Type Of Ventricular Septal Defect Research Articles

Clinical Profile and Natural History of Children with Ventricular Septal Defects in Tripoli, Libya from 1996 through 2009

Introduction and Objectives: Ventricular septal defect (VSD) is the most common congenital heart diseases, it accounts 40%. This study carried out to describe the epidemiological characters and clinical presentation of patients with VSD in Western and Southern Libya, and to evaluate spontaneous versus surgical closure in different types.  Patients and Methods It is hospital case series study conducted by reviewing the medical records of 1092 patients followed at cardiology outpatient department (OPD) of Tripoli Children Hospital from 1996 through 2009, the data abstracted from medical records and filed in a worked sheet, Excel and SPSS software used to analyze the data.  Results We identified 1092 patients. The results revealed that 30.9% diagnosed during the first month, and 49.7% from1 to 12 months. From 1092 patients; 50.8% have peri- membranous VSD, 18.8% muscular, and 13% having an apical type. 97.2% of males have peri-membranous VSD where muscular and apical seen more in female, p value = 0.001. Cardiac murmur is the common presenting sign 61.3%, 9.3% have feature of Down syndrome. Positive Family history of CHD in 9.9% with significant relationship between family history and type of VSD (peri- membranous type), P value = 0.001. Small VSDs accounts 66.9%, large VSDs 16.1%, followed by medium size VSD 11.8% of cases. Patients with large VSDs more prone for hospital admission as 101 (57.4%) from 176 patients were admitted to hospital, followed by moderate size (45%), P value = 0.001. 70.3% of patients with large VSD need either medical or surgical treatment, P value = 0.001. Spontaneous closure seen in 17%, 0.6% died, while 41.9% still on follow up. Muscular VSD shows the highest tendency for spontaneous closer as 72% closed by the age of 2 years.  Conclusion We conclude that peri- membranous VSD is the most common type. Two thirds of patients had been diagnosed in the first year of life. Big defects and some of moderate VSDs need either medical or surgical treatment. Spontaneous closer is usually seen in the first 2 years of life.  Recommendations We highly recommend for further multi-center study all over the country to get reliable data on the prevalence of congenital heart diseases and the incidence of ventricular septal defect in our population.

Navigating the spectrum of double-outlet right ventricle presentations: Outcomes from a contemporary cohort based on subtypes.

Our aim in this study was to investigate the prenatal and postnatal prognosis of double outlet right ventricle (DORV) cases diagnosed prenatally by analyzing the outcomes based on the subtype. This study is a retrospective chart review. Cases diagnosed with fetal DORV by prenatal ultrasound in the maternal-fetal medicine department of our hospital between 2014 and 2022 were included. Data on maternal characteristics, fetal echocardiographic features (type of DORV), pregnancy and neonatal outcomes (termination of pregnancy [TOP], intrauterine fetal death [IUD], neonatal death [NND], death in infancy (IND), survival) were collected and analyzed. Ninety-nine cases of prenatally diagnosed cases of DORV were included. The prenatal diagnosis was right in 97% of the liveborn fetuses. The cases were classified into subtypes, including transposition of great arteries (TGA), Fallot, ventricular septal defect (VSD), remote, and heterotaxy types. The cohort consisted of 32.3% TGA type, 19.1% fallot type, 11.1% VSD type, 2% remotetype, and 35.3% heterotaxy type of DORV. An additional cardiac anomaly was observed in 87% and an extra-cardiac anomaly was observed in 54% of the cases. When we excluded the cases with heterotaxy type but without any chromosomal abnormality, additional genetic abnormalities were detected in 42% of the remaining cases. Outcome of pregnancy was livebirth in 68/99 (68.7%), IUFD in 5/99 (5.1%), and TOP in 26/99 (26.3%). Postnatal cardiac surgical repair was performed in 48 cases. Survival among livebirths was 39/68 (57.3%). Twenty-nine neonates or infants who had additional cardiac anomalies and/or genetic abnormalities died before any surgical intervention. The postoperative survival rate was 39/48 (81.2%). The prognosis in DORV depends on the anatomical subtype, the presence, and severity of associated anomalies. Survival increases in isolated cases without any additional structural or genetic anomalies.

Echocardiographic Study of Ventricular Septal Defect in 1- to 12-Year-Old Children Visiting a Tertiary Care Center in Patna, India.

Background Symptoms of serious heart problems present at birthoften appear during the first few days, weeks, or months of a child's life. Shunt formation between the left and right ventricle is a crucial component of the pathophysiology of ventral septal defects. Objectives We aim to determine the most frequent types of ventricular septal defect (VSD) by echocardiography and whether there is any gender variation in the type of ventricular septal defect. Material and methods A total of 100 children who were clinically suspected of or diagnosed with VSD at the age of 1-12 years were enrolled in this study. The septum of the atrioventricular (AV) canal, the muscular septum, and the parietal band of the distal conal septum were evaluated by color Doppler. Ventricular septal defect (VSD) size and kind are similarly impacted by the 2D echo mode. The size and site of the VSD, associated congenital anomaly, and significant morphological changes in ventricular cavities, gender discrimination, and relation-specific types of ventricular septal defect were observed. Results A total of 100 VSD children presentedwith clinical symptoms of fast breathing, retraction of the chest, cough, cyanosis, fever, difficulty during feeding, cyanotic spell, chest pain, and edema at 65%, 62%, 54%, 52%, 54%, 29%, 9%, 11%, and 4%, respectively. Conclusion Early diagnosis is essential for effective medical care of diseases such as infective endocarditis (IE), which is present in some cases of VSD, and the avoidance of persistent pulmonary veno-occlusive disease (PVOD).

Electrocardiographic characteristics of newborns with ventricular septal defects: a Copenhagen Baby Heart Study

Ventricular septal defects (VSD) represent the most common congenital heart defect in newborns. We assessed the electrocardiographic characteristics of newborns with VSDs in a general population sample. The Copenhagen Baby Heart Study is a prospective population–based cohort study offering cardiac evaluation of newborns. Echocardiograms and electrocardiograms were obtained within 30 days after birth and systematically analysed. A VSD was identified in 530 newborns (mean age 11 ± 7 days, 42% boys). Newborns with VSDs had a more left-shifted QRS axis (116 ± 34 vs. 120 ± 3°, p = 0.02), and a higher S-wave amplitude in V1 (721 ± 584 vs. 636 ± 549 µV, p = 0.001) than controls. The largest differences were found in newborns with large or perimembraneous VSDs with a higher frequency of left axis deviation, higher S-wave amplitudes in V1, and higher R- and S-wave amplitudes in V6 compared with controls. R-waves in V1 and V6 were significantly associated to left ventricular mass, whereas S-waves in V1 and V6 were dependent on left ventricular end-diastolic diameter on echocardiography. Conclusion: Newborns with VSDs showed significant differences in QRS axis, and R- and S-wave precordial amplitudes compared to matched controls. Perimembranous and large VSDs had the greatest effect on the neonatal ECG.What is Known:• Ventricular septal defects in newborns are prevalent and may affect cardiac function and structure.What is New:• The Copenhagen Baby Heart Study is the largest study including a cohort of unselected newborns undergoing postnatal cardiac examination.• We found that newborns with VSD showed significant electrocardiographic differences depending on size and type of VSD compared with healthy newborns.

Ventricular septal defect in octogenarian: a case report

It is not a common case that we see in our day-to-day clinical practice, a patient presenting with congenital VSD at the age of eighty. Ventricular septal defect (VSD) is a developmental defect of the interventricular septum resulting from a deficiency of growth or a failure of alignment or fusion of component parts of ventricular septum.1Ventricular septal defects are the most common form of congenital heart disease and among the most frequently seen congenital abnormalities.2Perimembranous defects are the most common types of ventricular septal defects and account for 80% of such defects.3It is estimated that 25–40% of VSDs will close by the age of 2 years, and they are unlikely to persist after the age of 10 years; thus adults with congenital heart disease, VSDs represent only about 10% of the cases.4

Update on Transcatheter Device Closure of Congenital Septal Defects.

The goal of this paper is to review currently available devices for closure of atrial septal defects (ASDs) and ventricular septal defects (VSDs). Favorable results from the ASSURED trial resulted in FDA approval for the most recently developed device for transcatheter ASD closure in the United States. Further studies are required to assist in the development or approval of safe devices for transcatheter perimembranous VSD closure in pediatric patients. Device closure is the less invasive and preferred management option for many ASDs, with multiple studies demonstrating lower complication rates, shorter hospital stays, and lower mortality than surgical repair. Complex ASDs that make device closure more difficult include large defects, rim deficiencies, fenestrated defects, multiple defects, and the presence of pulmonary arterial hypertension. Device closure has also become an accepted alternative to surgery for some types of ventricular septal defects VSDs, though challenges and limitations remain. Future innovations including novel devices and techniques are needed to further expand on the types of defects that can be safely closed via transcatheter approach.

Experience of Percutaneous Closure of Ventricular Septal Defects in 140 Patients With Different Duct Occluders in a Tertiary Care Rural Hospital in Central India.

Background Ventricular septal defects (VSDs) are the most common type of septal defects in early infants and are very complicated. This has paved the way for the development of new minimally invasive procedures for interventional cardiologists. This study presents our experience using duct occluders instead of conventional ventricular septal devices in the Department of Cardiology at Acharya Vinoba Bhave Rural Hospital (AVBRH) in central rural India. This study aimed to reviewsuccess and complications and assess safety and its relation to age, sex, size of the VSDs, type of VSD, and types of devices used after transcatheter closure of perimembranous and muscular VSDs using various types of duct occluders. Methodology This retrospective study included patients who underwent percutaneous VSD device closure at the AVBRH between July 2017 and December 2020. We reviewed the patients' medical records to recognize imaging, clinical, and interventional data pre- and post-procedure and at the last follow-up. Results The success rate of VSD closure was 98.6%, one (0.7%) out of 81 females developed a complication due to device dislodgement, and one male aged six years (0.7%) out of 59 developed a post-procedural complication; hence, the total failure rate was 1.4%. The perimembranous type had no complication, and the muscular type had two (14.3%) unsuccessful procedures. Conclusion This study has concluded an impressive percentage of VSD closure, showing no mortality and low morbidity, using a percutaneous approach with different duct occluders. As the type of device used is not correlated with device failure and failure rate, duct occluders will be financially helpful in the closure ofVSD in indicated patients.

Tran Catheter Closure of Ventricular Septal Defects (VSD): Preliminary Results in Children Weighing 5kg or Less

<i>Aim: </i>This study aims to evaluate feasibility and complications of device closure of ventricular septal defect (VSD) in children weighing 5kg. <i>Methods:</i> Between March 2018 and March 2021, total 15 patients with Ventricular Septal Defect (VSD) weighing 5Kg or less were taken to Cath lab for percutaneous VSD closure out of which 13 (86%) had successful transcatheter closure and 2 (14%) cases were unsuccessful and subsequently send for surgical closure. All of these13 patients under went transcatheter closure of VSD using either a Amplatzer duct occluder1, Amplatzer duct Occluder 2 or Amplatzer Muscular VSD Occluder. A retrospective review of the results and related complications was done. <i>Results:</i> Among these 15 patients, 7 were females, 6 were male and the mean age was 8.5 (4-16month. The mean weight in this study was 4.46Kg (2.3-5Kg). Mean VSD size was 4.5 (3-10mm), 9 patients had VSD sizes between 3to5mm, 3 had between5-10 mm and 1 with more than 10mm. Among types of VSD, 9 cases were having Perimembranous, 1 was upper muscular, 1was mid while 1was lower muscular and only 1 had outlet muscular VSD. Amplatzer Duct Occluder (ADOI) was used in 2 cases, 9 were closed with Amplatzer Duct Occluder (ADO2) and 2 were selected for closure with Amplatzer Muscular VSD Occluder. Transthoracic Echocardiography (TTE) in immediate post intervention period revealed all these devices in situ with no or minimal residual flow which subsided within 24 hours period. As far as complications are concerned, we had one device embolization noted in our study. Tricuspid regurgitation (TR) was noted at the time of discharge in 4 patients but subsided after 48 hours while trivial aortic regurgitation was noted (AR) only in one case which is under close follow up and not increasing in severity after 6 months follow-up. <i>Conclusions</i>: Transcatheter closure of VSD in children 5kg or less is feasible and safe alternative to surgical VSD closure.

Ventricular septal defect in children and adults by echocardiography study in Iraqi patients

Objective: A ventricular septal defect (VSD) is defined as a communication between the left and right ventricles or between the left ventricle and the right atrium. VSDs are amongst the most common abnormalities of the heart. They can be present in isolation or in association with other congenital cardiac abnormalities. This is study done with the aim to evaluate the types, size, associated CHD with ventricular septal defect in children and adolescent in two cardiac centers (Medical City Complex cardiac clinics, Ibn Al Nafaes teaching hospital) in Baghdad - Iraq Methods: Prospective cross sectional study based on echocardiography done pediatric cardiology centers and included all children and adult (birth to 25 years old) with VSD during period from 1st of October 2021 till 1st of July 2022. The examination performed in the lateral decubitus position using the echocardiography device (GE VIVID 9), transducer M6Sc-D and M5Sc-D. All patients were examined standard transthoracic echocardiography (TTE) including two dimensional, colors Doppler and M -mode. The standard technique was used to obtain the measurements. Size and type of VSD were examined in different standards four chambers, five chambers, parasternal long and short axis and subcostal views. The sample was divided into two groups, group 1 isolated VSD; and Group 2 associated with other CHD. The data collected for patients with ventricular septal defect and the age (from birth to 25 years old).A convenient sample of 206 patients with VSD was selected from consultancy clinics and wards of selected hospitals. Results: A total of 206 patients with ventricular septal defect were included in this study; 105 patients (51%) from Medical city complex, 101 patients (49%) from Ibn Al Nafeas teaching hospital. Males were 49% while females were 51%. The prevalence of isolated VSD 99(48%) and VSD associated with other CHD 107(52%). Symptomatic VSD were 60%, while Asymptomatic VSD diagnosed incidentally were 40%. The most common type of VSD was Perimembranous 73 followed by muscular 19%, Inlet (canal type) 7% and Outlet (subarterial) Subpulmonic VSD 1% respect. The most common associated CHD was PDA 33 (30.8%), followed by ASD Secundum 30 (28%), PS 10 (9.3%), Coarctation of aorta 8 (7.4%), MR 7(6.5%), TOF 6 (5.6%), Atrioventricular canal defect 3 (2.8%), DORV 2 ( 1.8%) and each of L-TGA, DTGA, Dextrocardia , truncus arteriosus and tricuspid atrasia had 1 (1%). Conclusions: The most common VSD type of studied patients is perimembranous in followed by muscular, inlet type and the less common is outlet. Although multifactorial, Consanguinity marriage with positive family history plays a great role of recurrent CHD in families.

Spontaneous closure of isolated Ventricular septal defect in the first year

Background/Aim: Ventricular septal defect (VSD) is the most common congenital heart anomaly that in many cases closes spontaneously. The spontaneous closure (SC) rate of VSD varies widely between studies. The aim of this study was to identify clinical and echocardiographic factors influencing SC of isolated VSD in the first year of life among a group of patients presented at the Paediatric Clinic. Methods: Prospective study was performed in 60 consecutive patients with trivial, small or medium isolated VSD during the first year of life. Patients were divided into groups, according to gender and gestational age of the patient, type, number and the size of the defect and persistence of pulmonary hypertension. The size of defect was described in comparison to the diameter of the aortic annulus (VSD/Ao ratio). Results: At the time of diagnosis, the mean VSD/Ao ratio was 0.33 mm. Muscular VSD was more common (76.7 %) than perimembranous (23.3 %). SC of VSD occurred in 60 % of all patients, in case of muscular defect in 73.9 % and in case of perimembranous in 14.3 %. There was a negative correlation between defect size and SC rate. SC probability for a given defect size was described by the formula: probability = -1.82933X+1.20145. None defect with pulmonary hypertension closed. Conclusion: It was found that type and size of VSD and the persistence of pulmonary hypertension were significant predictors for SC, while gender and gestational age of the patient and the number of defects were not. This study can be useful in predicting the natural outcome of the VSD to make proper follow-up and management plans.

Comparative study, using transthoracic echocardiography versus left ventriculography to assesses ventricular septal defect eligibility for device closur

Accurate evaluation of ventricular septal defects types (locations) and measurement of the size of ventricular septal defects and distance from ventricular septal defects to aortic valve are essential for successful trans catheter device closure. The aim of study to assess in patient with ventricular septal defects the accuracy of transthoracic echocardiography in determining the size, position (type), and the distance from ventricular septal defects to the aortic valve as compared to trans- catheter approaches. Cross sectional study included patients with a diagnosis of ventricular septal defects with specific criteria suitable for treatment with transcatheter device closure. Eligibility was confirmed during this study and subject demographic (age, sex), growth parameters (height, weight, body surface, and body mass index) were extracted. During study period, patients underwent catheterization for device closure. Prior to catheterization two- dimensional echocardiography evaluation of VSD was done then left ventriculography was performed by interventional pediatric cardiologist to accurately determine the ventricular septal defects location (type), size and the distance from ventricular septal defects to the aortic valve. Sixty-three patients with in ventricular septal defects. The sensitivity of transthoracic echocardiography in detection the types ventricular septal defects of compared to catheter- based assessment (left ventriculography) was (100%) for all types of ventricular septal defects. The correlation coefficient sensitivity of assessment of ventricular septal defects size by transthoracic echocardiography compared to catheter-based assessment was (97%) p-value (0.001*). The correlation coefficient sensitivity of distance of ventricular septal defects to the aortic valve measured by transthoracic echocardiography compared to catheter based measurement was (91 %) p-value (0.001*). Conclusion: Transthoracic echocardiography is useful to evaluate VSDs location and useful to assess measurements of ventricular septal defects prior to transcathetered occlusion. Irregularity of ventricular septal defects shape and its changes during cardiac cycles are sub-optimally estimated by trasthoracic echocardiography.

Should prenatal chromosomal microarray analysis be offered for isolated ventricular septal defect? A single-center retrospective study from China.

ObjectiveTo evaluate the utility of chromosomal microarray analysis (CMA) in fetuses with isolated ventricular septal defect (VSD) and to explore the favorable factors for predicting spontaneous closure of defects.MethodsThe study included 436 singleton pregnancies seen at a referral prenatal diagnosis center, between January 2016 and May 2020, of which 168 fetuses with isolated VSD were diagnosed in the prenatal setting. VSD was classified as an isolated VSD whether it had ultrasound soft markers or not. All patients underwent testing employing quantitative fluorescent polymerase chain reaction (QF-PCR) and CMA as the first-line genetic detection strategies, mainly in amniotic fluid and umbilical blood samples. Rates of chromosomal abnormalities were compared by subgroups of isolated VSD (muscular or perimembranous). Binary logistic regression analysis was performed to predict the independent determinants of spontaneous closure by 2 years.ResultsOverall, the CMA identified clinically significant copy number variations (CNVs) in 7/168 (4.2%) fetuses and variants of unknown significance (VOUS) in 15/168 (8.9%). Muscular and perimembranous VSDs were found in 53.6 and 46.4%, respectively. Clinically significant relevant subchromosomal aberrations were revealed in seven (9.0%) perimembranous VSDs compared with none in 90 muscular defects (P < 0.01). The median initial size of the defect in the muscular VSDs was 2.2(1.8–2.7) mm, as compared to that of 2.8 (2.2–3.2) mm in the perimembranous VSDs group (p = 0.000). In muscular vs. perimembranous VSDs, spontaneous closure occurred more frequently and earlier [40.0 vs. 15.4% in utero (p = 0.000), 61.1 vs. 30.8% at 1-year (p = 0.000), and 75.6 vs. 42.3% at 2-year (P = 0.000)]. Postnatal surgical closure was warranted in 4/90 (4.4%) of the infants with muscular VSDs, as compared to 29/71 (40.8%) with perimembranous defects (p = 0.000). Furthermore, isolated muscular type VSD, smaller defect size, and maternal age of less than 35 years are all positive predictors of spontaneous closure of the defects.ConclusionThis study highlighted the value of microarray for unbalanced subchromosomal abnormalities in fetuses with isolated VSD, particularly in the perimembranous defects. The detection of an isolated muscular VSD prenatally may be considered a benign or likely benign finding; in contrast, for perimembranous VSD, a prenatal CMA should be offered.

Defining the optimal historical control group for a phase 1 trial of mesenchymal stromal cell delivery through cardiopulmonary bypass in neonates and infants.

The Mesenchymal Stromal Cell Delivery through Cardiopulmonary Bypass in Pediatric Cardiac Surgery study is a prospective, open-label, single-centre, dose-escalation phase 1 trial assessing the safety/feasibility of delivering mesenchymal stromal cells to neonates/infants during cardiac surgery. Outcomes will be compared with historical data from a similar population. We aim to define an optimal control group for use in the Mesenchymal Stromal Cell Delivery through Cardiopulmonary Bypass in Pediatric Cardiac Surgery trial. Consecutive patients who underwent a two-ventricle repair without aortic arch reconstruction within the first 6 months of life between 2015 and 2020 were studied using the same inclusion/exclusion criteria as the Phase 1 Mesenchymal Stromal Cell Delivery through Cardiopulmonary Bypass in Pediatric Cardiac Surgery trial (n = 169). Patients were allocated into one of three diagnostic groups: ventricular septal defect type, Tetralogy of Fallot type, and transposition of the great arteries type. To determine era effect, patients were analysed in two groups: Group A (2015-2017) and B (2018-2020). In addition to biological markers, three post-operative scoring methods (inotropic and vasoactive-inotropic scores and the Pediatric Risk of Mortality-III) were assessed. All values for three scoring systems were consistent with complexity of cardiac anomalies. Max inotropic and vasoactive-inotropic scores demonstrated significant differences between all diagnosis groups, confirming high sensitivity. Despite no differences in surgical factors between era groups, we observed lower inotropic and vasoactive-inotropic scores in group B, consistent with improved post-operative course in recent years at our centre. Our studies confirm max inotropic and vasoactive-inotropic scores as important quantitative measures after neonatal/infant cardiac surgery. Clinical outcomes should be compared within diagnostic groupings. The optimal control group should include only patients from a recent era. This initial study will help to determine the sample size of future efficacy/effectiveness studies.

Assessment of ventricular septal defects by real-time three-dimensional echocardiography and comparison with surgical measurements

BackgroundThree-dimensional (3D) echocardiography has facilitated evaluation of a ventricular septal defect (VSD) with its true dimensions and exact localization and improved identification of various anatomical characteristics in different types of VSDs. ObjectivesWe aimed at investigating the feasibility of 3D echocardiography in assessing VSDs in comparison to two-dimensional (2D) echocardiography. MethodsWe employed both 2D and 3D echocardiography for measuring the longest diameter of VSD. The morphology, number, and size of the defect as well as its relation and distance to the tricuspid and aortic valves were analyzed by 3D echocardiography displaying the VSD from the right ventricular aspect. The size was defined in terms of maximum area, long and short axis diameters at end-diastole. The longest diameters of VSDs were compared with 2D and 3D echocardiography data in all patients as well as with the intra-operative findings in 17 patients. ResultsThe mean diameters of end-diastolic VSDs measured by 3D echocardiography from the right ventricular aspect were significantly larger than those obtained by 2D echocardiography (15.6 ± 8.2 vs 10 ± 4.2 mm, P = .02), however, there was a good correlation between them (r = 0.73, P < .001). 3D echocardiography proved to be superior to 2D echocardiography for visualizing the shape of VSD and for measuring tissue rims from the aortic and tricuspid valves. The advantage was prominent in particular for viewing defects hidden by a ventricular septal aneurysm or a tricuspid septal leaflet, which can be erased digitally to reveal the VSD underneath. The dimensions of VSDs obtained by 3D echocardiography (r = 0.85, P < .001) correlated significantly better with actual dimensions revealed during surgery as compared to those obtained by 2D echocardiography (r = 0.53, P = .03). ConclusionsThe study demonstrated that 3D echocardiography provides more reliable information from both qualitative and quantitative aspects regarding the morphology, size, and tissue rims of VSD compared to 2D views.

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.

Wyniki przezskórnego zamknięcia ubytku typu Gerbode z zastosowaniem Nit-Occlud Le VSD (PFM) coil.

Introduction: Left ventricle-to-right atrial (LV-RA) communications termed Gerbode defects are a special and very rare type of ventricular septal defects. Transcatheter closure using Nit-Occlud Le VSD-coils is a new and not well-known alternative to cardiac surgery in selected cases. The aim of our study was to describe results and our experience with interventional closure of Gerbode defects using Nit-Occlud Le VSD-Coil. Material and Methods: The procedures were performed between October 2014 and October 2018. Patients were selected based on detailed transthoracic echocardiography (TTE). The diameter of the defects based on the TTE study was verified and comparable to values found in the angiocardiography. Despite of the fluoroscopy guidance the intraprocedural transesophageal echocardiography was carried out in every case. Finally, the effectiveness of the procedure and the occurrence of complications during the observation were assessed in each case. Results: The study involved eight children, including an infant with native Gerbode defect and seven older children with acquired post-operative LV-RA shunts. Age ranged from 8 months to 17.8 years, body weight from 7.4 kg to 56 kg, body weight from 7.4 kg to 56 kg, 5/8 females. The diameter mean of the defects in the angiocardiography was 3.86±0.82 mm and it was comparable to values from TTE. All procedures were successful. The coils ranged from 8x6 mm to 12x6 mm. Early complications after procedure: one case of a transient haemolysis which required blood transfusion and steroids, one case of temporary arrhythmia. The follow-up period ranged 2-36 months, with only one case of a permanent small residual shunt was observed. Conclusions: The interventional treatment of very rare Gerbode defect seems to be a safe alternative to surgery in selected cases. This study is one of the largest suchlike published.

Toward Routine Minimally Invasive Ventricular Septal Defect Closure Via Right Lateral Minithoracotomy.

Background: Improving the surgical results and recent advancement of transcatheter techniques for closure of ventricular septal defect (VSD) increased the demand for minimally invasive approaches. In this study, we analyzed the results of the patients who underwent VSD closure with right lateral minithoracotomy (RLMT).Methods: Between September 2014 and February 2021, 24 patients underwent minimally invasive VSD closure with RLMT. The median age of the patients was 16 months (range, 4-84 months). Fifteen patients (62.5%) were female. The median weight of the patients was 9.75 kg (range, 4.6-30 kg). The types of VSD were perimembranous in 19 patients, subaortic in three patients, inlet in one patient, and subpulmonic in one patient. Five patients had low-lying pulmonary stenosis in addition to VSD.Results: No perioperative death or major complication occurred during follow-up. All defects were repaired through RLMT. The median cardiopulmonary bypass time was 81 min (range, 44-163 min), and the aortic cross-clamp time was 65 min (range, 33-131 min). The median hospital stay was 6 days (range, 5-21 days). One patient had minimal (2 mm) residual left-to-right shunt. All families were satisfied with the cosmetic results during the follow-up.Conclusions: The RLMT method is a safe and effective alternative to standard median sternotomy for VSD closure and can be performed with favorable cosmetic and clinical results.

Acquired Left Ventricular to Right Atrial Shunt (Gerbode′s Defect) after Aortic Valve Replacement: Case Report

Background: Left ventricular to right atrial (LV—RA) shunt is an unusual type of ventricular septal defect (VSD). Acquired LV—RA shunts may be due to complications of cardiac operation, endocarditis, trauma or myocardial infarction. A previous cardiac operation is the most common cause. The diagnosis of LV—RA communication is not easy, and it should be remembered in patients who do not recover normally. Diagnosis can be confirmed with ultrasound or magnetic resonance image (MRI) or multi-slice CT. Surgical correction is usually the treatment of choice, but closing the communication percutaneously should be considered as an option. Objective: Aim of this case presentation was to show the clinical scenario of a rare post-operative complication (after aortic valve replacement). Patient and methods: Male patient aged 35 years, during hospital admission in the CCU post-operative after aortic valve replacement was complaining of dyspnea, orthopnea, paroxysmal nocturnal dyspnea and by echocardiographic examination revealed Gerbode defect, not improved by modification of medical treatment necessitating cardio-thoracic surgery consultation who recommend conservative treatment and follow up if the patient still symptomatic surgical repair versus percutaneous closure could be done. Conclusion: Acquired left ventricular to right atrium shunt (Gerbode′s defect) can result from septal trauma after valve replacement, infective endocarditis, or myocardial infarction. In addition to the usual causes of cardiac decompensation following aortic valve surgery, one should consider the possibility of a left-to-right shunt secondary to an iatrogenic left ventricular-right atrial communication, particularly if either septal trauma or extensive valvular calcification was encountered during the surgical procedure.

Prevalence of Ventricular Septal Defect and Associated Diseases Among Patients Under 18 Years in Shiraz During 2016-2017

Background and aims: Since ventricular septal defect (VSD) is the most common congenital heart disease, this study aimed to investigate its prevalence, characteristics, and associated diseases in a referral children’s heart clinic in south of Iran.Methods: In this cross-sectional study that was conducted based on the databases of children with heart diseases, patients under 18 years of age referring to Imam Reza clinic were examined. All patients with at least one record of VSD in echocardiography during 2016-2017 were included. Demographic and echocardiographic characteristics including size of VSD, shunt gradient, pulmonary hypertension (PH), aortic regurgitation, and associated cyanotic and acyanotic defects were analyzed.Results: The prevalence of VSD found in 7458 echocardiography records was 12%, the median age of patients was 9.3, and the male/female ratio was 1.08. The perimembranous VSDs were determined to be the most common types of VSD. The most common associated complication with VSD was detected to be PH followed by aortic regurgitation. Sub-pulmonic showed the highest association with aortic failure. Atrial septal defect and tetralogy of Fallot (TOF) were the most common acyanotic and cyanotic heart defects, respectively. Only 0.5% of the patients had Eisenmenger syndrome.Conclusion: Fortunately, the prevalence of the complication of VSD was not high in south of Iran, and the number of Eisenmenger syndrome was low. The types of VSD and the number of its complications identified in study population were similar to those in other populations.

The Application and Teaching Value of a Ventricular Septal Defect Canine Model Established by Transcatheter Puncture.

This study aimed to improve and further explore a ventricular septal defect (VSD) canine model on the basis of the transcatheter puncture method and to evaluate its application and teaching value.In order to lessen the complications of VSD closure, it is necessary to improve the currently available treatment devices using appropriate animal models.In this study, we used 16 healthy adult canines as our models. After anesthesia, the VSD puncture was performed, followed by balloon dilatation of the perforation. VSD was confirmed by angiography. The venous-artery orbit was established, and the VSD was then closed once the catheter and occluder were across the defect.Of the experimental canines, 14 of the 16 canines were successfully modeled, giving a success rate of 87.5%. The canines underwent an immediate creation of a venous-artery orbit for teaching practice and were implanted with an occluder during the procedure. After 4 weeks, 13 canines survived. As per our findings, most VSD types established by the puncture were perimembranous (10 of 13, 77%).The current model has a high success rate. The model can not only avoid the risk of infection and hemodynamic disorders associated with an open thoracotomy, but can also be effectively used in evaluating the impact of occluders. It can also directly measure the parameters of the devices during the procedure, thus having a very high experimental and teaching value.