VSD Treatment Research Articles

The 3-year follow-up of a fully biodegradable implantable device closure for perimembranous ventricular septal defects in children using echocardiography.

The aim of this study was to investigate the morphologic changes of a novel fully biodegradable implantable device after closing a perimembranous ventricular septal defect (Pm-VSD) and to evaluate the effect of the occluder on the myocardial function in patients during a 3-year follow-up period. One-year, 2-year, and 3-year follow-ups were carried out after implantation with a total of 30 Pm-VSD patients who had successful closure by the fully biodegradable occluder. In total, 30 healthy children were enrolled as controls. At discharge and at every follow-up visit, the lengths of the left and right discs of the novel device were measured in the apical three- and four-chamber as well as short-axis views. At the end of the follow-up, using three-dimensional speckle-tracking conditions, the values of myocardial deformation, including global longitudinal strain, global circumferential strain, and global area strain, were acquired. The fully bioabsorbable double-disc occluder gradually decreased over time and was eventually invisible under echocardiographic scanning during the follow-up (p < 0.05). At the end of the third year, there were no significant differences in the myocardial deformation parameters between the cases implanted with the novel devices and the controls; no significant differences were found between the basal segments of the ventricle septa and that of the left ventricle (LV) free wall among the patients who completed the Pm-VSD closure using the fully biodegradable occluder (p > 0.05). The novel fully biodegradable occluder is a safe, effective, and perfect alternative for the treatment of VSD. Echocardiography plays a crucial role in the follow-up of this new type of occluder implantation.

Clinical efficacy of flap transplantation combined with vacuum sealing drainage and methylprednisolone and cyclosporine in the treatment of pyoderma gangrenosum.

This study was aimed to evaluate the clinical efficacy of flap transplantation combined with vacuum sealing drainage and methylprednisolone and cyclosporine in the treatment of ulcer wound of patients with pyoderma gangrenosum (PG). From August 2014 to February 2022, 30 patients with pyoderma gangrenosum ulcer wounds were selected as the research objects and randomly divided into the observation group (n=12) and the control group (n=18) in this retrospective study. The patients in observation group were treated with VSD combined with flap transplantation and immunosuppressive agent treatment, while the control group was treated with normal dressing change combined with hormone and cyclosporine. The ulcer wound healing time and dressing change times were compared between the two groups. All the 30 cases of two groups healed after corresponding treatment. The wound healing time of ulcer in the observation group was 35-40 days, with an average healing time of (35.83 ± 1.95) days, and the wound healing time of the control group was 60-200 days, with an average healing time of (44.14 ± 9.67) days. The healing time of observation groups was significantly shorter than that in the control group (t=4.652, P < .05). The frequency of dressing change in the observation group was seven-eight times, with an average of (7.17 ± 0.39) times, and the frequency of dressing change in the control group was 75-86 times, with an average of (79.22 ± 3.62) times. The difference between the two groups was significant (t=6.214, P < .05). The treatment of VSD combined with flap transplantation and immunosuppressive agent treatment promote ulcer wound healing of pyoderma gangrenosum.

Techniques, Timing, and Prognosis of Transcatheter Post Myocardial Infarction Ventricular Septal Defect Repair.

This review aims to delineate the actual role of percutaneous intervention in the closure of post-myocardial infarction ventricular septal defect (post-MI VSD) and to briefly summarize the main steps of this procedure. Most of the published studies report experiences using Amplatzer devices for post-MI VSD closure. In the acute phase, morbidity and mortality are quite high up to 70%, with a mean success rate of 90%, with 95% confidence intervals from 60 to 100%, and a 30-day mortality of 40%, with 95% confidence intervals from 0 to 55%. In the chronic phase, that is 14days after myocardial infarction, results are very encouraging, with lower morbidity and mortality (23% at 30days) and a higher rate of complete closure. A multimodality imaging approach has been proposed in order to increase the success rate of this procedure. Percutaneous closure is a safe and effective procedure in highly specialized centers and an appropriate patient selection is of paramount importance to the success of the procedure. Device closure of post-MI VSD can be considered a true alternative to the standard surgical approach. However, many problems still exist for percutaneous post-MI VSD treatment.

Utility of three-dimensional models in resident education on simple and complex intracardiac congenital heart defects.

Applications of three-dimensional (3D) printed models in medicine include preprocedure planning, patient education, and clinical training. Reproducing complex anatomy as a 3D printed model can be useful for understanding congenital heart defects (CHD). We hypothesized that using 3D printed models during didactic sessions with resident physicians will improve trainees' understanding of CHD. We performed a prospective, randomized educational intervention for teaching pediatric and pediatric/emergency medicine residents about simple (ventricular septal defect [VSD]) and moderately complex (tetralogy of Fallot [ToF]) CHD. Residents were divided into two groups: intervention and control. Each group completed a subjective survey about their comfort with the anatomy, evaluation, and treatment of VSD and ToF and took an objective test on VSD and ToF. They separately received the same 20 min lecture, including projected two-dimensional digital images of VSD and ToF; the intervention group was given 3D printed models created using the same imaging data. After the lecture, the groups repeated the survey and test questions. Twenty-six residents participated in the VSD session, 34 in the ToF. There were no differences in demographics between control and intervention groups. All residents had higher subjective comfort with VSD and ToF after the lectures. There was no difference in baseline test scores for VSD or ToF groups. The control group scored higher on the VSD postlecture test. The intervention group scored higher on the ToF postlecture test. Incorporation of 3D printed models into lectures about CHD imparts a greater acute level of understanding, both subjective and objective, for pediatric and combined pediatric/emergency medicine residents. There does not seem to be an added benefit for understanding ventricular septal defects, but there is for tetralogy of Fallot, likely due to increased complexity of the lesion and difficulty visualizing spatial relationships in CHD with multiple components.

Hybrid Surgical Approach Using Amplatzer Occluder for Treatment of VSD in a Cat

Abstract Ventricular septal defect (VSD) is among the most common feline congenital heart malformations. Although usually treated by pulmonary artery banding or pharmacotherapy, neither method is curative. Curative procedures have been performed in humans. Treatment of VSD is usually not required in dogs and cats, but is necessary in cases of non-restrictive VSD. Dogs with non-restrictive VSD are treated either using surgical correction under open-heart surgery, or percutaneous insertion of an occluder under interventional radiation. In our experience, neither method alone is appropriate for treating ventricular septal defect in cats with non-restrictive VSDs. We have applied a hybrid surgical method in a 13-month-old, female Maine Coon cat weighing 3.5 kg. A catheter was inserted and an occluder placed directly at the defect through thoracotomy. This method is less invasive than open-heart surgery and requires no special equipment, using direct puncture of the heart to minimize the distance to the defect and improving maneuverability. By combining the advantages of both surgical defect closure and occlusion guided by interventional ultrasound, treatment that could not be performed with either method alone became possible. In this case, the VSD could not be embolized, but some important points were suggested regarding surgical treatment of VSD in cats. One is that a sizing balloon catheter may be the most accurate method to measure VSD in cats. Amplatzer occlusion of a large non-restrictive VSD in a cat is currently not an option, but the described hybrid technique may still be an option for smaller non-restrictive VSDs. However, criteria and adjustments must be considered carefully.

POSTINFARCTION VENTRICULAR SEPTAL DEFECT: OPERATE OR WAIT

The objective of this paper was to study the clinical applications of our decision algorithm in the treatment of post-infarction VSD at the Montréal Heart Institute.

Mortality and complications in 3495 children with isolated ventricular septal defects

BackgroundVentricular septal defects (VSDs) are the most common congenital heart defects (CHDs). Previous studies indicate an increased risk of endocarditis, aortic regurgitation, left ventricular outflow tract obstructions, pulmonary hypertension, arrhythmias...

Application of vacuum sealing drainage in the treatment of severe necrotizing fasciitis in extremities of patients

To study the application of VSD in the treatment of severe necrotizing fasciitis in extremities of patients. Eight patients, suffering from severe necrotizing fasciitis, who had been traditionally treated with iodophor-soaked gauze for 21 to 365 days in other hospitals, were transferred to our institute because of the nonhealing wounds and systemic toxic symptoms induced by infection, from January 2011 to August 2013. After admission, surgical debridement was performed timely, and the necrotic tissue was collected during the operation for pathological observation after HE staining. After the operation, VSD was started with negative pressure ranging from -100 to -80 kPa, and the furacilin solution (0.2 g/L) and oxygen (2 L/min) were continuously infused into the wound during the treatment. Surgical debridement was performed repeatedly according to the wound condition followed by change of VSD dressings to continue VSD treatment. The wounds were closed by suturing or with autologous skin grafts after being covered by fresh granulation tissue. The times of surgical debridement, times of change of VSD materials, wound healing status, and length of stay in our institute were recorded. All patients were followed up for a long time. Results HE staining showed that there were diffuse necrotic adipose and fibrous connective tissues in the necrotic tissue, and the normal tissue structure disappeared accompanied by significant infiltration of inflammatory cells. The number of surgical debridement was 2 to 10 (3.9 +/- 2.8) times. The number of VSD materials change was 2 to 10 (4.0 +/- 2.9) times. Wounds were closed by suturing and healed in two patients; wounds in the other six patients were partially sutured, their residual wounds were healed by autologous skin grafting. The length of stay in our institute was 20 to 49 (33 +/- 10) days. All patients were discharged after recovery. Patients were followed up for 2 to 24 months, and their wounds were found to be in good condition without ulceration or recurrence. VSD can effectively remove the necrotic tissues and exudates from the fascial spaces and promote proliferation of granulation tissue. Therefore it serves as an effective approach to the treatment of severe necrotizing fasciitis in extremities.

Application of clinical nursing path in VSD treatment for patients on wound nursing of micro-surgical infection

Objective To explore the prepare and implement the report of Clinical nursing path and its nursing application effects of micro-surgical wound infection, and regulate nursing management of VSD treatment. Methods A total of 50 patients received VSD treatment with clinical nursing path as experimental group during January to November 2013, and regression analysis 50 patients underwent VSD treatment and routine nursing during January to December 2012 as control group. All clinical data collected and analyzed. During VSD treatment, the index of health knowledge, sense of self-responsibility, and health duty in patients had been assessed effects in order to perfect and prove Clinical nursing path. Results The health knowledge, sense of self-responsibility, health duty, stress management, and patients satisfaction were (55.47±4.41), (25.53±1.60), (26.12±2.21), (23.96±2.14) and (3.80±0.39) higher than these of the control group (P<0.01). Conclusions Clinical nursing path is an effective method to treat wound infection of micro-surgery by VSD treatment, and can provide a quality nursing service, and enhance patients′ satisfaction. It can acquire an excellence economic benefits and has a certain application value for nursing process management. Key words: Clinical nursing path; Vacuum sealing drainage; Micro-surgical; Wound nursing

The nursing effect of closed negative pressure drainage on the treatment of traumatic tissue loss

Objective To study the effect of closed negative pressure drainage on the treatment of traumatic tissue loss.Methods The effects of closed negative pressure drainage on the treatment of traumatic tissue loss and the methods of VSD treatment and nursing were reviewed.Results The wound granulation of 48 patients was fresh,11 cases were still significantly exposed VSD again in the treatment of bone,in a row of free skin graft or flap wound healing,wound healing was all good,no complications.Conclusions To maintain an effective negative pressure,drainage tube nursing,strengthen psychological nursing and nutritional support,functional exercises instruction,is the key to guarantee the success of VSD. Key words: Closed negative pressure drainage; Limb trauma; Soft tissue injury; Bone exposure; Nursing

Clinical value of echocardiography in prenatal diagnosis, classification and follow-up of evolution in fetal isolated ventricular septal defect

Objective To study clinical value of echocardiography in prenatal diagnosis,classification and follow-up after birth of isolated ventricular septal defect (i-VSD).Methods In 6145 fetuses undergoing fetal echocardiography,95 fetuses were diagnosed with i-VSD.The characteristics of fetal echocardiography,pathological classification of i-VSD,findings of genetic examination and follow-up of evolution of VSD were analyzed.Results In 95 fetuses with i-VSD,color Doppler flow imaging displayed bi-directional shunts at the ventricular level.Defect sizes ranged from 0.9 mm to 13.4 mm,averaged (3.3 ± 2.0)mm.There were 60 cases (63.2％) with perimembranous i-VSD,33 cases (34.7％) with muscular i-VSD,1 cases (1.1％)with subarterial i-VSD,1 cases (1.1％) with multiple i-VSD.Chromosome tests were performed successfully in 32 cases.Among these cases,there were 3 cases (9.4％) with Trisomy 21,1 case (3.12％)with Trisomy 18 and 28 cases with normal chromosomes.Among the cases,14 were lost to follow-up,50 were life labor,5 were stillbirth,23 were induced abortion and 3 had not finished follow-up.Among 50 cases of life labor,VSD were naturally closed in 13 cases (25％) prenatally or in one year after the birth.VSD were surgically repaired in 2 cases after birth.35 cases were still under follow-up.Conclusions Solitary and perimembranous i-VSDs were the most common types.Part of fetal i-VSDs naturally closed after birth.Prenatal i-VSD is a valuable suggestive clue for genetic abnormalities.Echocardiography has an important value in prenatal diagnosis,follow-up and treatment of VSD and may play an important role in predicting fetal genetic abnormality. Key words: Ultrasonography,prenatal; Heart septal defect,ventricular; Chromosome aberrations

主題II-1-11 PDAを伴う心室中隔欠損症の外科治療

主題II-1-11 PDAを伴う心室中隔欠損症の外科治療

PDAとVSD合併例における外科治療の検討

PDAとVSD合併例における外科治療の検討

主題II-A-7 著明な肺高血圧を伴う心空中隔欠損症の乳幼児期根治手術の検討

主題II-A-7 著明な肺高血圧を伴う心空中隔欠損症の乳幼児期根治手術の検討