Ventricular Septal Defect Closure Research Articles

Delayed closure of ventricular septal defect with prolonged mechanical support

Introduction: Ventricular septal defect (VSD) is a severe complication following acute myocardial infarction (MI) resulting from mechanical disruption of the interventricular septum due to extensive myocardial necrosis. Despite advances in management, the mortality rate approaches 50%. We report a case of a 58-year-old male with VSD following MI who was successfully treated with a delayed surgical approach after haemodynamic support using Impella. Case description: A 58-year-old man with type 2 diabetes mellitus and hypertension presented with three days of chest pain. Testing revealed late presenting acute anterior ischaemic infarction and left-to-right shunt in the apical ventricular septum. Urgent cardiac catheterisation showed near-total occlusion of the left anterior descending artery. An Impella CP® was placed before angioplasty with a drug-eluting stent to optimise haemodynamics. After a multidisciplinary discussion, the Impella CP® was upgraded to Impella 5.5®, and surgery was delayed allowing for scar formation. The patient remained in the intensive care unit, where he underwent physical therapy, showing improvements in exercise tolerance by the time of surgery. He underwent a left ventriculotomy with a successful repair via an endocardial patch 28 days after initial presentation. Post-operative recovery was uneventful, with the patient discharged five days later, reporting no physical limitations one month post-discharge. Conclusion: The successful management of VSD post-MI relies on interdisciplinary collaboration, careful timing of surgical intervention and the strategic use of mechanical support devices such as the Impella. This case highlights the potential for favourable outcomes when tailored treatment approaches are employed.

Characteristics of the Device and Conduction Disturbances in Transcatheter Device Closure of Perimembranous Ventricular Septal Defects.

Characteristics of the Device and Conduction Disturbances in Transcatheter Device Closure of Perimembranous Ventricular Septal Defects.

Transcatheter Closure of Postinfarct Ventricular Septal Defect: Promises and Uncertainties

Transcatheter Closure of Postinfarct Ventricular Septal Defect: Promises and Uncertainties

Transcatheter Closure of Perimembranous Ventricular Septal Defect Using KONAR-MF™: A Multicenter Experience.

Transcatheter closure of perimembranous ventricular septal defect (PmVSD) is an established procedure. However, the occurrence of complete heart block limits its scope. The newer KONAR-MF™ occluder has specific design characteristics that may improve the safety of PmVSD closure. The objective of the studywas to describe the efficacy and mid-term follow-up of transcatheter closure of PmVSD using KONAR-MF™. The study was conducted prospectively in 3 Indian centers (January 2018-December 2022). PmVSD closure was done by both antegrade and retrograde methods, and patients were followed up at 1, 3, 6, 12months, and annually after that. 121 out of 123 patients were included with the following characteristics: median age 4.4 (0.18-40) years; weight 15 (2.1-88) kg; mean Qp/Qs ratio 1.87 ± 0.52 and pulmonary artery mean pressure: 22 ± 6.9mmHg. The procedure was successful in all but 3; the device was removed due to significant residual shunt (n = 2) and new development of aortic regurgitation (AR) (≥ mild) in 1. The median defect size was 5.2 (2.5-12) mm. Device sizes from 6/4 to 14/12 were deployed (median fluoroscopy time 13.3min; range 3.6-47.8). Shunt occlusion rates were 90%-Immediate, 95%-pre-discharge, and 97%-1month, with no instances of complete heart block after the procedure and during follow-up. Six had new onset AR (mild: 2, trivial 4), and one had increased tricuspid regurgitation. All patients were well during follow-up (median: 20months; range: 6-46). The new KONAR-MF™ occluder appears to be a promising and safe alternative for the closure of the PmVSD; further long-term follow is merited.

The results of single–stage repair for coarctation with ventricular septal defect in neonates

Background: The association of coarctation of the aorta (CoA) with a ventricular septal defect (VSD) in neonates is seriously who needs to surgery if not control heart failure by medicine in neonates. There are 2 procedures for repair includes: Two-stage repair (the repair coarctation and closure of the concomitant VSD as a secondary procedure), One-stage repair (the repair coarctation and closure of the concomitant VSD). Methods: We retrospectively reviewed patients (in neonate) undergoing repair of CoA with closure of VSD from 1/2015 to 12/2023. There were sixteens patients who underwent one-stage repair. The mean of age and body’s weight were 21 days (range from 14 days to 29 days) and 3,3 kilograms (range from 2,9 to 3,6). All patients had severe heart failure, lager VSD and gradient through aortic isthmus that was 54 mmHg. Results:  The time of cardiopulmonary bypass, aortic clamping  and selective cerebral perfusion time were: 126 mins; 87 mins and 18 mins. There were 5 patients with open chest. One patient died at ICU by multiple organ failure and one patient with cerebral haemorrhage.  The gradient postopration of aortic arch was 7 mmHg with no residual VSD. During follow-up time 57 months after surgery, there was no late death. The mean gradient  of aortic arch was 12 mmHg and one patient with 25 mmHg Conclusion: The results of single–stage repair for coarctation with ventricular septal defect in neonates was good  with low re-coarctation.

How do Age at the Surgery and Birth Weight Influence Post-Operative Anthropometric Parameters in Infants with Surgical Closure of Large Ventricular Septal Defects? A Prospective Cohort Study from a Lower-Middle-Income Country.

Closure of the large ventricular septal defects (VSD) in infancy can lead to normalization of growth, but data are limited. Our study is done to assess the growth pattern in different age groups of children and lower birth weight babies after shunt closure. This is a prospective observational study that included infants with isolated large VSD operated in infancy. Anthropometric data were collected at baseline and at follow-up, and growth patterns were analyzed. 99 infants were included in the study. The mean age and weight at the time of surgery were 6.97 ± 2.79months and 5.07 ± 1.16kg, respectively. The mean follow-up duration was 8.99 ± 2.31months. The weight for age (W/A) was the most adversely affected parameter preoperatively, and there was significant improvement noted in the mean Z score for W/A after shunt closure (-3.67 ± 1.18 vs. -1.76 ± 1.14, p = 0.0012). There was improvement in Z-scores for length for age (L/A) and weight for length (W/L), although it was not statistically significant. The infants from all the age groups had statistically significant growth in the anthropometric parameters. The rate of weight gain was maximum in the infants operated below 8months of age (2-4months = 3588g, 5-6months = 3592g, 7-8months = 3606g, 9-10months = 2590g, 11-12months = 2250g). Low birth weight and normal birth weight infants had similar Z-scores at the time of surgery and at follow-up in all 3 anthropometric parameters, and birth weight did not affect pre- as well as post-operative growth parameters. Suboptimal improvement in weight and length was seen in 40 and 20% of babies even after successful surgical repair, respectively. Growth failure in infants with a large VSD can be multifactorial. Early surgical closure of the shunt can lead to early normalization of growth parameters and faster catch-up growth. Few babies may fail to demonstrate a positive growth response even after timely surgical correction, and may be related to intrauterine and genetic factors or faulty feeding habits.

Predictive Value of Post-operative Cardiac Troponin I and Lactate Levels After Ventricular Septal Defect Closure

Objectives: Although the mortality rate of primary ventricular septal defect (VSD) closure surgery has been reduced to <0.5% in many centers, low cardiac output syndrome and multi-organ failure syndrome development in the post-operative period are still the most common causes of mortality and morbidity. The use of biochemical markers in the early period can be used as effective predictors for reducing mortality and morbidity. In this study, the effect of post-operative serum lactate and cardiac troponin I (cTNI) levels on hospital mortality in patients who underwent primary closure of VSD was investigated retrospectively. Methods: The effect of lactate and cTNI values on hospital mortality in 52 patients who underwent surgical repair for VSD was investigated. Serum lactate levels of all patients in the first 6 h after the operation; on the first post-operative day, cTNI values were examined retrospectively. Serum lactate levels exceeding 3.5 mmol/ lt and cTNI values exceeding 35 ng/mL were determined as the cut-off points. Results: Serum lactate level and cTNI increase were found to be statistically different in the mortality group (p<0.05). It was shown that increased cTNI was associated with weight, left ventricular end-diastolic diameter, and cardiopulmonary bypass time (p<0.05). Serum lactate levels were 4.1±0.5 mmol/lt in the non-mortality group and 15.3±8.3 mmol/lt in the mortality group, and the difference was statistically significant (p<0.05). Hospital mortality was observed in 6 patients. Conclusion: In patients undergoing VSD closure surgery, serum lactate levels measured in the first 6 h postoperatively and cTNI levels measured on the first post-operative day are associated with hospital mortality. Concomitant elevations of lactate and cTNI values in patients after VSD closure should suggest to take caution and early supportive treatments to reduce mortality.

TCTAP C-222 A Case of Transcatheter Ventricular Septal Defect Closure in a Challenging Pectus Excavatum Patient

TCTAP C-222 A Case of Transcatheter Ventricular Septal Defect Closure in a Challenging Pectus Excavatum Patient

Double Intervention in a Patient with Large Patent Ductus Arteriosus (PDA) and Moderate Upper Muscular Ventricular Septal Defect (VSD) with Bidirectional Shunt with Severe Pulmonary Hypertension

Patent ductus arteriosus (PDA) and Ventricular septal defect (VSD) are commonly encountered problems and constitute about 40% of all congenital heart lesions. The association of these two conditions in a single patient is not very uncommon. Both these conditions can be treated by placing intracardiac devices. Double interventional closure of Patent Ductus Arteriosus (PDA) and Ventricular Septal Defect (VSD) was performed in a gravely ill infant at her 3 months and 5 months of age respectively, who was suffering from recurrent pneumonia and heart failure since birth. These were lifesaving procedure for that patient which led to writing this report.

Mid-Term Outcome of the Hybrid Method of Ventricular Septal Defect Closure in Children.

<b>Objective: </b>To describe the clinical experiences and mid-term follow-up results of the hybrid method of ventricular septal defect closure in children.<br /> <b>Methods: </b>This study was a combined - multidirectional cohort. Between May 2016 and December 2020, 250 patients with isolated VSD (or residual VSD after a previous repair) underwent surgery by the hybrid method at the pediatric cardiac surgery department in the National Scientific Medical Center. This study adopted a combined and multidirectional cohort approach, initially starting as a retrospective cohort and later transitioning into a prospective cohort.<br /> <b>Results: </b>A total of 250 patients in this cohort underwent hybrid VSD closure, of which 233 (93.2%) patients were successful, 16 (6.4%) patients were converted to the traditional method and 1 (0.4%) death occurred. New trivial or mild tricuspid regurgitation was detected in 35 patients (15%) and aortic regurgitation in 9 patients (3.9%) by intraoperative TEE. For the remaining 10 patients with incomplete right bundle branch blocks the sinus rhythm was restored in follow-up. In addition, the left ventricular ejection fraction improved over time. One of the important points after surgery is the deformation of the chest. In 122 (91%) patients, there is no deformation; unfortunately, in 12 (9%) patients, there is deformation. <br /> <b>Conclusions: </b>The hybrid method is a rapidly developing technique that has been safe and effective in a selected group of patients in recent years. The advantages of this method are minimum incision namely the size and length of the postoperative scar from 2 to 4 cm. Also, no myocardial injury, and reduces operation time, intensive care unit stay, and hospital stays.

Clinical Presentation, Echocardiographic Findings, Treatment Options Available for Ventricular Septal Defect in Children: A Study in a Tertiary Care Military Hospital

Introduction: Ventricular Septal Defect (VSD) is the most common congenital heart defects. Early diagnosis, appropriate treatment and transcatheter VSD closure with newer devices in favorable cases, decrease the need for surgical interventions and mortality. Objectives: To determine the clinical presentation, echocardiographic findings and the treatment options available for VSD in Paediatric Cardiology Department, Combined Military Hospital (CMH) Dhaka. Methods: It was a cross sectional observational study carried out in the department of Paediatric Cardiology, CMH Dhaka. Forty six isolated ventricular septal defect cases were diagnosed by echocardiography. Clinical features, echocardiographic findings and treatment options of all 46 cases were observed and recorded in pre formed data sheet and statistical analysis was done in statistical software SPSS version 25. Results: Among the 46 patients of VSD, majority 20(43.48%) were in age group 0-6 months. Most of them were male 24(52%). Common presenting features were dyspnea on exertion 23(50%), cough 30(65.20%), head sweating 23(50%), and feeding problem in 34(73.91%). VSD in 27(58.6%) patients were <5mm, 15(32.6%) were 5-10mm and 4(8.7%) had size >10mm. Most of the VSDs were perimembranous 31(67.39%). Among the 46 cases medical management was given to 20(43.5%), device closure was done in 10(21.7%) patients and surgical interventions done in 16(34.8 %) patients. Conclusion: Most of the VSD patients presented at an earlier age some of them were undergone device closure and some require surgical interventions that were not suitable for device closure. Patients those presented lately developed pulmonary hypertension. JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 22-26

Predictive Scoring System for Spontaneous Closure of Infant Ventricular Septal Defect: The P-VSD Score.

Ventricular septal defect (VSD) is a common congenital heart disease. However, consensus on the utility of echocardiography in predicting spontaneous closure (SC) of VSD remains lacking. This study aimed to identify and validate significant predictors of SC through a predictive scoring system. This retrospective study included medical records of 712 echocardiography instances performed on 304 patients diagnosed with VSD from 2016 to 2020 in their first year of life. A novel scoring system for predicting the SC of VSD was developed and validated using another dataset from different hospitals. Of the 304 patients, 215 (70.7%) had perimembranous (PM) VSDs and 89 had muscular (29.3%) VSDs. The median follow-up periods were 36.2 (interquartile range [IQR], 13-59) months and 13.7 9 (IQR, 5-37.4) days for PM and muscular VSDs, respectively. The overall SC rate during follow-up was 29.3%. Pulmonary hypertension (HTN), concomitant left ventricle (LV)-right atrium (RA) shunt, VSD size to aortic valve (AV) annulus size ratio, and left ventricular end-diastolic dimension (LVEDD) z-score were significant risk factors affecting SC of VSD. The "P-VSD" score, a new scoring system, demonstrated an area under the curve for predictability of 0.769. Pulmonary HTN, concomitant LV-RA shunt, LVEDD z-score, and VSD size-to-AV annulus size ratio at diagnosis were significantly associated with non-SC VSD after infancy. The P-VSD score can predict the SC of VSD in clinical settings and simplify the identification and appropriate management of high-risk patients.

Bilateral remote ischemic conditioning in children: A two-center, double-blind, randomized controlled trial in young children undergoing cardiac surgery

ObjectiveThe study objective was to determine whether adequately delivered bilateral remote ischemic preconditioning is cardioprotective in young children undergoing surgery for 2 common congenital heart defects with or without cyanosis. MethodsWe performed a prospective, double-blind, randomized controlled trial at 2 centers in the United Kingdom. Children aged 3 to 36 months undergoing tetralogy of Fallot repair or ventricular septal defect closure were randomized 1:1 to receive bilateral preconditioning or sham intervention. Participants were followed up until hospital discharge or 30 days. The primary outcome was area under the curve for high-sensitivity troponin-T in the first 24 hours after surgery, analyzed by intention-to-treat. Right atrial biopsies were obtained in selected participants. ResultsBetween October 2016 and December 2020, 120 eligible children were randomized to receive bilateral preconditioning (n = 60) or sham intervention (n = 60). The primary outcome, area under the curve for high-sensitivity troponin-T, was higher in the preconditioning group (mean: 70.0 ± 50.9 μg/L/h, n = 56) than in controls (mean: 55.6 ± 30.1 μg/L/h, n = 58) (mean difference, 13.2 μg/L/h; 95% CI, 0.5-25.8; P = .04). Subgroup analyses did not show a differential treatment effect by oxygen saturations (pinteraction = .25), but there was evidence of a differential effect by underlying defect (pinteraction = .04). Secondary outcomes and myocardial metabolism, quantified in atrial biopsies, were not different between randomized groups. ConclusionsBilateral remote ischemic preconditioning does not attenuate myocardial injury in children undergoing surgical repair for congenital heart defects, and there was evidence of potential harm in unstented tetralogy of Fallot. The routine use of remote ischemic preconditioning cannot be recommended for myocardial protection during pediatric cardiac surgery.

Del Nido versus cold crystalloid cardioplegia for myocardial protection during ventricular septal defect repair in children under one year of age: a prospective randomized trial

Rationale: The choice of strategy for myocardial protection during procedures with cardiopulmonary bypass and cardioplegic arrest in children is not regulated by clinical guidelines due to insufficient data from clinical studies. The issue of methods to assess myocardial injury remains unresolved.
 Aim: To assess the frequency and specifics of the development of intraoperative myocardial injury syndrome in children of the first year of life with ventricular septal defect depending on the strategy for cardioplegia.
 Materials and methods: In a single center, prospective, randomized controlled trial we compared two cardioplegia strategies during surgical closure of ventricular septal defect in infants aged from 1 to 12 months: del Nido blood cardioplegia (n = 102) and cold crystalloid cardioplegia with Custodiol solution (n = 102). The primary endpoint was a persistent over 10-fold increase above the upper limit of the normal in the plasma concentration of high-sensitivity troponin I at 6 hours after surgery persisting after 24 hours. The secondary combined endpoint was myocardial damage verified by persistent increase in troponin I level more than 10-fold above the upper limit of the normal, persisting at 6 and 24 hours, accompanied by new pathological Q waves, acute complete left bundle branch block, abnormalities of the end part of the ventricular complex on the electrocardiography (ST segment elevation 1 mm or ST depression of 1 mm in more than 2 adjacent leads), and a decrease in the global longitudinal strain of the left ventricle by 50% from the initial value at 6 hours after surgery.
 Results: In 53/204 (26%) patients, the increase in troponin I persisted at 24 hours after the surgery and was associated with electrocardiography abnormalities, changes in the parameters of left ventricle longitudinal mechanics, and in some cases required greater inotropic support. By the end of the 1st postoperative 24 hours, the longitudinal strain of the left ventricle showed more negative changes over time in the Custodiol group compared to that in the del Nido group (-10 [-14.1; -6.27] versus -14.8 [- 16.5; -10]%; p 0.0001). The same was true for the left ventricle global strain rate (-0.71 [-0.9; -0.52] s-1 in the del Nido group and -0.57 [-0.760; - 0.44] s-1 in the Custodiol group; p = 0.0049). The primary endpoint was achieved by 21 (20.6%) and 55 (53.9%) patients in the del Nido and Custodiol groups, respectively (p = 0.032). The combined endpoint in the Custodiol group was achieved by 34 (33.3%) versus 19 (18.6%) patients in the del Nido group (p = 0.049, χ2 = 3.875, DF = 1, φ = 0.191).
 Conclusion: Del Nido blood cardioplegia compared to cold crystalloid cardioplegia with Custodiol has advantages in terms of preventing intraoperative myocardial damage and minimizing its severity. When assessing myocardial damage, such indicators as left ventricle global longitudinal strain and left ventricle global strain rate are informative, along with an increase in the troponin I level.

Impact of the Tricuspid Valve Detachment Technique on Hard-to-Expose Ventricular Septal Defect Closure

Ventricular septal defect (VSD) closure is a common procedure in congenital heart surgery. The exposure of VSDs can be challenging, especially in cases involving the tricuspid septal or anterior leaflets, chordae, or subvalvular apparatus. Although tricuspid valve detachment has been suggested to improve surgical visibility, its long-term effects remain unclear. Herein, we investigated the outcomes of VSD closure with or without tricuspid valve detachment and assessed the impact of this technique on postoperative tricuspid valve function and atrioventricular conduction. In total, 175 patients who underwent isolated VSD closure through the right atrium were retrospectively enrolled and divided into 2 groups: the tricuspid valve detachment group (n = 17, 9.7%) and the nontricuspid valve detachment group (n = 158, 90.3%). Patient characteristics were comparable between the two groups, and medical records and echocardiography reports were reviewed for each patient. The primary outcomes were mortality and reoperation, whereas the secondary outcomes included residual VSD, tricuspid valve regurgitation, advanced atrioventricular block, and aortic valve regurgitation. Clinical variables were compared between the two groups. Overall, tricuspid valve detachment did not increase perioperative complications or affect long-term tricuspid valve function. There were no cases of mortality or reoperation in either group. Although the tricuspid valve detachment group had longer bypass and cross-clamp times, this did not significantly affect ventilation or intensive care unit stay duration. Follow-up echocardiography revealed no significant intergroup differences in tricuspid regurgitation, residual shunt, or aortic valve regurgitation. In conclusion, tricuspid valve detachment is a safe and reliable technique for the complete closure of hard-to-expose VSDs without compromising tricuspid valve function. Moreover, it does not increase the risk of adverse events, and its outcomes remain favorable during short- and long-term follow-ups.

Risk Factors of Long-Term Sequelae After Transcatheter Closure of Perimembranous Ventricular Septal Defect in Young Children.

Complications arising from transcatheter closure of perimembranous ventricular septal defects (pmVSD) in children, such as residual shunts and aortic regurgitation (AR), have been observed. However, the associated risk factors remain unclear. This study identified risk factors linked with residual shunts and AR following transcatheter closure of pmVSD in children aged 2-12 years.Methods and Results: The medical records of 63 children with pmVSD and a pulmonary-to-systemic blood flow ratio <2.0 who underwent transcatheter closure between 2011 and 2018 were analyzed with a minimum 3-year follow-up. The success rate of transcatheter closure was 98.4%, with no emergency surgery, permanent high-degree atrioventricular block, or mortality. Defects ≥4.5 mm had significantly higher odds of persistent residual shunt (odds ratio [OR] 6.85; P=0.03). The use of an oversize device (≥1.5 mm) showed a trend towards reducing residual shunts (OR 0.23; P=0.06). Age <4 years (OR 27.38; 95% confidence interval [CI] 2.33-321.68) and perimembranous outlet-type VSD (OR 11.94, 95% CI 1.10-129.81) were independent risk factors for AR progression after closure. Careful attention is crucial for pmVSDs ≥4.5 mm to prevent persistent residual shunts in transcatheter closure. Assessing AR risk, particularly in children aged <4 years, is essential while considering the benefits of pmVSD closure.

Fast-track extubation guided by pulmonary artery pressure monitoring after ventricular septal defect closure in infants with pulmonary hypertension

BackgroundThe fast-track extubation approach in pediatric cardiac surgery shortens hospital stays and reduces medical costs. ObjectivesThis study aims to evaluate the feasibility of the fast-track extubation approach and the role of intraoperative pulmonary artery pressure (PAP) monitoring in managing patients with preoperative pulmonary hypertension (PH) who underwent ventricular septal defect (VSD) closure. MethodsThis retrospective study included 102 infants with VSD and preoperative PH (mean PAP > 20 mmHg on cardiac catheterization). We excluded four cases that required complex procedures with long cardiopulmonary bypass time for associated lesions. Intraoperative systolic PAP monitoring was performed to evaluate the suitability of the fast-track extubation approach (<35 mmHg). We defined the fast-track extubation approach as extubation in the operation room after VSD closure. This study also aimed to assess the predictors of postoperative adverse events. Postoperative adverse events included in-hospital death, PH crisis and prolonged mechanical ventilation time, and nitric oxide (NO) administration. ResultsThe fast-track extubation approach was carried out in 39 patients (38 %). One in-hospital death (1 %) occurred in a non-fast-track patient due to postoperative PH crisis. Two patients (5.1 %) required re-intubation after the fast-track extubation approach due to upper airway issues. The frequency of NO inhalation and administration of pulmonary hypertensive medicines was significantly lower in the fast-track group than in the non-fast-track group (P < 0.001). Multivariate analysis revealed that body weight of <4 kg at surgery (P = 0.006), surgery by trainees (P = 0.003), and greater intraoperative systolic PAP (P < 0.001) were significant risk factors for postoperative adverse events. ConclusionsOur findings showed that the fast-track extubation approach after VSD closure in infants with preoperative PH was feasible, as indicated by the low frequency of re-intubation and postoperative adverse events. Intraoperative systolic PAP measurement was useful for selecting patients to be included in the fast-track extubation approach.

Procedural Efficiencies and Clinical Outcomes for Transcatheter Device Closure of Perimembranous Ventricular Septal Defects With Different Waist-Length Occluders.

Potential differences in complications and/or long-term outcomes of perimembranous ventricular septal defect (pmVSD) closures with 3-mm waist vs. 4-mm waist double-disk symmetrical occluders are not known.Methods and Results: A total of 395 consecutive pediatric patients with pmVSD recruited between January 2017 and March 2021 underwent successful transcatheter closure using symmetrical pmVSD devices. The final analysis involved 208×3-mm and 172×4-mm cases. The median follow-up was 42 months (range: 12-62 months). A total of 175 post-procedure adverse events (AEs) were observed. Most of these AEs were temporary, and there were only 8 major AEs. Compared to the 3-mm waist group, the incidence of residual shunts was significantly higher in the 4-mm waist group (13.4% vs. 6.7%; P=0.030), whereas other AEs showed similar incidences between the 2 groups. Multivariate Cox regression analysis revealed that larger defect, higher ratio between device size and body surface area, and longer procedure time can cause an increased likelihood of AEs, and smaller defect or left disk placement within aneurysmal tissue may reduce it. Transcatheter closure of pmVSD using a symmetrical double-disk occluder is safe and effective. Compared with a 3-mm waist symmetrical occluder, transcatheter closure with a 4-mm waist symmetrical occluder correlated with higher incidences of residual shunts.

Hybrid versus traditional method closure of ventricular septal defects in children

ObjectiveThe aim of our study was to evaluate the safety and effectiveness of the hybrid method off-pump for closure of isolated ventricular septal defect (VSD) compared with the traditional method of on-pump of children. MethodsThis research was a retrospective cohort study. Data were collected from 500 patients with isolated VSD (or residual VSD after a previous repair) who underwent surgery at the National Scientific Medical Center from May 2016 to December 2020. Patients were operated with 1 of 2 methods of surgery: the traditional method of on-pump or the hybrid method of off-pump. This study assessed the safety and efficacy of the hybrid method by comparing it with the traditional method for the treatment of patients with isolated VSD. ResultsThe procedural success rate reached 93.2% in the hybrid method, with a 6.4% conversion rate to the traditional method and 0.4% hospital mortality. The mean operation time was 84 minutes (31; 160 minutes) in the hybrid group (n = 250) and 168 minutes (70; 300 minutes) in the traditional group (n = 250) (P = .000). Hospital mortality was 0.43% in the first group and 1.5% in the second group (P = .000). ConclusionsThe hybrid method of VSD closure is safe and effective in a selected group of patients. The advantages of the hybrid method are improved cosmetics and shorter operation time and overall hospital stay.

Possibilities of predicting early postoperative complications after surgical correction in infants of the first year of life with ventricular septal defect

Objective. To study the echocardiographic (Echo-CG) indicators in infants of the first year of life with ventricular septal defect (VSD) in the early postoperative period after surgical correction of the defect.&#x0D; Materials and methods. Examination of 205 infants with VSD was carried out. Complex examination before the surgery, 6, 24 hours and the day 10th after the surgery was fulfilled.&#x0D; Results. In the early postoperative period, myocardial dysfunction (MD) was detected in 30.2 % of cases (n = 62). The patients were longer subjected to artificial lung ventilation (p = 0.04), had a longer period of staying in the intensive care unit (p = 0.002) and hospital (p = 0.004). The data, predicting the postoperative MD were revealed including VSD area index (OR 2.7; р = 0.00001), longitudinal deformation of the left ventricle (SLV; OR 2.69; р = 0.00001), longitudinal deformation of the free wall of the right ventricle (SRV; OR 1.04; р = 0.0001) and the average estimated pressure in the lung artery (OR 1.6; р = 0.0001).&#x0D; Conclusions. 1. After the surgery, MD was detected in 30.2 % of cases. 2. SLV and SRV in infants with MD demonstrate the aggravation of ventricular contractility earlier than traditional indicators of the systolic function. 3. Preoperative SLV «–» 12 %, SRV «–» 6 %, VSD area index 100,5 mm2/m2, average estimated pressure in the lung artery 38 mm Hg are independent predictors of complications accompanied by MD during the first day after the VSD closure. 4. Complications, connected with longer ALV, are associated with duration of staying in the intensive care unit and hospital.