Ventricular Septal Defect Closure Research Articles

Long-term Outcomes of Surgical Repair for Corrected Transposition of the Great Arteries

BackgroundThis study investigated the long-term outcomes of physiological and anatomical repair for corrected transposition of the great arteries and double-outlet right ventricle with discordant atrioventricular connection. MethodsThis single-center retrospective study included 146 patients who underwent biventricular repair of corrected transposition of the great arteries or double-outlet right ventricle with discordant atrioventricular connections from 1972 to 2023. Survival rate, freedom from reoperation, New York Heart Association (NYHA) Functional Classification, and incidence of systemic ventricular dysfunction in the long-term were compared between physiological repair (PR) and anatomical repair (AR) groups. ResultsThe PR group consisted of 55 patients, with median age at repair of 10.3 years. Thirty-one patients underwent conventional Rastelli procedure, and 24 patients underwent atrial and/or ventricular septal defect closure. The AR group consisted of 91 patients, with median age at repair of 5.8 years. Seventy-two patients underwent atrial switch plus Rastelli procedure and 19 patients underwent atrial plus arterial switch operation. The 30-year survival was 63.5% in the PR group and 72.3% in the AR group (P = .448). The 30-year freedom from reoperation was 71.9% in the PR group and 62.2% in the AR group (P = .220). There was a significant difference in the incidence of systemic ventricular dysfunction between the groups (87.5% in the PR group and 35.3% in the AR group, P < .001) and in the NYHA classification of long-term survivors (mean NYHA class of 1.9 in the PR group and 1.5 in the AR group, P = .009). ConclusionsThe systemic ventricular function and general status in the long-term were significantly better in AR patients, suggesting the potential advantage of AR.

Midterm follow-up results of implantation of a fully biodegradable ventricular septal defect occluder.

Ventricular septal defect (VSD) is a prevalent congenital cardiac anomaly. By enhancing the occluder design and optimizing procedural approaches, the indications for VSD closure can be broadened while minimizing associated complications. The utilization of fully biodegradable occluder holds promising potential in resolving conduction block issues encountered during VSD closure. This study aims to compare the results of the fully biodegradable occluder with the metal occluder in transoesophageal echocardiography-guided VSD closure via lower sternal level minor incision at the interim follow-up, and to find risk factors for the occurrence of electrocardiographic and valvular abnormalities postoperatively. We reviewed the postoperative and 3-year follow-up data of all patients who underwent the randomized controlled study of VSD closure from January 1 to November 7, 2019 in the Second Xiangya Hospital of Central South University. The safety and efficacy of the procedure were assessed and compared between the 2 groups by electrocardiogram and echocardiography results, and the risk factors for the occurrence of postoperative electrocardiogram and valve abnormalities were studied with Logistic regression analysis. Twelve and fifteen patients underwent VSD closure with the metallic occluder and the fully biodegradable occluder, respectively. All patients survived during the follow-up period without major complications such as atrioventricular block, significant residual shunt, too rapid absorption of the occluder, and significant valvular regurgitation. There were no significant differences in the results of electrocardiograph and color Doppler ultrasonography the metal occluder group and the fully biodegradable occluder group 1, 2, and 3 years after operation (all P>0.05). The size of the occluder were risk factors for tricuspid regurgitation at 2 and 3 years postoperatively, and the difference between the occluder size and the VSD defect size were risk factors for tricuspid regurgitation at 2 years postoperatively (P<0.05). This study adequately demonstrates the safety and efficacy of fully biodegradable occluders in small VSD closure and shows the same postoperative effects as conventional nitinol occluders.

A Case of Ross Procedure for Aortic Regurgitation due to Prolapse of a Right Coronary Cusp Caused by Natural Closure of Ventricular Septal Defect

A Case of Ross Procedure for Aortic Regurgitation due to Prolapse of a Right Coronary Cusp Caused by Natural Closure of Ventricular Septal Defect

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.

Infected right ventricular outflow tract pseudoaneurysm in an infant with tetralogy of Fallot: Successful palliation using a Gore VBX® covered stent

ABSTRACT Pseudoaneurysm formation within the right ventricular outflow tract (RVOT) is a rare but serious complication following cardiac surgeries involving the RVOT. This report presents the case of a 3-month-old, 4 kg infant with tetralogy of Fallot and pulmonary atresia, previously treated with ventricular septal defect closure and right ventricle (RV)–pulmonary artery homograft placement. The patient presented critically ill with septic shock and suprasystemic RV pressure. A high-risk surgical approach was averted through the endovascular exclusion of the pseudoaneurysm using a Gore VBX® balloon expandable covered stent, in addition to stenting of bilateral proximal branch pulmonary arteries to alleviate RV hypertension. This case underscores the multifactorial nature of RVOT pseudoaneurysm formation and the importance of a high index of suspicion for diagnosis. Management options, including surgical and transcatheter strategies, are discussed, focusing on the successful use of a covered stent for stabilization in a critically ill patient.

Long-term Outcomes With Expanded Polytetrafluoroethylene Valved Conduits in Pediatric Patients

BackgroundThe expanded polytetrafluoroethylene (ePTFE) valved conduit (VC) has been reported for pulmonary valve replacement (PVR). The purpose of this study was to review long-term outcomes of our trileaflet ePTFE VC. MethodsThis multicenter study was performed with institutional review board approval from each institution. Our VC is fashioned from commercially available ePTFE tube grafts (for the conduit) and 0.1-mm-thick ePTFE membrane (for the trileaflet material). The patients were followed up in our clinic. Valve function was assessed by echocardiography in the operating room and at follow-up clinic visits after implantation. ResultsFifty-five patients received ePTFE VC between 2012 and 2023 (16-28 mm in diameter). Patients’ age at the time of implantation ranged from 6 months to 20 years (median, 7.5 years). Clinical follow-up ranged from 4 days to 10.1 years (average, 3.6 years). There were no hospital deaths. There were 2 non–valve-related late deaths. There have been no cases of endocarditis. Two patients required balloon dilation for the distal pulmonary artery stenosis, and 1 patient required residual ventricular septal defect closure. Five patients have received transcatheter PVR (TPVR) because of increased pressure gradient across the VC. Freedom from TPVR at 10 years was 90%. No valves required explantation or surgical replacement. ConclusionsCompared with historical data for other PVR options, our ePTFE VC shows excellent long-term performance and, when required, provides an easily accessible “landing zone” for TPVR. Our technique is easily learned, is reproducible, and can be a valuable option for surgeons performing PVR in pediatric patients.

The outcome of surgery for congenital heart disease in India: A systematic review and metanalysis

ABSTRACT Background: The mortality risks of children undergoing various cardiac surgeries for congenital heart disease (CHD) in India are not well defined. We conducted a systematic review and meta-analysis to estimate the inhospital mortality of various common CHD surgeries reported in India and compared it to representative data from established Western databases. Methods and Results: We searched four bibliographic databases for studies published in India over the last 25 years. In total, 135 studies met the inclusion criteria and included 30,587 patients aged from 1 day to 65 years. The pooled mortality rate of 43 Indian studies reporting multiple CHD surgical outcomes is 5.63% (95% confidence interval [CI]: 4.26–7.16; I 2 = 93.9%), whereas the Western data showed a pooled mortality rate of 2.65% (P value for comparison &lt;0.0001). The pooled mortality risk for ventricular septal defect closure and tetralogy of Fallot repair in Indian studies was 2.87% (95% CI: 0.76–5.91; I 2 = 62.4%) and 4.61% (95% CI: 2.0–8.02; I 2 = 87.4%), respectively. The estimated mortality risk was higher than the Western databases for all subcategories studied except for surgeries in the grown-ups with CHD population and coarctation repair. Conclusions: The estimated mortality risks are higher among Indian patients undergoing cardiac surgery for CHD as compared to Western data. We need prospective multicentric data to document whether the observed excess mortality exists after adjusting for various high-risk features and comorbidities in Indian patients. We need systemic measures to improve the outcomes of CHD surgeries in India.

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.

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.&#x0D; 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.&#x0D; 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.&#x0D; 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).&#x0D; 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.

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 &lt;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&lt;0.05). It was shown that increased cTNI was associated with weight, left ventricular end-diastolic diameter, and cardiopulmonary bypass time (p&lt;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&lt;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.

&lt;b&gt;Objective: &lt;/b&gt;To describe the clinical experiences and mid-term follow-up results of the hybrid method of ventricular septal defect closure in children.&lt;br /&gt; &lt;b&gt;Methods: &lt;/b&gt;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.&lt;br /&gt; &lt;b&gt;Results: &lt;/b&gt;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.&amp;nbsp;&lt;br /&gt; &lt;b&gt;Conclusions: &lt;/b&gt;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 &lt;5mm, 15(32.6%) were 5-10mm and 4(8.7%) had size &gt;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

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.

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.

Procedural outcomes of percutaneous closure of perimembranous and other ventricular septal defects using Konar-MF occluder and short-term follow-up.

The study aims to assess the procedural outcomes and follow-up after transcatheter closure of ventricular septal defects (VSDs) in children utilizing the Konar-MF™ occluder (Lifetech Scientific, Shenzhen, PRC) device. Clinical features, demographic characteristics, and follow-up findings of children undergoing percutaneous VSD device closure were retrospectively analyzed from the medical records. Fifty-seven patients underwent VSD closure using the Konar-MF occluder between January 2019 and April 2023. Median age and body weight of patients were 36 (5-216) months and 12.5 (3.8-42) kg, respectively. The mean size of the defect on the left ventricular side was 6.5 ± 2.4 mm on echocardiography; the mean pulmonary artery pressure was 19.1 ± 9.7 mmHg. Three patients with severe pulmonary hypertension had successful device closure. The most used device size was 8 mm × 6 mm. The initially chosen device was upsized in 4 (7.01%) patients and downsized in 1 (1.7%) patient. Forty-five patients (78.9%) had device closure through the retrograde route. The procedure was successful in 53 (93.0%) patients. Immediate shunt occlusion was achieved in 86.8% of patients. Major complications, namely, embolization (1) and moderate aortic regurgitation (1) in two patients were successfully managed by surgery. One patient with severe tricuspid regurgitation has been on close follow-up. There was no mortality. Late complications such as valve regurgitation or rhythm disturbance were not identified on a median follow-up of 6 (1.5-47) months. Transcatheter VSD closure using a Konar-MF occluder device is safe and effective, even in smaller children. The ability to deliver both anterogradely and retrogradely is a unique advantage.