Type Of Ventricular Septal Defect Research Articles

Small Ventricular Septal Defect Considered Not Requiring Surgical Closure: The Frequency of Developing Complications in Our Center

Objectives: The study was conducted to check the frequency of development of complication in the patients with small Ventricular Septal Defects (VSDs) considered not requiring surgical closure during childhood. Methods: A descriptive study was conducted on children from January 2015 to December 2015 at Children Hospital and Institute of Child Health, Lahore, Pakistan. The data with isolated VSDs considered too small to require surgery from 1 month to 15 years of age were reviewed. The data was analyzed with SPSS 20 version. Results: The total of 883 patients of restrictive VSDs considered not to require surgery, 60.6% (n=535) were males and 39.4% (n=348) were females. The significant number of patients i.e. 18.7% (n=166) developed complications. Aortic cusp prolapsed developed in 13.6% i.e. p≤0.05, 2.3% developed aortic regurgitation secondary to aortic cusp prolapsed. 1.8% developed right ventricular track outflow obstruction (RVOT) i.e. p≤0.05 and 0.3% of patient developed left ventricular outflow track obstruction (LVOT) i.e. p≤0.05. Similarly 0.8% patients developed endocarditis. Regarding types of VSD, we found Perimembranous in 65.8%, muscular in 12.6%, Subaorticin 8.3%, doubly committed in 6.0%, Inlet in 5% and outlet in 1.7% of our patients. Conclusions: Patients with small restrictive Ventricular Septal Defects (VSDs) generally been considered as do not required surgery, the data suggested that a significant percentage of these patients developed complications later in their life i.e., 18.7%.

Anesthetic management for cesarean section in a patient with uncorrected double-outlet right ventricle.

BackgroundWe describe the anesthetic management for cesarean section in a pregnant woman with uncorrected double-outlet right ventricle. The anesthetic method, treatment of complications and lessons are discussed.Case presentationA 28-year-old woman visited our emergency room for progressive dyspnea and recurrent hemoptysis at 30 weeks’ gestation. Her New York Heart Association functional class was III–IV. Echocardiography indicated that she had congenital heart disease of double-outlet right ventricle. She hadn’t received any treatment. The obstetrician decided to terminate the pregnancy by cesarean section. We chose epidural anesthesia and pumped phenylephrine at the same time to minimize hemodynamic fluctuation. Just in the process of changing position to supine position with uterus displaced to the left, the patient coughed badly and complained about dyspnea. At the same time, the oxygen saturation decreased quickly. The symptoms were ameliorated soon by treating as heart failure. But the symptoms reappeared after oxytocin administration. At the end of surgery, the baby was sent to the Neonatal Intensive Care Unit for premature birth. The mother recovered successfully and discharged 7 days later.Discussion and EvaluationDouble-outlet right ventricle is a seldom disease and pregnancy with uncorrected double-outlet right ventricle is rare. In this case, the patient belonged to the type of ventricular septal defect characterized by subaortic ventricular septal defect without pulmonary stenosis. Most of the aorta arises from the right ventricle, the volume of venous blood was injected from the right ventricle into the aorta, which decided the oxygen saturations. Compared to general anesthesia, epidural anesthesia reduces venous return and alleviates the cardiac burden. So, we pumped phenylephrine along with epidural anesthesia in case of critical cyanosis following significant blood pressure decrease. In the process of anesthesia, dyspnea, cough and cyanosis attacked the patient for two times. The most probable reason was heart failure which induced by the sudden increasing of returned blood. As a result of severe cough, pulmonary artery pressure increased rapidly. Then a great amount of venous blood was injected into the aorta and cyanosis became more serious as well as oxygen saturation declined quickly. ConclusionEpidural anesthesia with continuous phenylephrine infusion is a preferable choice for parturient women with uncorrected double-outlet right ventricle for cesarean section. It is not the optimal choice for this type of patients to lie on the left. The dose of oxytocin should be reduced to avoid potential cardiovascular complications.

Utility of dual source CT with ECG-triggered high-pitch spiral acquisition (Flash Spiral Cardio mode) to evaluate morphological features of ventricles in children with complex congenital heart defects.

We evaluated the ability of dual source CT (DSCT) with ECG-triggered high-pitch spiral acquisition (Flash Spiral Cardio mode) to depict the morphological features of ventricles in pediatric patients with congenital heart defects (CHD). Between July 2013 and April 2015, 78 pediatric patients with CHD (median age 4months) were examined using DSCT with the Flash Spiral Cardio mode. The types of ventricular abnormalities were ventricular septal defect (VSD) in 42 (the malaligned type in 11, perimembranous type in 23, supracristal type in 2, atrioventricular type in 2, and muscular type in 4), single ventricle (SV) in 11, and congenital corrected transposition of the great arteries (ccTGA) in 4. We evaluated the accuracy of the diagnosis of the VSD type. In cases of SV and ccTGA, we assessed the detectability of the anatomical features of both ventricles for a diagnosis of ventricular situs. DSCT confirmed the diagnoses for all VSDs. The type of defect was precisely diagnosed for all patients. The anatomical features of both ventricles were also depicted and ventricular situs of SV and ccTGA was correctly diagnosed. The results suggest that DSCT has the ability to clearly depict the configuration of ventricles.

Genome-wide copy number variant analysis for congenital ventricular septal defects in Chinese Han population.

BackgroundVentricular septal defects (VSDs) constitute the most prevalent congenital heart disease (CHD), occurs either in isolation (isolated VSD) or in combination with other cardiac defects (complex VSD). Copy number variation (CNV) has been highlighted as a possible contributing factor to the etiology of many congenital diseases. However, little is known concerning the involvement of CNVs in either isolated or complex VSDs.MethodsWe analyzed 154 unrelated Chinese individuals with VSD by chromosomal microarray analysis. The subjects were recruited from four hospitals across China. Each case underwent clinical assessment to define the type of VSD, either isolated or complex VSD. CNVs detected were categorized into syndrom related CNVs, recurrent CNVs and rare CNVs. Genes encompassed by the CNVs were analyzed using enrichment and pathway analysis.ResultsAmong 154 probands, we identified 29 rare CNVs in 26 VSD patients (16.9 %, 26/154) and 8 syndrome-related CNVs in 8 VSD patients (5.2 %, 8/154). 12 of the detected 29 rare CNVs (41.3 %) were recurrently reported in DECIPHER or ISCA database as associated with either VSD or general heart disease. Fifteen genes (5 %, 15/285) within CNVs were associated with a broad spectrum of complicated CHD. Among these15 genes, 7 genes were in “abnormal interventricular septum morphology” derived from the MGI (mouse genome informatics) database, and nine genes were associated with cardiovascular system development (GO:0072538).We also found that these VSD-related candidate genes are enriched in chromatin binding and transcription regulation, which are the biological processes underlying heart development.ConclusionsOur study demonstrates the potential clinical diagnostic utility of genomic imbalance profiling in VSD patients. Additionally, gene enrichment and pathway analysis helped us to implicate VSD related candidate genes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12920-015-0163-4) contains supplementary material, which is available to authorized users.

Abstract 15284: Blessing in Disguise: Absent Pulmonary Valve in an Adult Without Ventricular Septal Defect

Introduction: Congenital absence of the pulmonary valve (APV) is a rare cardiac malformation. Adults with this condition generally need corrective surgery before the age of 20. We report a unique case of an isolated APV in a Jamaican female who remained asymptomatic until presentation at the age of 39. Case: Patient presented to a local cardiologist with recent onset of NYHA II symptoms and atrial fibrillation. Her cardiovascular exam revealed a right ventricular (RV) heave , III/VI holosystolic murmur along right lower sternal border, III/VI early diastolic murmur in pulmonic area, no clinical signs of right heart failure (RHF). Diagnostics: An echocardiogram showed dilated RV outflow tract, APV, dilated main pulmonary artery (MPA) and severe pulmonary regurgitation (PR) (Figure 1A). RV size and function were quantified with cardiac MRI demonstrating RV end diastolic volume: 340 ml/m2 (Z score 11.9) and RVEF: 46% ( Z score -2.8) (Figure 1B). Flow data of the MPA showed a flow of 4.9L/min, severe PR with a regurgitant fraction of 48% and Qp/Qs of 1.1:1 (Figure 1C). Right heart catheterization demonstrated equalization of diastolic pressure in both RV and PA (52/10 mm Hg) diagnostic of free PR. (Figure 1D). Mean PA pressure was 24 mm Hg and pulmonary vascular resistance was 3 wu. On cardiopulmonary stress testing, the patient completed 10.6 METS, achieving a peak VO2 of 18.5 ml/kg/min at RER 1.1. Discussion: APV is commonly categorized as with or without ventricular septal defect (VSD). APV with VSD is commonly associated with tetralogy of Fallot (TOF). The distinguishing features from TOF are: unobstructed RV infundibulum and aneurysmally dilated PA. APV in its severe form presents in infancy with severe respiratory distress from bronchial obstruction caused by massively dilated PAs. Isolated APV (non VSD type) is a rare variant. Our report is the first in literature to illustrate isolated APV in an asymptomatic adult approaching the fourth decade of her life.

Amplatzer duct occluder II for closure of congenital Gerbode defects.

Congenital left ventricle to right atrial communications (Gerbode defects) are extremely rare (0.08%) type of ventricular septal defects. They were traditionally closed by surgery in the past. There are few case reports and small series of acquired and congenital Gerbode defects, closed with various types of devices. Aim of our study is to assess the feasibility, efficacy, and complications of transcatheter closure of congenital Gerbode defects with Amplatzer duct occluder II (ADO II). Twelve consecutive cases of Gerbode defects, age ranging from 10 months to 16 years (mean 6.7 years), weight ranging from 6.5 kg to 34 kg (mean 19.3 kg), were diagnosed on transthoracic echocardiography. Transcatheter closure of Gerbode defects was done successfully through retrograde approach with ADO II. No aortic or tricuspid regurgitation or residual shunt occurred in any of the patients. One patient developed transient complete heart block needing temporary pacing. The soft low profile, easily trackable ADO II appears to be ideal for closure of Gerbode defects, as the central cylinder fits in the defect and the soft retention discs on either side, without polyester material, do not impinge on either aortic, mitral, or tricuspid valve. We report the successful transcatheter closure of twelve cases of congenital Gerbode defects with ADO II. Transcatheter closure of congenital Gerbode defects with ADO II is safe, effective, and an attractive alternative to surgical closure. ADO II appears to be tailor made for Gerbode defects, as the success rate is very high and complication rate is very low.

Three-Dimensional Echocardiographic En Face Views of Ventricular Septal Defects: Feasibility, Accuracy, Imaging Protocols and Reference Image Collection

Ventricular septal defect (VSD) is the most common congenital cardiac anomaly. Accurate assessment is critical for planning treatment. Recent advances in three-dimensional (3D) echocardiography have improved image quality and ease of use. The feasibility and accuracy of three specific 3D echocardiographic protocols to demonstrate en face views of VSDs were analyzed in a retrospective review of 100 consecutive patients. Sixty-four patients underwent transthoracic echocardiography and 36 transesophageal echocardiography. Types of VSDs included 34 muscular, 32 perimembranous, 18 malaligned, 11 inlet, four outlet, and one acquired. Ages ranged from 1day to 77years, and body weights from 3 to 92kg. Three-dimensional echocardiographic full-volume mode with standard XYZ and adjustable plane cropping, 3D full-volume mode with iCrop, and narrow-sector live 3D protocols were compared for feasibility and accuracy to obtain a diagnostic-quality en face view of a VSD. The success rate for obtaining a high-quality en face image for the three protocols was 100% for full-volume mode with iCrop, 97% for full-volume standard mode, and 94% for narrow-sector live 3D mode. The ability of both full-volume mode with iCrop and full-volume standard mode to demonstrate a VSD was slightly better than that of narrow-sector live 3D mode (P<.001 for both vs narrow-sector live 3D mode). In all patients, the type, size, and location of the VSD were demonstrated accurately by two or more of the protocols. Three-dimensional echocardiography of VSDs is feasible and accurate in most patients using defined protocols. The protocols are described and illustrated in detail, and a reference 3D image collection is presented.

143 Natural History of Repaired and Unrepaired VSD – an Experience of a District General Hospital with Dedicated Adult Congenital Heart Disease Clinics

<h3>Background</h3> Ventricular septal defect are the most common congenital defect but only accounts for 10% of congenital defects in the adults due to spontaneous closure. The objective of this study is to review the natural course and outcomes of the repaired and unrepaired VSD in this large follow up cohort in non surgical (CHD) centre. <h3>Methods</h3> We reviewed the NORPAP database (n = 2322) and found 300 patients with ventricular septal defect (12.9% incidence) <h3>Results</h3> 137/300 were male, 163/300 (54%) were female. Age range 17–83, median age at FU was 39 years. Spectrum of type of ventricular septal defect is described Table 1 and associated concomitant cardiac lesions. Surgical closure of VSD occurred in 122 and percutaneous closure in 3 (total 125). 24/125 had redo surgery and 10/24 had 3^rd operation. 1/10 had 4^th, 5^th and 6^th procedure for repeated tricuspid valve obstruction (thrombus and pannus). 175 patients were unoperated at transition to adult clinic, 26 have since had spontaneous closure, 6 partial closure; 1 is waiting VSD closure. Arrhythmia incidence was low (33) and equal in both operated and unoperated. Atrial arrhythmias in 21, ventricular in 9, bradycardia requiring pacemaker in 3; overall incidence of device therapy was low (7). 22 patients had endocarditis – 9 had had previous surgery, 13 unoperated (1 twice). 12/163 (7.3%) females and 10 males/137 (7.3%) was against male preponderance. IHD disease was not a common associated feature of VSD n = 4. 10 patients had RVOT – obstruction associated VSD out of which 6 required resection and repair of VSD- 1 patient required further intervention due to LVOT-obstruction caused by aneurysmal septal patch 38 patients developed pulmonary hypertension out of which 21 patients had Eisenmenger syndrome. 32 patients were unoperated in this group while 6 patients developed pulmonary hypertension post repair <h3>Conclusion</h3> Ventricular septal defects associated with concomitant lesions require long term follow up in dedicated adult CHD clinics. Small unoperated VSD’s and repaired VSD’s can be followed in physiologist led echo clinics with ACH-CSN review as required to watch for late outflow tract obstruction or other sequelae. No death was reported in our cohort up to date. Over 50% of endocarditis in this cohort occurred in unoperated VSD’s

Review Of surgery of VSD in Ibn Al-Nafees Teaching Hospital

Background: Ventricular septal defect (VSD) is the most commonly recognized congenital heart defect. Isolated VSDs represent about 20-30% of all congenital cardiac malformations and have a prevalence of 1- 2 % per 1,000 live births.Objective: This study is planned to review the outcome of surgical closure of VSD at Ibn Al-Nafees Teaching Hospital (Department Cardiac Surgery) Baghdad/Iraq.Patients and methods: This study includes 50 cases of VSD both isolated and VSD associated with other congenital malformations admitted and underwent surgical repair of age range between 3 to 28 years and weight range between 9 to 80 kg. Different type of VSD, were found and repaired whether isolated or with other associated congenital anomalies which dealt with at the same time.Results: The following VSD types were found: 40 peri- membranous 80%, 3 outlet 6%, 5 inlet 10% and 2 muscular 4%. Additional surgery were 3 pulmonary valvotomy 6%, 3 right ventricular outflow patch 6%, 7 closure of atrial septal defect 14%, 2 excision of subaortic ridge 4% and 2 aortic valve replacement 4%. One patient required reoperation for bleeding. Four patients had complete heart block that required temporary pacemaker. Over all operative mortality were two cases (4%), median postoperative hospital length stay was 7 days (range 5-18 days).Conclusions: Surgical closure of VSD is a safe and effective therapy in isolated VSD or VSD with other malformations and reoperation is minimal. Other cardiac malformations can be repaired at the same time with the closure of VSD with good results and very minimal complications.

The association of ventricular noncompaction and apical long tunnel type ventricular septal defect causes electrocardiographic abnormality

The association of ventricular noncompaction and apical long tunnel type ventricular septal defect causes electrocardiographic abnormality

Ventricular septal defect repair in children during first year of life in a public hospital

Ventricular septal defect (VSD) is the most common congenital heart disease; primary surgical closure is the usual strategy for repairing it. Our objective is to describe results of surgical repair in children under 1 year of age and analyze risk factors for morbidity and mortality. Retrospective study; all patients with VSD repaired between 2004 and 2011 were included. Demographic, surgical procedure and postoperative variables were recorded: age, weight, genetic syndrome, type of VSD, length of stay, complications and outcome. Risk factors of mortality and morbidity: age < 6 m, weight < 3 kg, Down, malnutrition and respiratory infection prior syndrome were analyzed. 256 patients, age 5.3 months (21d-1y), weight 4.75 kg (2.2 to 13), 32% with Down syndrome and 17.5% with preoperative mechanical ventilation were operated. Perimembranous VSD was the most frequent type (62%). 28% experienced complications and 7% required reoperation for bleeding, infection or defect. The median hospital stay was 6 days (1-185). Postoperative 30 days mortality was 3%. Age < 6 m, weight < 3 kg, malnutrition and prior respiratory viral infection were associated with prolonged hospitalization, but no risk factors for mortality were identified. The primary surgical closure of the VSD is a procedure with satisfactory results at our institution.

Abstract 14058: Intramural Ventricular Septal Defects After Repair of Conotruncal Anomalies Are Associated With Postoperative Morbidity

Introduction: Intramural ventricular septal defects (VSDs) are tunnel-like communications between a great artery and right ventricular free wall trabeculations that can occur after repair of conotruncal anomalies. We sought to assess the prevalence of residual intramural VSDs and their impact on postoperative course. Methods: We reviewed all patients at our institution who underwent biventricular repair of a conotruncal anomaly involving VSD baffle to a great artery from the left ventricle from 1/1/11 to 6/30/13. Perioperative echocardiographic images were reviewed for residual intramural or non-intramural VSDs. The primary outcome was a composite of ECMO use, cardiac transplantation, or mortality. Secondary outcomes included hospital length of stay (LOS) and need for repeat catheter-based or surgical VSD closure. Results: Of 158 total subjects, 92 (58%) were male and diagnoses were tetralogy of Fallot (n=111), d-transposition of the great arteries (14), truncus arteriosus (13) and other (20). Median age at surgery was 51 days (IQR 6,107). Residual VSD was present in 111 subjects; 29 (26%) had an intramural defect, and 82 (74%) had non-intramural defects (71 peripatch defects, 6 small muscular defects, and 5 with both). Of the non-intramural VSDs, 79 (96%) were hemodynamically insignificant lesions (&lt;2mm). Residual intramural VSDs were more likely than non-intramural VSDs to be greater than 2mm (48% vs 4%, p&lt;0.001). There was no difference in weight, age at operation, or type of conotruncal anomaly based on type of residual VSD. The primary composite outcome was more prevalent in subjects with residual intramural defects compared to non-intramural defects (5/29 [17%] vs 4/82 [5%], p = 0.05). In addition, subjects with residual intramural VSDs had longer LOS (24 days [IQR 13,67] vs 11 days [IQR 5,23], p=0.002). The rates of repeat catheter-based or surgical closure were low overall but higher in subjects with intramural VSDs (8/29 [28%] vs 5/82 [6%], p=0.005). Conclusions: Intramural VSDs are common after repair of conotruncal anomalies and tend to be larger than non-intramural VSDs. Although most subjects still have favorable outcome, intramural VSDs are associated with greater postoperative morbidity, longer LOS, and need for reintervention.

Mutations in NTRK3 suggest a novel signaling pathway in human congenital heart disease.

Congenital heart defects (CHDs) are the most common major birth defects and the leading cause of death from congenital malformations. The etiology remains largely unknown, though genetic variants clearly contribute. In a previous study, we identified a large copy-number variant (CNV) that deleted 46 genes in a patient with a malalignment type ventricular septal defect (VSD). The CNV included the gene NTRK3 encoding neurotrophic tyrosine kinase receptor C (TrkC), which is essential for normal cardiogenesis in animal models. To evaluate the role of NTRK3 in human CHDs, we studied 467 patients with related heart defects for NTRK3 mutations. We identified four missense mutations in four patients with VSDs that were not found in ethnically matched controls and were predicted to be functionally deleterious. Functional analysis using neuroblastoma cell lines expressing mutant TrkC demonstrated that one of the mutations (c.278C>T, p.T93M) significantly reduced autophosphorylation of TrkC in response to ligand binding, subsequently decreasing phosphorylation of downstream target proteins. In addition, compared with wild type, three of the four cell lines expressing mutant TrkC showed altered cell growth in low-serum conditions without supplemental neurotrophin 3. These findings suggest a novel pathophysiological mechanism involving NTRK3 in the development of VSDs.

Insights gained from three-dimensional imaging modalities for closure of ventricular septal defects.

Ventricular septal defects (VSDs) are the commonest group of congenital heart lesions, accounting for ≈30% of congenital heart defects in liveborn infants.1 Defects in the ventricular septum are classified according to their position when the ventricular septum is viewed from the right ventricle and these may vary in their location, size, and number.2,3 VSDs can occur as isolated lesions or as part of more complex disease, for example, transposition of the great arteries or double outlet right ventricle, where the location and size of such defects assume great importance in planning the optimal mode of surgical repair.4 In most cases, surgical closure remains the mainstay treatment for VSDs, but selected lesions may be amenable to catheter closure.5,6 Cross-sectional echocardiography is the most commonly used noninvasive diagnostic method to delineate the position of a VSD before surgery.7 Multiple sonographic cuts and cross-sectional sweeps of the region of interest are used to build a virtual reconstruction of the three-dimensional (3D) anatomy in the mind of the echocardiographer. However, for the surgeon who deals solely with 3D images there can remain an element of uncertainty when called to operate on the patient. The number, size, location of VSDs, and their relationship to adjacent structures are central for selecting whether the defects might be best closed via the tricuspid valve, via the semilunar valves, or via a ventriculotomy or whether these might not be readily approachable and a palliative pulmonary artery banding is desirable.8,9 In this review, we present key 3D echocardiographic projections and examples of different types of VSDs where the images have a direct effect on the approach taken to VSD closure. Comparison of 3D echocardiography (3DE) with other 3D imaging modalities is also described. Images are presented in an …

Ventricular septal defect in children and adolescents in Angola: Experience of a tertiary center

Introduction and ObjectiveThis is the first study in Angola with the aim of characterizing ventricular septal defect (VSD) among children and adolescents. MethodsA cross-sectional study based on echocardiographic records of the largest pediatric cardiology center in Angola included all children and adolescents (0 to 18 years old) with VSD between April 2010 and March 2011. The diagnosis was made by transthoracic and Doppler echocardiography with a Medison SA 8000 system. The sample was divided into two groups: Group 1, isolated VSD; and Group 2, VSD associated with other congenital heart defects (CHDs). Age, gender, type of VSD, associated CHDs and genetic syndromes were assessed. ResultsA total of 490 CHDs were diagnosed, of which 283 were VSDs. In Group 1 (140, 49%) the mean age was 29±36 months. The most frequent age (mode) at diagnosis was 24 months. There was no predominance of gender (ratio 1:1). The majority (127, 91%) had perimembranous VSD. In Group 2 (143, 51%) 113 patients (79%) had one, 27 patients (19%) had two and three patients (2%) had three other CHDs. Trisomy 21 was the most common genetic syndrome (23, 96%). ConclusionsThe study shows that VSD is the most common CHD in childhood, the diagnosis is made late and almost half of VSDs are associated with other CHDs.

Ventricular septal defect in children and adolescents in Angola: Experience of a tertiary center

Introduction and ObjectiveThis is the first study in Angola with the aim of characterizing ventricular septal defect (VSD) among children and adolescents. MethodsA cross-sectional study based on echocardiographic records of the largest pediatric cardiology center in Angola included all children and adolescents (0 to 18 years old) with VSD between April 2010 and March 2011. The diagnosis was made by transthoracic and Doppler echocardiography with a Medison SA 8000 system. The sample was divided into two groups: Group 1, isolated VSD; and Group 2, VSD associated with other congenital heart defects (CHDs). Age, gender, type of VSD, associated CHDs and genetic syndromes were assessed. ResultsA total of 490 CHDs were diagnosed, of which 283 were VSDs. In Group 1 (140, 49%) the mean age was 29±36 months. The most frequent age (mode) at diagnosis was 24 months. There was no predominance of gender (ratio 1:1). The majority (127, 91%) had perimembranous VSD. In Group 2 (143, 51%) 113 patients (79%) had one, 27 patients (19%) had two and three patients (2%) had three other CHDs. Trisomy 21 was the most common genetic syndrome (23, 96%). ConclusionsThe study shows that VSD is the most common CHD in childhood, the diagnosis is made late and almost half of VSDs are associated with other CHDs.

PS-023 The Prevalence And Spontaneous Closure Rate Of Isolated Ventricular Septal Defect In Newborns By Echocardiographic Screening

<h3>Aims</h3> Evaluation of the prevalence and spontaneous closure rate of the most common congenital heart defect (CHD) – the ventricular septal defect (VSD) – in one maternity clinic, using colour flow Doppler echocardiographic screening (ECHO). <h3>Methods</h3> Over a period of 7 years ECHO was offered to all babies who were born at the Marien hospital in Darmstadt. An experienced paediatric cardiologist performed the ECHO using a 10 MHz transducer within the first 72 h of neonatal life. The prevalence of different types of VSD and their outcome were evaluated. <h3>Results</h3> 8082 neonates were screened. 399 cases (49/1000) of CHD were detected by ECHO. VSD was found in 320 neonates (40/1000) (137 male, 183 female): 4 perimembranous, 24 multiple and 292 muscular VSD. 2 major, 16 hemodynamically significant and 304 minor VSD. 46 had a typical murmur (14%), 274 were without clinical sign (including 1 major VSD). In the follow-up (3 month to 6,7 years) 280 could be included: the 2 major VSD had to be closed interventionally and surgically within the first year of life. The spontaneous closure rate was 89% after 0,2–4,5 years (average 0,6) (hemodynamically significant: 50%, minor VSD: 93%). All VSD without spontaneous closure after 1 year (22 cases) had a typical murmur. <h3>Conclusions</h3> The prevalence of VSD is considerably high in neonates when ECHO is performed. There are slightly more female neonates with this diagnosis. The spontaneous closure rate is high regarding minor VSD. Auscultation is insufficient to diagnose VSD in neonatal period but is excellent in the follow-up to detect VSD without spontaneous closure.

Pulmonary annulus preservation lowers the risk of late postoperative pulmonary valve implantation after the repair of tetralogy of Fallot.

The long-term benefits of pulmonary annulus preservation in tetralogy of Fallot (ToF) repair in patients with a marginally small pulmonary annulus are controversial. We sought to determine whether pulmonary annulus preservation (AP) is superior to transannular patching (TAP) in lowering the risk of pulmonary valve implantation (PVI) long after the repair of ToF. Of the 255 patients who underwent total correction of ToF during infancy between January 1989 and December 2005, 114 patients (AP group = 57, TAP group = 57) were selected by propensity score matching for various preoperative variables, such as age and body weight at operation, sex, pulmonary artery size, pre-repair palliation, anatomical types of ventricular septal defect, and Z-score of pulmonary valve annulus diameter (PVA-Z). The PVA-Z of the AP and TAP groups were -2.3 ± 1.3 and -2.1 ± 1.3, respectively (p = 0.547). The time to PVI was compared between the two groups. The median follow-up duration was 146 months (AP group: 141 months, TAP group: 147 months; p = 0.191). During the follow-up periods, there were 12 reoperations for the relief of right ventricular outflow tract obstruction (RVOTO), eight PVIs, and three late deaths. While freedom from reoperation for RVOTO was comparable between the two groups (p = 0.182), freedom from PVI at postoperative 15 years was significantly lower in the TAP group than in the AP group (74 and 100 %, p = 0.015). In repairing ToF with marginally small pulmonary valve annulus, AP is associated with a lower risk of late postoperative PVI.

A systematic review on the efficacy and safety of transcatheter device closure of ventricular septal defects (VSD).

Advances in interventional techniques now allow for transcatheter treatment of some ventricular septal defects (VSD), although there remain concerns about adverse events. We performed a systematic review to look at outcomes and complications associated with transcatheter closure of VSD. A PubMed search for series in English on device closure of VSD from 2003 to June 2012 was performed. We excluded small series that were included in multicenter studies and patients who had acquired VSD following myocardial infarction. The random effects model was used to obtain pooled estimates of success and complications. A total of 37 publications comprising 4,406 patients with VSD (perimembranous = 3,758, muscular = 419, intracristal = 47, doubly committed subarterial = 36, multiple = 16, postsurgical = 123, unclassified = 7) were included in this analysis. The age of patients ranged from 3 days to 84 years. The pooled estimate of successful device implantation was 96.6% (95% CI: 95.7-97.5). The most common complication is residual shunt (pooled estimated 25.5%; 95% CI: 18.9-32.1). Others included valvular defects (pooled estimate 4.9%; 95% CI: 3.4-6.4) and arrhythmias (pooled estimate 10.6%; 95% CI: 8.4-12.7). Our analysis suggests that transcatheter device closure of VSD is safe and yields good results. The limitations of this study are difficulties in analyzing different devices individually, and segregating the different VSD types. Further stratification by type of VSD, age of patients, and prevention of complications is needed before this can be recommended for routine treatment.

Echocardiographic diagnosis of sinus of Valsalva aneurysm: A 17-year (1995–2012) experience of 212 surgically treated patients from one single medical center in China

ObjectiveTo evaluate the value of echocardiography in the diagnosis of different pathological patterns of sinus of Valsalva aneurysms (SVAs). MethodsEchocardiographic features and surgical findings of 212 consecutive patients with SVAs treated in the last 17years (1995–2012) at the Union Hospital of Huazhong University of Science and Technology were compared and analyzed retrospectively. Results212 Chinese patients with SVAs underwent surgical repairs from January 1995 to May 2012 in our hospital. The aneurysms originated from the right, non-, multiple and left coronary sinus in 77.8%, 19.3%, 2.4% and 0.5%, respectively. 71.7% were ruptured, most commonly into the right ventricle (67.9%) followed by the right atrium (27.4%). Other rare entry sites of rupture included the left atrium, the left ventricle, the interatrial septum, the interventricular septum and the pulmonary artery (0.5%–1.9%). 164 SVAs arising from the right coronary sinus were classified by the Sakakibara method: 47.6% type I, 33.5% type II, 6.1% type IIIv and 12.8% type IIIa. 41 aneurysms of the non-coronary sinus were classified by the Guo method: 61.0% type I, 34.1% type IIa and 4.9% type IIv. The three most common associated cardiovascular lesions were ventricular septal defect (VSD) (53.3%), stenosis of right ventricular outflow tract (RVOTS) (7.5%) and aortic valvular malformations (5.2%).Compared with surgical results, the sensitivity, specificity and accuracy of echocardiographic diagnosis of SVAs were 93.9%, 99.9% and 99.8%, respectively. Of the 13 SVAs that were missed on echocardiography, 77% were small aneurysms of the right coronary sinus extending into the right ventricle across a VSD. Of the 199 cases diagnosed by echocardiography prior to surgery, the diagnostic accuracy of aneurismal origination, termination and whether ruptured or not was 99.0%, 99.0% and 97.5%, respectively. Echocardiography also diagnosed accurately all of the complications of the SVAs with the exception of aneurismal vegetations. The sensitivity, specificity and accuracy of echocardiography in diagnosing the associated cardiovascular lesions were 89.2%, 99.9% and 99.0%, respectively. The most common misdiagnosis and misdiagnosed associated lesions were the RVOTS and the types of VSD, respectively. ConclusionsEchocardiography has a specific value in the diagnosis of different pathological patterns of the SVAs with distinguishing ultrasonic features. To the best of our knowledge, this is the largest series of patients with SVAs surgically treated in a single medical center.