Ventricular Septal Defect In Infants Research Articles

Transcatheter closure of perimembranous ventricular septal defect using the cocoon membranous VSD occluder

BackgroundTranscatheter device closure is a well-established treatment for suitable ventricular septal defects (VSDs). The Cocoon Membranous VSD Occluder is a relatively new device specifically designed for perimembranous VSDs. Existing research on the Cocoon Membranous VSD Occluder for closing PM VSD is limited. ObjectiveThis study aimed to describe a single-center experience using the Cocoon Membranous VSD Occluder for perimembranous VSD. MethodsWe retrospectively analyzed data from patients who underwent device closure of perimembranous VSD using the Cocoon occluder between May 2023 and April 2024. Procedural success, complications, and short-term outcomes were evaluated. ResultsBetween May 2023 and April 2024, 13 patients with perimembranous VSD and left-to-right shunt underwent device closure with the Cocoon Membranous VSD Occluder. Twelve patients (92.3 %) achieved successful VSD closure. The mean age was 8.06 years with standard deviation (SD) of 7.24 years. The mean weight was 11.98 kg with SD of 18.93 kg. The mean VSD size was 4.96 mm with SD of 0.92 mm. The VSD was crossed from the right ventricle in 5 patients and from the left ventricle in 9 patients. All patients had successful device placement from the right ventricle approach. The Cocoon Membranous VSD device size ranged from 6 to 4 mm to 12–4 mm. In one smaller patient, the device was electively removed due to significant flow through an additional exit, and the patient subsequently underwent surgery. Another patient developed hemoglobinuria on the fourth day, which resolved by the tenth day with hydration therapy. Two patients experienced trivial to mild aortic regurgitation, and one had Wenckebach phenomenon that resolved the next day. In the short-term follow-up (mean duration of 4.33 months), all patients were doing well, had good device performance, and showed no evidence of heart block. ConclusionsDevice closure of perimembranous VSD in infants with the Cocoon Membranous VSD Occluder appears to be safe and effective in carefully selected patients during short-term follow-up. Larger studies with long-term data are necessary for future recommendations.

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.

Left Ventricular Dysfunction Following Repair of Ventricular Septal Defects in Infants.

Left ventricular systolic dysfunction (LVSD) is frequently observed following repair of ventricular septal defects (VSD), although little is known about its incidence, time course, or risk factors. Among infants undergoing VSD repair, for postoperative LVSD, we sought to determine (1) incidence, (2) predictors, and (3) time to resolution. We queried our institution's surgical database for infants who underwent repair of isolated VSDs from November 2001 through January 2019. The primary outcome was postoperative LVSD, which was defined as a shortening fraction (SF) of <26% by M-mode. Postoperative echocardiograms were reviewed, and measurements were made using standard methods. Receiver operating characteristic analysis was generated to determine the preoperative left ventricular internal dimension (LVIDd) z-score most predictive of LVSD. Multivariable analysis was conducted to determine associations with LVSD; covariates in the model were weight percentile, genetic syndrome, preoperative diuretic, VSD type, and preoperative LVIDd z-score. Of the 164 patients who met inclusion criteria, 62 (38%) had postoperative LVSD. Fifty-eight (94%) of patients had resolution of LVSD within 9months of surgery. Preoperative LVIDd z-score of >3.1 was associated with both an increased incidence of postoperative LVSD and prolonged time to resolution. Multivariable logistic regression analysis showed only preoperative LVIDd z-score was independently associated with postoperative LVSD. LVSD following VSD closure is common, but nearly all cases resolve by 9months postoperatively. Elevated LVIDd prior to surgery is associated with postoperative LVSD. These data suggest VSD closure should be considered prior to the development of significant left ventricular dilation.

Hybrid Perventricular Ventricular Septal Defect Device Closure in a 3-Months Old Infant with Severe Failure to Thrive

We report a case of successful hybrid device closure of large mid muscular Ventricular Septal Defect (VSD) in an infant for the very first time in Pakistan. Increasing collaboration between pediatric cardiac interventionalists and congenital cardiac surgeons has resulted in introduction of various hybrid procedures in the management of Congenital Heart Diseases (CHD). Advantages of hybrid procedures include complex interventions by using minimally invasive methods, avoidance of cardiopulmonary bypass, shorter procedure and recovery time leading to subsequent decrease in complications. A large VSD in an infant carries an increased risk of morbidity including failure to thrive, congestive cardiac failure, and recurrentrespiratory tract infections. Timely and safely the successful perventricular closure of large VSD using hybrid approach is a milestone in the management of VSDs in infants.

The Interventricular Septal Hematoma Following Surgical Correction of Ventricular Septal Defect in Infants: A Single-Center Experience.

To review and analyze the cases of interventricular septal hematoma (IVSH) following surgical correction of the ventricular septal defect (VSD) in infants in our center. Retrospective analysis was performed on five infants with IVSH after surgical correction of VSD in our center from January 2020 to January 2022. The general preoperative information and intraoperative and postoperative results were collected and analyzed. All five infants with VSD were repaired under cardiopulmonary bypass and occurred IVSH. The cardiac arrest occurred in one patient five hours after return to the intensive care unit (ICU). The patient's hemodynamics were difficult to maintain after cardiopulmonary resuscitation, and the patient died. Two other patients had arrhythmia and unstable hemodynamics during the perioperative period, the hematoma puncture was performed, and the patients' symptoms lessened. Perioperative and postoperative echocardiography showed that the hematoma gradually was shrunk, and the hemodynamics became stable. The hemodynamics were stable in the remaining two infants during the perioperative period. No specific medical intervention was required other than clinical observation in these two patients. Finally, the four infants successfully were discharged with good clinical results. IVSH is a rare complication of surgical repair of VSD. Prevention and early detection of IVSH during operation in infants with VSD are essential.

Association of polymorphisms of FOLR1 gene and FOLR2 gene and maternal folic acid supplementation with risk of ventricular septal defect: a case-control study.

It was the first time to examine the role of maternal polymorphisms of FOLR1 gene and FOLR2 gene, as well as their interactions with maternal folic acid supplementation (FAS), in the risk of ventricular septal defect (VSD). A case-control study was conducted with 385 mothers of VSD infants and 652 controls. The exposures of interest were FAS and FOLR1 gene and FOLR2 gene polymorphisms. The logistic regression model was used for accessing the strength of association. After controlling for the potential confounders, women who did not utilize folic acid had a substantially higher risk of VSD (aOR = 2.25; 95% CI: 1.48 to 3.43), compared to those who did. We also observed genetic polymorphisms of FOLR1 gene at rs2071010 (GA vs. GG: aOR = 0.63, 95%CI: 0.45 to 0.88) and rs11235462 (AA vs. TT: aOR = 0.53, 95%CI: 0.33 to 0.84), as well as FOLR2 gene at rs651646 (AA vs. TT: aOR = 0.46, 95%CI: 0.30 to 0.70), rs2298444 (CC vs. TT: aOR = 0.58, 95%CI: 0.36 to 0.91) and rs514933 (TC vs. TT: aOR = 0.57, 95%CI: 0.41 to 0.78) were associated with a lower risk of VSD. Furthermore, there was a statistically significant interaction between maternal FAS and genetic polymorphisms at rs514933 on the risk of VSD (FDR_P = 0.015). The maternal genetic polymorphisms of the FOLR1 gene and FOLR2 gene, as well as FAS and their interactions, were shown to be significantly associated with the risk of VSD in offspring.

A comparison of autologous pericardium with Dacron™ for closure of ventricular septal defect in infants.

Glutaraldehyde-treated autologous pericardium (GtAP) and Dacron™ are 2 patch materials commonly used to repair ventricular septal defects (VSDs) in children. The primary objective of this study was to test the hypothesis that GtAP is as effective as Dacron for the repair of isolated VSD in infants. Data were collected retrospectively from all infants who underwent repair of isolated VSD at our institution between January 2009 and April 2017. A total of 156 patients were divided into 2 groups: 99 underwent repair with Dacron patch and 57 with GtAP. The primary end point was the need for reintervention for significant residual VSD. Adjusted hospital charges were also compared. The 2 groups were comparable in their baseline characteristics. There was no significant difference in postoperative morbidity indicators. One patient in each group underwent reintervention for the closure of residual VSD. The GtAP group had a higher incidence trivial and small residual VSD at discharge than the Dacron group (65% vs 39%, P = 0.007). The median duration of follow-up was 37 (15-75) months with no difference between the 2 groups. Forty-five percentage of the residual VSDs in the Dacron group (19/42) and 54%in the GtAP group (21/39) had closed. There was no difference in hospital charges and clinical outcomes. GtAP for the closure of isolated VSD in infants is comparable to Dacron. Although the incidence of trivial or small residual VSD is higher with the use of pericardium immediately after surgery, this difference disappears over time.

Application of the WeChat platform in midterm follow-up after surgical repair of ventricular septal defects in infants.

To explore the feasibility and superiority of applying the WeChat platform in a midterm follow-up of surgical repair for ventricular septal defects in infants. Eighty-six infants with VSD who underwent surgical repair were divided into an outpatient follow-up group and a WeChat follow-up group. The clinical data, including complications, economic cost, time spent, loss to follow-up rate, and parents' satisfaction at the 3-month and 1-year follow-ups, were recorded and analysed. There was no significant difference in the incidence of post-operative complications between the two groups. Although the loss to follow-up rate in the WFU group was lower than that of the OFU group, the difference was not statistically significant. The economic cost and time spent in the 3 months and 1 year after discharge in the WFU group were significantly lower than those in the OFU group. One year after discharge, the PSQ-18 score of the WFU group was significantly higher than that of the OFU group. Compared with outpatient follow-up, the WeChat platform at the midterm follow-up after surgical repair of VSDs in infants has the advantages of saving time and economic costs and improves parents' satisfaction.

The Albumin-to-Fibrinogen Ratio Independently Predicts Acute Kidney Injury in Infants With Ventricular Septal Defect Undergoing Cardiac Surgery With Cardiopulmonary Bypass.

Background: Acute kidney injury (AKI) is a common and serious complication faced by children following ventricular septal defect (VSD) surgery with cardiopulmonary bypass (CPB). The objective of this study was to explore potential predictors inherent to AKI.Methods: VSD infants who were scheduled for elective cardiac surgery with CPB from 2017 to 2020 were enrolled in this study. Based on the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE) criteria, patients were divided into AKI and non-AKI groups. Univariate and multivariate logistic regression analyses were carried out in order to evaluate potential risk factors for AKI. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive probabilities of risk factors for AKI.Results: Of all the 338 enrolled VSD infants, 49 manifested AKI with an incidence of 14.5% (49/338). The ROC curve indicated that albumin-to-fibrinogen ratio (AFR) during CPB was a significant predictor of AKI [area under the curve (AUC), 0.711; p < 0.001]. Based on the univariate and multivariate logistic analyses, AFR during CPB [odds ratio (OR), 1.89; 95% confidence interval (CI), 1.22–2.76, p = 0.011] was the only independent risk factor for AKI.Conclusions: This study demonstrated that a low AFR (<9.35) during CPB was an independent risk factor for AKI in VSD infants following cardiac surgery with CPB.

Percardiac closure of large apical ventricular septal defects in infants: Novel modifications and mid-term results.

Background/AimBoth open heart surgery and percutaneous approaches retain several limitations in closing large apical muscular ventricular septal defects (AmVSD) in infants. We present probe‐assisted percardiac device closure (PDC), an exclusively transoesophageal‐echocardiography guided technique, as an alternative with midterm results.MethodsThirty‐six infants with large AmVSDs (single or multiple‐holed) underwent PDC in our department. Mean AmVSD for single and multiple‐holed measured 7.2 ± 2.4 mm and 6.3 ± 3.4 mm, respectively. Subjects presented with a spectrum of cardiopulmonary sequelae and growth retardation, either alone or combined. Some were ventilator dependent and re‐do cases. In addition, AmVSDs were categorized: cylindrical, tunnel and cave‐like shaped as per color Doppler interrogation. Pursuant to cardiac access and deployment technique, subjects were apportioned: group A; inferior median sternotomy (perventricular), B; right mini‐thoracotomy (peratrial) and C; complete median sternotomy (perventricular). Under exclusive echocardiography, the Z‐ or J probe‐assisted delivery system was utilized to access AmVSDs and implant device(s) via aforementioned techniques.ResultsForty‐two muscular ventricular septal devices (8.4 ± 2.6 mm) were implanted in 36 subjects uneventfully. Seventeen “complex,” and 10 cylindrical or straight tunnel‐shapedAmVSDs (including 2 re‐do patients) suited perventricular and peratrial techniques respectively. Comparatively, group B exhibited shorter procedural indices than A (p < .01). Five of 15 multiple‐holed AmVSDs (four Swiss cheese) required two or three devices for a satisfactory occlusion. Nevertheless, post occlusion insignificant residual shunts( ≤ 2 mm) seldom achieved spontaneous closure, and at 36‐month follow‐up complete closure was 67%. Residual shunt persisted amongst multiple‐holed. All patients improved during follow up.ConclusionPDC is feasible, safe and effective alternative technique for AmVSD in infants.

The choice of tactic for surgical treatment of aortic arch hypoplasia with ventricular septal defect in infants

Aim: to determine the optimal tactic for surgical correction of aortic arch hypoplasia and ventricular septal defect (VSD) in infants based on the comparison of immediate and follow-up outcomes of one- and two-stage repair.Materials and methods. Between 2011 to 2019, 138 patients under the age of one year underwent surgical repair of aortic arch hypoplasia with VSD in the leading Ukrainina cardiosurgical institutions – National M. Amosov Institute of Cardiovascular Surgery Affilated to National Academy of Medical Sciences of Ukraine and Center for Pediatric Cardiology and Cardiac Surgery. Patients were divided into two groups: group I involved 66 (47.8 %) patients who underwent one-stage repai of aortic arch hypoplasia and VSD, group II included 72 (52.2 %) patients with two-stage repair, consisting of aortic arch reconstruction and pulmonary banding at the first stage, and correction of VSD at the second stage.Results. The total hospital mortality was 3.6 % (n = 5). In group I, hospital mortality was 3.0 % (n = 2), in group II – 4.2 % (n = 3), but this difference is not statistically significant (P > 0.05). Follow-up was from 1 month to 11 years. Mortality rate over follow-up period was 0 %. Aortic arch restenosis developed in 16 (11.6 %) patients: 6 (9.1 %) patients in group I and 10 (13.9 %) patients in group II. There was no statistically significant difference in restenosis development between two groups. Compression of the trachea and left main bronchus developed in two patients of group II (2.8 %). There were no residual VSDs which would need repeated repair.Conclusions. Both one-stage and two-stage tactic for surgical treatment of aortic arch hypoplasia with VSD in infants is effective and safe showing good immediate and long-term follow-up results. The study indicates that one- stage correction is more acceptable in infants with hypoplasia of segment C or all aortic arch segments. Stage tactic can be used in hypoplasia of segments B and A.

The Natural and Unnatural History of Ventricular Septal Defects Presenting in Infancy: An Echocardiography-Based Review

Ventricular septal defect (VSD), the most common congenital heart defect, accounts for 40% of heart malformations. Despite this prevalence, there remains no consensus on the utility of echocardiography to guide modern-era treatment. In this study, we evaluated patients with isolated VSDs to test the hypothesis that echocardiographic evidence of left ventricular (LV) volume overload and type of VSD are associated with surgical intervention and to identify useful echocardiographic indicators for management of VSDs in infants and children. We reviewed 350 patients with VSDs diagnosed during the first year of life. Echocardiographic measurements were made at the time of diagnosis and at the endpoint. The VSD area was calculated using inner edge to inner edge dimensions obtained from two planes and indexed to body surface area. Aortic annulus dimension, left atrium to aortic root ratio, LV end-diastolic diameter, left atrial volume, VSD velocity-time integral, ejection fraction, and pulmonary to systemic blood flow ratio (Qp:Qs) were measured using conventional methods. One hundred seventy-seven muscular (50.5%) and 162 perimembranous (46%) VSDs accounted for the vast majority of defects. Only seven (4%) muscular defects required surgical closure, while 76 (47%) perimembranous defects required surgery. Indexed VSD area, VSD to aortic valve ratio, indexed left atrium volume, LV end-diastolic diameter, VSD velocity-time integral, and Qp:Qs at diagnosis were significantly different between the surgical and nonsurgical groups. Ventricular septal defect area > 50mm2/m2 at initial diagnosis was independently associated with risk for surgery (P=.0055). Indexed VSD area is an echocardiographic variable that can be easily measured at diagnosis and can provide insight into the likelihood of requiring surgical intervention regardless of the type and location of the defect.

Postoperative Recovery of Left Ventricular Function following Repair of Large Ventricular Septal Defects in Infants

Early postoperative left ventricular (LV) dysfunction is observed following repair of large ventricular septal defects (VSDs), but the frequency and rate of recovery of LV function are unknown. This study aims to characterize the incidence and rate of recovery of postoperative LV dysfunction following repair of large VSDs and to improve understanding of LV mechanics before and after VSD repair. Infants who underwent surgical repair of an isolated large VSD were included. Pre- and postoperative echocardiographic images were reviewed, and LV function was assessed by both conventional echocardiography and speckle-tracking strain analyses. Postoperative LV dysfunction was defined as an LV ejection fraction (LVEF)<50% using the 5/6 area-length method. Echocardiograms were reviewed to assess LVEF and LV volume through 1-year follow-up. Of 104 infants evaluated (median age, 0.31 [0.22, 0.56] years), all had normal preoperative LVEF and 39 (38%) had postoperative LV dysfunction. Follow-up echocardiograms were available in 31 (80%) patients, all of whom had LVEF>50% within 9months of surgery. Lower preoperative apical four-chamber longitudinal strain (A4LS) and greater LV end-diastolic volume indexed to body surface area1.38 were independently associated with postoperative LV dysfunction. An absolute preoperative A4LS < 16.7% (area under the curve=0.87; 95% CI, 0.78-0.95; P<.001) was most strongly associated with postoperative dysfunction. Infants with LV dysfunction following repair of large VSDs recover function within 9months. Preoperative A4LS can be helpful to detect subclinical LV dysfunction in the setting of a large hemodynamically significant VSD and guide postoperative expectations for providers and families.

Атрезия легочной артерии с дефектом межжелудочковой перегородки у детей первого года жизни

Атрезия легочной артерии с дефектом межжелудочковой перегородки у детей первого года жизни

Isolated ventricular septal defect in infants

Ventricular septal defect is a hole in the interventricular septum and may be isolated or associated with other major defects involving patency of the arterial duct, coarctation of aorta, pulmonary stenosis, tetralogy of Fallot, double-outlet right ventricle, truncus arteriosus, and transposition, and account for over half of the patients with congenital heart disease. Isolated ventricular septal defect is the most commonly recognized congenital heart anomaly in children and accounts for about one-fifth of all congenital heart disease. In this chapter, we’ll cover isolated ventricular septal defects.

Transcatheter closure of muscular ventricular septal defect in infant with dilated cardiomyopathy

Transcatheter closure of muscular ventricular septal defect in infant with dilated cardiomyopathy

Sertraline use in the first trimester and risk of congenital anomalies: a systemic review and meta-analysis of cohort studies.

To perform a meta-analysis of available cohort studies on the association between sertraline use by pregnant women in the first trimester and the findings of congenital anomalies in infants. A comprehensive search of articles published from the index date up to 31st December 2015 investigating the aforementioned associations was conducted on PubMed and Web of Science. Mesh headings used included the terms "serotonin reuptake inhibitor," "sertraline," "congenital anomalies" and "obstetrical outcome." Twelve cohort studies that involved 6 468 241 pregnant women were identified. We summarized odds ratios (ORs) and 95% confidence intervals (CIs) of congenital anomalies using the random-effects model. Pregnant women who used sertraline in the first trimester had a statistically significant increased risk of infant cardiovascular-related malformations (OR=1.36; 95% CI=1.06-1.74; I2 =64.4%; n=12) as well as atrial and/or ventricular septal defects (OR=1.36, 95% CI=1.06-1.76; I2 =62.2%; n=8). Additionally, positive but nonsignificant associations between sertraline use and congenital anomalies of the nervous system (OR=1.39; 95% CI=0.83-2.32; I2 =0%; n=5), digestive system (OR=1.23; 95% CI=0.76-1.98; I2 =0%; n=5), eye, ear, face and neck (OR=1.08; 95% CI=0.33-3.55; I2 =32.1%; n=3), urogenital system (OR=1.03; 95% CI=0.73-1.46; I2 =0%; n=5), and musculoskeletal system (OR=0.97; 95% CI=0.69-1.36; I2 =0%; n=5) were observed. This meta-analysis suggested that the use of sertraline use by pregnant women in the first trimester had an increased risk of cardiovascular-related malformations as well as atrial and/or ventricular septal defects in infants. Meanwhile, nonsignificant associations between sertraline use and other congenital anomalies were found. More cohort studies are warranted to provide detailed results of other congenital anomalies.

Prediction of Fluid Responsiveness Using Pulse Pressure Variation in Infants Undergoing Ventricular Septal Defect Repair with Median Sternotomy or Minimally Invasive Right Thoracotomy.

Fluid management is challenging in infants after cardiopulmonary bypass. Pulse pressure variation (PPV) derived from pressure recording analytical method (PRAM) is based on lung-heart interaction during mechanical ventilation. A prospective observational study conducted in operating room tested PPV to predict fluid responsiveness in ventricular septal defect infants. Infants in open chest conditions with median sternotomy (n=26) or minimally invasive right thoracotomy (n=29) undergoing ventricular septal defect repair were enrolled. After cardiopulmonary bypass and modified ultrafiltration, all patients received fluid challenge. PPV was recorded using PRAM along with heart rate, diastolic blood pressure, stroke volume index (SVI), and cardiac index (CI) before and after volume replacement. Patients were considered as responders to fluid loading when CI increased ≥15%. In infants with median sternotomy, 12 were responders and 14 non-responders. PPV in responders was higher than that in non-responders (24.7±6.4 vs. 16.6±5.0%, P<0.01). Area under the curve was 0.85 (95% confidence interval, 0.69-1, P=0.001) and cutoff value 19% with a sensitivity of 92% and a specificity of 71%. In infants with minimally invasive right thoracotomy, 16 were responders and 13 non-responders. PPV in responders was higher than that in non-responders (25.0±6.8 vs. 18.2±5.3, P<0.01). Area under the curve was 0.83 (95 confidence interval, 0.66-0.98, P=0.001) and cutoff value 18% with a sensitivity of 94% and a specificity of 69%. PPV sensitively predicts fluid responsiveness in ventricular septal defect infants after surgical repair in open chest conditions both with median sternotomy and minimally invasive right thoracotomy.

50th Anniversary Landmark Commentary on Rein JG, Freed MD, Norwood WI, Castaneda AR. Early and Late Results of Closure of Ventricular Septal Defect in Infancy. Ann Thorac Surg 1977;24:19–27

50th Anniversary Landmark Commentary on Rein JG, Freed MD, Norwood WI, Castaneda AR. Early and Late Results of Closure of Ventricular Septal Defect in Infancy. Ann Thorac Surg 1977;24:19–27

ASSA14-14-01 The application of minimally invasive open heart surgery through right subaxillary shorter incision for ventricular septal defects in infants weighted less than 5 Kg

<h3>Objective</h3> To explore the safety and outcome of minimally invasive open heart surgery for ventricular septal defects (VSD) in infants with low body weight. <h3>Method</h3> Eighty five infants weighted less than 5 Kg who had undergone repair of VSD through a right subaxillary short incision were surveyed (right group) and 113 patients of the same weight were surveyed who had undergone the repair of VSD through a median sternotomy (median group). Preoperative data, perioperative parameters, mortality and morbility were investigated for retrospective analysis. <h3>Results</h3> Most of the preoperative data in right group and median group were similar (p &gt; 0.05) except that the body weight, (4.61 ± 0.41 Kg vs 4.95 ± 1.18 Kg, p &lt; 0.05), body surface area (0.27 ± 0.02 m² vs 0.28 ± 0.01 m², p &lt; 0.05), the incidence of preoperative pneumonia history (44.2% vs 64.7%, p &lt; 0.05) in median group were lower than that of right group (p &lt; 0.05). Compared with median group, right group was with shorter incision (6.01 ± 0.85 cm vs 9.13 ± 1.04 cm, p &lt; 0.05), length of operative time (143.64 ± 22.41 min vs 152.12 ± 22.80 min, p &lt; 0.05) and postoperative stay (7.13 ± 2.60 vs 8.86 ± 3.67, p &lt; 0.05), and less drainage (14.47 ± 4.99 ml/Kg vs 17.21 ± 10.98 ml/Kg, p &lt; 0.05) and transfusion of red blood cell (10.34 ± 9.70 ml/Kg vs 14.60 ± 1.59 ml/Kg, p &lt; 0.05). There were no deaths and low incidence of complications in both groups, and without significant difference between them (p &gt; 0.05). <h3>Conclusion</h3> The minimally invasive open heart surgery through right subaxillary short incision for VSD in infants with low body weight was safe and effective.