case of repairing coarctation of the aorta by stenting in an infant with VSD due to the placement of a large Amplatzer during ductus arteriosus closure. Case Presentation: The patient was a one-and-a-half-year-old girl with Down syndrome and congenital heart disease. In the initial examination, a second loud heart sound and a systolic ejection murmur could be heard at the left sternal border. The results of the previous echocardiography showed the presence of VSD, PDA, and coarctation of the aorta. She underwent angioplasty a few months ago, and since the coarctation had not been repaired by balloon aortoplasty due to a large amplatzer. Therefore, the surgeon could not repair the VSD because of uncorrected pulmonary hypertension. Hence, we decided to repair the coarctation by stenting. After two weeks of medication treatment, the patient underwent angiography, and a formula stent placement was done for the patient. Conclusions: Pulmonary artery blood flow correction is an effective factor in treating patients with VSD that can be achieved by using the correct amplatzer placement. We corrected the aortic coarctation caused by improper amplatzer placement using stenting.

Follow up and outcome of transcatheter device closure in pediatric patients in a tertiary cardiac centre of Nepal

BackgroundCongenital heart diseases have significant effect on the growth and development of a child. Timely intervention helps a child to grow and develop to full potential. Cardiac interventionists have not long ago developed methods to cure conditions via transcatheter methods like device closures for shunt lesions. These interventions have been hugely accepted and applied all over the world. ObjectivesThe aim of this study was to determine the outcome of Transcatheter device closure in Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD) and Patent Ductus Arteriosus (PDA) in terms of improvement in echocardiographic parameters and nutritional well-being. It also outlined the immediate and long term complications of Transcatheter device closure of the shunt lesions. MethodologyA prospective study was carried out among 129 pediatric patients who underwent Transcatheter device closure of shunt lesions at Shahid Gangalal National Heart Centre from March 2019 to March 2021. Simple convenient, consecutive non-probability sampling method was used for the study.Independent sample t-test was applied to see the correlation and significance of continuous variables and Linear regression was used to find out relation between weight gain and device closure. ResultsAmong 129 pediatric patients having either ASD, PDA or VSD without other comorbidities who underwent transcatheter device closure at Shahid Gangalal National Heart Centre, there was 1 mortality (0.7 %), 3 device embolization (2.3 %), 11 (8.5 %) tiny residual leaks, 6 (4.6 %) femoral artery thrombosis, 19 (14.7 %) Left ventricular systolic dysfunction, 4 (3.1 %) new onset arrhythmia, 13(10.0 %) new onset trivial AR and 2 (1.5 %) mild obstruction to surrounding structures. There were no long term complications observed during the study period. Pulmonary artery pressures improved in most along with normalization of chamber dilatation. There was significant improvement in weight of children at the end of one year follow up (P < 0.001), however among individual shunt lesion, only patients undergoing PDA device closure demonstrated significant weight gain. ConclusionTranscatheter device closure is a promising, safe and effective means of treatment for ASD, PDA and VSD. It has significant bearing in weight gain as well as general well-being of children. Judicious selection of cases, proficient expertise and availability of suitable infrastructures are paramount for successful outcome.

Tricuspid valve detachment for ventricular septal defect closure: A meta-analysis of existing evidence.

Ventricular septal defect (VSD) is one of the most common congenital cardiac defects. However, in some cases, VSD sites are difficult to expose due to obstruction from chordal attachments and leaflets of the tricuspid valve (TV). To systematically review the efficacy and safety of tricuspid valve detachment, (TVD) versus conventional surgical repair (non-TVD) in the treatment of ventricular septal defect (VSD). This article is aimed to compare the many outcomes from existing studies and provide evidence regarding the necessity of performing TVD. We searched the following databases: PubMed via NCBI, the Cochrane Central Register of Controlled Trials (no date restriction), Medline via Ovid (from 1966 to May 2020); Embase via Ovid (no date restriction), and China National Knowledge Infrastructure for studies comparing the efficacy of TVD and other surgical techniques in VSD repair. Cardiopulmonary bypass time, Cross-clamp time; postoperative complications including residual defect, postoperative atrioventricular block, implantation of pacemakers, tricuspid regurgitation; length of stay (LOS), length of intensive care unit (ICU) stay were analyzed. Only nine studies were included after selection, including seven retrospective cohort studies, one respective cohort study, and one prospective observational study, a patient pool of 1404 patients with 374 underwent TVD and 1030 underwent non-TVD procedures, met the inclusion criteria. Meta analysis has drawn to the following conclusions. First, TVD prolongs CPB time (MD = 7.75, 95% confidence interval [CI] = 2.60-12.89, p = .003) and cross-clamp time (MD = 7.77, 95% CI = 4.76-10.78, p < .001) compared with non-TVD techniques in VSD repair surgeries. Second, no significant difference exists in LOS, length of ICU stay, postoperative atrioventricular block, implantation of pacemakers, incidence of ≥mild tricuspid valve regurgitation (TR) postoperatively and at discharge, as well as the incidence of ≥small residual VSD after surgery and during follow-up (all p ＞ .05). Third, application of TVD increases the risk of TR during follow-up (odds ratio [OR] = 2.42, 95% CI = 1.55-3.76, p < .001). VSD closure using TVD technique results in longer CPB and cross-clamp time, and increases risk of TR during follow-up. TVD provides equally viable and safe alternative in treating VSD.

Evolution of surgery of ventricular septal defect closure

A ventricular septal defect is one of the foremost prevalent congenital heart defects, accounting for around 20% of all congenital heart malformations.&lt;br /&gt; Nowadays, there are three surgical methods for ventricular septal defect: surgical treatment of ventricular septal defect with a heart-lung machine, interventional closure of ventricular septal defect by percutaneous puncture, and hybrid operation (with no heart-lung machine).&lt;br /&gt; Hybrid operation – there is some of the latest evolutions introduced in cardiac surgical treatment practice. This technique is mild, to reduce surgical trauma, and perform not connecting the patient to the heart-lung machine, without X-ray exposure, and there are additional indications than the interventional procedure.&lt;br /&gt; The article reviewed literature sources on the surgical treatments of the ventricular septal defect and the results of the above methods, and also considers more detail especially hybrid operation (without a heart-lung machine).

Incidence, Clinical Features, and Association with Prognosis of Bloodstream Infection in Pediatric Patients After Percutaneous or Surgical Treatment for Ventricular Septal Defect or Atrial Septal Defect: A Retrospective Cohort Study.

Bloodstream infection (BSI) may occur after cardiac procedures, but this has rarely been investigated specifically in pediatric patients after percutaneous or surgical treatment for ventricular septal defect (VSD) or atrial septal defect (ASD) with recent data. The current study aimed to investigate the incidence, clinical features, and association with prognosis of BSI in this patient population. Pediatric patients who received percutaneous or surgical procedure for VSD or ASD between 2010 and 2018 in a large children's hospital in China were retrospectively enrolled via the Pediatric Intensive Care database, but only those who had blood culture records within 24h after the procedure and who had no prior positive blood culture records were included. BSI after the procedure was identified by reviewing blood culture records, and baseline characteristics associated with BSI were explored by univariable logistic regression. In-hospital mortality and length of hospitalization were studied as prognostic outcomes and compared between patients with and without BSI. A total of 1340 pediatric patients were included. Among them, 46 (3.43%) patients had BSI within 24h after the procedure, of which the majority (78.26%, 36/46) were caused by Gram-positive bacteria and 65.22% (30/46) had antibiotic-resistant organisms. Age [odds ratio (OR) 0.98 per 1-month increase, 95% confidence interval (CI) 0.97-1.00, P = 0.021] and antibiotic use within 72h before the procedure (OR 1.81, 95% CI 1.00-3.26, P = 0.049) were statistically significantly associated with developing BSI. Compared with patients without BSI, there was no statistically significant difference in in-hospital mortality (0.00% versus 0.54%, P = 1.000), but patients with BSI had statistically significantly longer length of hospitalization (median 14.51 versus 12.94days, P = 0.006), while the association was not statistically significant after adjustment for baseline characteristics by multivariable linear regression (β = 1.73, 95% CI -0.59 to 4.04, P = 0.144). BSI is relatively uncommon in pediatric patients after procedures for VSD or ASD, but a younger age seems a risk factor. Developing BSI appears to be associated with increased length of hospitalization but not in-hospital mortality.

Health-related quality of life in children with congenital heart disease following interventional closure versus minimally invasive closure.

IntroductionThe presence of atrial septal defect (ASD) or ventricular septal defect (VSD) significantly affects children’s quality of life and, if not treated adequately, can contribute to increased mortality. In this study, we evaluated and compared the health-related quality of life (HRQL) of children who underwent treatment using either minimally invasive closure (MIC) or interventional closure (IC).Materials and methodsIn this observational and comparative study 199 children (2 to 4.5 years of age) underwent closure treatment for simple ASD or VSD at the Children’s Hospital of Chongqing Medical University between February 2021 and September 2021. Of these, 116 were treated with IC and 83 with MIC. Both preoperative and postoperative HRQL scores were assessed using the PedsQLTM3.0 Cardiac Module and the children were followed up at 3 and 6 months after surgery.ResultsThe two groups did not differ significantly in terms of demographics, baseline clinical characteristics, or pre-operative data. The duration of anesthesia (45 mins vs. 109 mins), procedures (25 mins vs. 48 mins), and length of postoperative hospital stay (4.32 days vs. 6.87 days) in the IC group were significantly less than in the MIC group (P < 0.001). The incidence of postoperative pneumonia in the VSD patients who underwent MIC was significantly higher than in those who underwent IC treatment (28.9% vs. 0 percent, P < 0.001). The HRQL scores increased significantly in both groups following treatment and follow-up evaluations (P < 0.001). The mean HRQL score of the IC group 3 months after treatment was significantly higher than that of the MIC group (88.9 vs. 85.7, P < 0.001), indicating a significant increase from the baseline score compared with the MIC group (5.4 vs. 2.6, P < 0.001). The IC group also showed higher scores than the MIC group (P < 0.05) in the dimensions of “Heart Problems and Treatment,” “Treatment Anxiety,” and “Cognitive Problems,” with higher scores indicating fewer problems.ConclusionThe health-related quality of life in children with ASD and VSD improved continuously regardless of IC or MIC intervention. However, IC led to better HRQL in the early postoperative stage.

Tactics of Surgical Treatment of Postinfarction Ventricular Septum Rupture Depending on the Time after the Development of an Acute Myocardial Infarction

The article is dedicated to topical issues of the tactics of surgical treatment of postinfarction ventricular septum rupture (PIVSR). Based on the study of the peculiarities of surgical treatment of ventricular septal defect in patients with different deadlines for surgical intervention after the development of acute myocardial infarction (AMI), the most appropriate approach to the correction of PIVSR in such patients was determined. In particular, taking into account mortality risk (42 %), the most reasonable is the use of wait-and-see tactics in the management of patients with PIVSR at the early stages after the development of AMI. At the same time, the decision on the timing of surgical intervention should be made individually, taking into account the clinical condition of the patient and the course of the postinfarction heart remodeling. Special attention is paid to the analysis of the effectiveness of the use of intra-aortic balloon counterpulsation and the time intervals of surgical intervention from the moment of hospitalization in patients with PIVSR. It was found that clinical course of coronary heart disease complicated by PIVSR can be extremely unpredictable not only in the early postinfarction period, but also up to 2 months after the development of AMI. In addition, when planning the amount of surgical intervention, it is necessary to take into account the presence of multivessel atherosclerotic lesions of the coronary arteries in patients with PIVSR, regardless of the timing after the development of AMI.

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.

Treatment of ventricular septal defect in children: Who, when, and how? A 20-years Lebanese multicentric retrospective study

Introduction: Ventricular Septal Defect (VSD) is a common congenital heart disease. Three therapeutic approaches exist to treat this anomaly: observation and regular follow-up, surgical closure, and Tran’s catheter intervention. We seek through this study to determine the appropriate indications for surgical and non­surgical treatment of VSD. Methods: We conducted a retrospective multicentric study between January 1, 2000 and June 30, 2020 on 942 VSD carriers. Cases with isolated VSD were studied for age of presentation, sex, type of VSD, and VSD outcome. Results: Majority of our patients (60.5%) had a perimembranous VSD. During 20 years of follow-up, 220 underwent an intervention for their cardiac anomaly (either surgery or catheterization) and 722 received medical treatment and were under observation. Among patients who were solely monitored, 36.7% patients had a complete spontaneous closure of their VSD, 20.9% had a partial closure, and 39.9% had an unchanged VSD size. Patients with perimembranous and inlet types were significantly more likely to undergo an intervention (p=0.018). The most common reason behind intervention was severe pulmonary arterial hypertension seen in 140 cases. Furthermore, 18 cases out of 457 unclosed VSD developed complications during follow-up. Conclusion: We found that 36.7% of VSDs might totally close over time, particularly if VSD is of muscular type. This rate might also increase with a longer follow-up period.

Treatment of ventricular septal defect in children: Who, when, and how? A 20-years Lebanese multicentric retrospective study

Treatment of ventricular septal defect in children: Who, when, and how? A 20-years Lebanese multicentric retrospective study

Features of surgical treatment of ventricular septal defect at different times after acute myocardial infarction

Features of surgical treatment of ventricular septal defect at different times after acute myocardial infarction

Optimization of Esophageal Ultrasound under Artificial Fish Swarm Algorithm and Its Adoption in Treatment of Ventricular Septal Defect

This work was aimed at exploring the adoption value of the optimized and upgraded esophageal ultrasound in the treatment of patients with ventricular septal defect (VSD) by artificial fish swarm algorithm. A model was built based on artificial fish swarm algorithm. A random ultrasonic optical signal in the database was decomposed several times and sparsity was optimized to complete partial optimization, which was then extended to global optimization. A total of 100 patients with ventricular septal defect were divided into control group who underwent cardiopulmonary bypass under the guidance of three-dimensional thoracic ultrasound and experimental group of ventricular septal defect occlusion under the guidance of esophageal ultrasound based on artificial fish swarm algorithm. The results showed that the number of successful cases in the experimental group was 12 cases of perimembranous type, 10 cases of septal type, 7 cases of simple membranous type, 13 cases of muscular type, 4 cases of subdry type, and 2 cases of ridge type. The average length of operation after surgery was 70.65 minutes, the average length of ventilator ventilation was 125.8 minutes, and the average length of intensive care unit was 377.9 minutes. The average length of hospital stay after surgery was 5.6 days, and the average total length of hospital stay was 8.2 days, which were better than the control group in many aspects, with statistical significance ( P &lt; 0.05 ). In short, the artificial fish swarm algorithm for esophageal ultrasound-guided ventricular septal defect closure had short operation time and good postoperative effect, which was of high application value in the clinical treatment of patients with ventricular septal defect.

Outcomes of Tricuspid Valve Detachment for Isolated Ventricular Septal Defect Closure.

Partial detachment of the septal and anterior leaflets of the tricuspid valve (TV) is a technique to visualize a perimembranous ventricular septal defect (VSD) for surgical closure in cases where the VSD is obscured by TV tissue. However, TV incision bears the risk of causing relevant postoperative TV regurgitation and higher degree atrioventricular (AV) block. A total of 40 patients were identified retrospectively in our institution who underwent isolated VSD closure between January 2013 and August 2015. Visualization of the VSD was achieved in 20 patients without and in 20 patients with additional partial detachment of the TV. The mean age of patients with partial tricuspid valve detachment (TVD) was 0.7 ± 0.1 years compared with 1 ± 0.3 years ( p = 0.22) of patients without TVD. There was no difference in cardiopulmonary bypass time between patients of both groups (123 ± 11 vs. 103 ± 5 minutes, p = 0.1). Cross-clamp time was longer if the TV was detached (69 ± 5 vs. 54 ± 4 minutes, p = 0.023). There was no perioperative mortality. Echocardiography at discharge and after 2.5 years (2 months–6 years) of follow-up showed neither a postoperative increase of tricuspid regurgitation nor any relevant residual shunt. Postoperative electrocardiograms were normal without any sign of higher degree AV block. TVD offers enhanced exposure and safe treatment of VSDs. It did not result in higher rates of TV regurgitation or relevant AV block compared with the control group.

Transposition of the Great Arteries, Ventricular Septal Defect, and Pulmonary Stenosis: Modified REV versus Rastelli

The objective of this study was to evaluate and compare the results of the modified réparation à l'ètage ventriculaire (REV) and the Rastelli operation for the treatment of transposition of the great arteries (TGA), ventricular septal defect (VSD), and pulmonary stenosis (PS). Records of 38 patients who underwent the modified REV (n = 16) or the Rastelli operation (n = 22) for the treatment of TGA, VSD, and PS between 2010 and 2019 were reviewed. The median age was 2.2 years (range 0.6-8.0 years) and the median weight was 11.3 kg (range 6.4-22.0 kg). No in-hospital death occurred and there were 4 early reoperations (two in each group). Overall survival at 10 years was 97.4% (100% in Modified REV group and 95.5% in Rastelli group, P = 0.39). Freedom from left ventricular outflow tract (LVOT) reoperation was 100% in both groups. Freedom from right ventricular outflow tract (RVOT) reoperation was 100% in Modified REV group and 75.4% in Rastelli group (P = 0.073). Event-free survival was 100% in Modified REV group and 72.0% in Rastelli group (P = 0.048). The most recent echocardiography showed that LVOT peak gradient was less than 10 mmHg in all patients. In Modified REV group, 30.8% of patients (4/13) had either RVOT obstruction (RVOT peak gradient more than 40 mmHg) or moderate or severe pulmonary insufficiency, while conduit stenosis (peak gradient more than 40 mmHg) was found in 25.0% of patients (3/12) in Rastelli group. The modified REV and the Rastelli operation provide satisfactory early results, as well as long-term survival and LVOT performance. However, the modified REV has better RVOT performance.

The Pulmonary Arterial Hypertension Associated With Ventricular Septal Defects: A Single-Centre Experience In The Republic Of Kazakhstan.

The aim of this study was to evaluate the impact of pulmonary arterial hypertension on outcomes following surgical or transcatheter repair of isolated ventricular septal defect in the Republic of Kazakhstan.&nbsp;Echocardiography and catheterisation reports of children with isolated ventricular septal defect complicated pulmonary arterial hypertension surgical or transcatheter repair between 2012 and 2016.Amongst 38 children ventricular septal defect mean size was 10.92 ± 6.38mm. The mean systolic pressure in the right ventricle on Echocardiography was 55.42 ± 18.47 mmHg.&nbsp; Mean pulmonary arterial pressure by right heart catheterisation was 52.12 ± 29.44 mmHg.&nbsp; The mean end diastolic index for all children was registered as 76.78±19.58ml. Cardiac output was preserved in all children. In the pre-operative period, 9 of these children were treated with sildenafil.One week after the operation, mean right ventricle systolic pressure decreased as for children who did not receive preoperative sildenafil (from 55.5±14.8mmHg to 32.2±14.4mmHg) (p &lt;0.01), as for children who did (from 81.4±10.3mmHg. to 48.1±12.4mmHg (p value &lt; 0.01)). End diastolic index normalized in 92.5% of cases. Right ventricle systolic pressure decreased &gt;40% in all children a month after the surgery.In our study prescription of specific drug therapy of pulmonary arterial hypertension with the purpose of preparing for surgery has no effect on the effectiveness of surgical treatment of ventricular septal defect. We had had no early postoperative mortality.

Comparisons of periventricular device closure, conventional surgical repair, and transcatheter device closure in patients with congenital ventricular septal defects: A Protocol for Systematic Review.

Surgical treatments for ventricular septal defects (VSDs) mainly include 3 approaches: conventional surgical repair (CSR), transcatheter device closure (TDC), and perventricualr device closure (PDC). PDC has been introduced in over 10 years, although there remain concerns about adverse events. This network meta-analysis is to compare PDC, CSR, and TDC in the treatment of congenital VSD. We will search MEDLINE, EMBASE, Clinical Trials, Cochrane Library, and China National Knowledge Infrastructure databases for comparative studies on device closure and conventional repair for congenital VSDs to August 2019. A network meta-analysis with frequentist frame will be performed to compare the 3 approaches involving the success rate, in-hospital indexes, and incidences of complications, using risk ratio with 95% confidence intervals. This study will be submitted to a peer-reviewed journal for publication. This network meta-analysis will assess the safety and efficacy of PDC, CSR, and TDC in the treatment of congenital VSDs, and provide more evidence-based guidance in clinical practice. CRD42019125257.

Outcomes of Patients Undergoing Surgical Management of Multiple Ventricular Septal Defects

Surgical treatment of multiple ventricular septal defects (VSDs) has advanced significantly in recent years, yet remains technically challenging. With high rates of complications and reoperations, we sought to assess the outcomes of patients undergoing a variety of management techniques for multiple VSDs. From 1988 to 2015, 157 consecutive patients underwent surgical management of multiple VSDs at a median age of 2.2 months (2 days-16 years). Sixty-nine patients (44%) had exclusively multiple VSDs, 62 patients (39%) had multiple VSDs with concomitant intracardiac anomalies, and 26 patients (17%) had multiple VSDs with aortic arch anomalies. The predominant techniques used at the initial operations were patch closure (84 patients), pulmonary artery band (83 patients), suture closure (37 patients), and sandwich technique (13 patients). Eighteen patients underwent ventriculotomies. There were 3 hospital deaths (2%). Mean follow-up time was 8.6 ± 6 years (1 day-22 years). Four patients died during follow-up, whereas freedom from reoperations was 52% (95% confidence interval 42-61%) at 16 years. Freedom from reoperation was significantly lower in the 1988-2002 era than in the post-2002 era (38% vs 73%, P = 0.016). Pacemaker implantation was ultimately required in 9% (14 of 150) of patients. No deleterious impact of a ventriculotomy could be detected. Surgical treatment of multiple VSDs can be performed with excellent short- and long-term survival, and normal late functional outcome, however, carries a significant rate of reoperation. The recent inclusion of absorbable pulmonary artery bands and the sandwich technique appear safe and are useful adjuncts in these patients.

The natural history of fetal diagnosed isolated ventricular septal defect.

This study was undertaken to clarify the natural course of ventricular septal defect, and to find an index that would help in prenatal counseling. Between January 2010 and December 2014, 18188 fetuses underwent echocardiographic examinations. Of these, 228 isolated ventricular septal defect cases were retrospectively reviewed. In this retrospective study, the incidence of isolated ventricular septal defect was 1.25% (228/18188). There were 146 patients who underwent echocardiography after delivery in order to confirm the natural course of patients with isolated ventricular septal defect. Of the 146 cases, 64 cases (43.84%) had the ventricular septal defect naturally closed in the fetal period. Of the 82 patients with ventricular septal defect at birth, 25 patients showed natural closure during follow-up. However, four patients (2.74%) required surgical treatment for ventricular septal defect. In case of perimembranous defects, natural closure is more frequent in the fetal period than in the postnatal period. Our results indicate that 60.96% (89/146) of isolated ventricular septal defects diagnosed during the fetal life are closed naturally. Perimembranous type defect, small defect (<2mm) and maternal age less than 35years are the good prognostic factors for the natural closure during fetal life. © 2017 John Wiley & Sons, Ltd.

Evaluation of Different Minimally Invasive Techniques in Surgical Treatment for Ventricular Septal Defect

Minimally invasive cardiac surgery is becoming a safe and cosmetic alternative to standard median sternotomy (SMS). This retrospective study reviews our results and experience with the lower mini-sternotomy (LMS) technique and the right lateral thoracotomy (RLT) technique for ventricular septal defect (VSD) closure compared with SMS. Between January 2013 and Dec 2015, 198 patients underwent repair VSD through lower mini-sternotomy (LMS Group, n=66), right lateral thoracotomy (RLT Group, n=59), standard median sternotomy (SMS Group, n=73). Cardiopulmonary bypass was achieved directly in the three different approaches. Procedures were performed successfully in all patients among the three groups and no in-hospital mortality occurred. No patient was reverted to standard median sternotomy in the LMS Group and RLT Group. The CPB time was 37.73±11.46 mins in the LMS Group, 41.3±13.97 mins in the RLT Group and 36.99±10.84 mins in the SMS Group (p=0.078); the cross-clamp times were 23.85±9.78 mins in the LMS Group, 22.54±9.08 mins in the RLT Group and 19.23±6.92 mins in the SMS Group (p=0.009). The total incision length of the procedure in the SMS Group (7.45±1.54cm) was longer than the other groups (LMS Group, 5.58±0.8cm and RLT Group, 5.96±1.48cm) and the difference was significant (p<0.001). Both the LMS and RLT approach can be performed with favourable cosmetic and acceptable clinical results for closing VSD. They are the promising alternatives to standard median sternotomy and merit further study.

Tricuspid injury in 11 patients after interventional transcatheter closure for perimembranous ventricular septal defect

Objective To investigate the characteristics of the newly discovered tricuspid injury during the follow-up of the patients with interventional transcatheter closure for perimembranous ventricular septal defect (VSD). Methods A retrospective analysis of clinical data was performed in the successful completion of membranous VSD intervention from March 2003 to April 2015, and 11 cases of serious tricuspid injury in children were found during the follow-up. Results Among 11 children, 10 cases underwent surgery again, and in 7 cases of them with pseudoaneurysm of perimembranous septum, the occluders were deviated toward the right ventricul which caused valvular inadequacy for plate winding closures, extrusion and wear of tricuspid chordae and/or leaflet by right ventricul(RV) disc.Among them, 1 case was caused by leaflet fusion tear and tricuspid valve insufficiency; 3 cases without pseudoaneurysm were caused by a spindle like RV disc recovery structure protruding into the right ventricle, and then the disc squeezed the tricuspid tendinous cord or leaflet and the right ventricular disc nut wrapped tendon of tricuspid valve finally leading to tricuspid valve insufficiency.There was a small amount of tricuspid regurgitation after surgery; the cardiac size and cardiac function returned to normal.One case did not receive surgery, and at present the right atrium and right ventricle were significantly enlarged, and the activity was limited. Conclusions Tricuspid injury discovered newly after perimembranous VSD interventional therapy is more common in pseudoaneurysm with large tumor occluding the right ventricular disc resulting in poor formation, and it is important to consider these factors in choosing the size of the occluder and the operation.Long term follow-up mechanism should be established for the treatment of VSD after interventional therapy. Key words: Perimembranous ventricular septal defect; Interventional transcatheter closure; Tricuspid injury; Follow-up