VSD Closure Research Articles

E-070 Endovascular treatment in a paediatric patient with thrombus extending from right internal carotid artery to right middle cerebral artery

IntroductionPaediatric stroke leads to significant morbidity and mortality. Approximately10–25% of children with a stroke will die, up to 25% of children will have a recurrence, and approximately 66% will have...

Diagnosis, treatment and outcomes of patients with aortopulmonary window.

Aortopulmonary window (APW) is a communication between the ascending aorta and the pulmonary artery in the presence of two separate semilunar valves and is the rarest of septal defects. To present our experience with the diagnosis and outcome of APW cases. Retrospective cohort study. Between June 2003 and October 2011, thirteen patients were diagnosed with APW. Clinical features of patients, findings of echocardiographic and angiographic examination, results of surgical intervention and follow-up were reviewed retrospectively. Eleven children (10 days to 16 years), underwent surgical correction of APW. In a 12-month-old boy, the defect was repaired by the transcatheter approach. In addition to APW repair, closure of VSD was performed in 2 patients. APW were associated with interruption in two patients; one also had a complex pathology. None of the patients died due to complications of surgical or transcatheter procedures. After a median follow-up period of 40 months, the patients were asymptomatic and none of them required additional medication, except for the patient with complex pathology including an interrupted aortic arch, who underwent balloon angioplasty for recoarctation. In any infant with the findings of congestive heart failure and failure to thrive, APW must be kept in mind as a differential diagnosis. In isolated APW cases before 6 months of age, echocardiography is often sufficient for diagnosis. In complex cases, cardiac catheterisation is performed for the comprehensive evaluation of associated defects. After 6 months, cardiac catheterisation could be utilised to perform vasoreactivity testing and, if possible, to close the defect.

ASSA13-17-8 Interventional Therapy of Combined Congenital Heart Disease

<h3>Objective</h3> To evaluate the interventional therapeutic strategy and effect of one-stage interventional therapy of 109 patients’ with combined congenital heart idsease. <h3>Methods</h3> From June 2000 to October 2012, 109 cases with combined congenital heart disease underwent one-stage interventional therapy. There are 38 males and 71 females ranging from 1 to 56 years old (13.8 +/- 14.6). All patients had been diagnosed by X-ray, ECG, echocardiogram, right heart catheterization and cardiac angiography before the interventional therapy. There were 12 cases with Atrial septal defect (ASD) and patent ductus arteriosus (PDA), 39 cases with ASD and pulmonary valvular stenosis (PS), 25 cases with ASD and ventricular septal defect, 1 case with ASD and mitral valve stenosis (MS), 23 cases with VSD and PDA, 8 cases with PDA and PS, 1 case with ASD and PDA and PS. The interventional therapeutic sequence was percutaneous balloon pulmonary valvuloplasty (PBPV) or percutaneous balloon mitral valvuloplasty, VSD closure, PDA closure, ASD closure in turn. And to evaluate the therapeutic effect by echocardiogram, cardiac angiography or cardiac chamber piezometry after procedure immediately. All patients were enforced X-ray, ECG, echocardiogram on 2d, 1, 3 and 6 months after operation for the follow-up. <h3>Results</h3> All patients were treated successfully. No complications occurred during the procedure. No residual shunt and dislocation of the devices were found. In the patients with PS, the systolic gradient pressure across the pulmonary valve decreased meet a criterion after operation. In 1 case with ASD and mitral valve, the mitral valve orifice areas increased markably after procedure. During the period of follow-up, the enlarged chambers heart were diminished progressively and all the occluders fixed wel1, X-ray examination showed that pulmonary vascularity diminished significantly, and there was no severe complication in all patients by echocardiogram. <h3>Conclusions</h3> Though the operation is more difficult and the interventional technic is more skillful, but multiple transcatheter interventions in the same session are feasible, safe and effective with satisfactory good results. However, a satisfactory result can be obtained from suitable indications by TTE before operation, proper algorithm of procedures and standardised manipulations.

Successful transcatheter closure of perimembranous ventricular septal defect with inlet extension using Amplatzer occlude device (ADOI)

Introduction Transcatheter closure of perimembranous ventricular septal defect (PM VSD) is abandoned in many center and in some became restricted to certain age and criteria because of the risk of complete heart block (CHB). The risk of damaging the tricuspid valve (TV) in the presence of inlet extension is another risk. I am presenting successful closure of such defect using Amplatzer occluder device for PDA with reasonable follow up period in Prince Sultan Cardiac Center PSCC. Method Through 2011 4 patients underwent transcatheter closure of PM VSD with inlet extension, all patients were consented and procedure were done under general anesthesia, Transesophageal echocardiography was done in all, one has 3D assessment Hemodynamics were assessed pre procedural, A–V loop was applied in 2 patients, ADOI were used in all,heparin and antibiotics were giving during and 24 h post procedure, 3 patients were extubated same day and one the following day, all patients were kept on aspirin for 6 months. Result Median age 17 kg, 3 female and 1 male, median age 7 year, Median ventilatory duration is one day, Median hospital stay is 2 days, Median Follow up is 16 months, No immediate or early complication or deaths, normal ECG immediately and during follow up period, normal Echocardiography with no residual leak during follow up period. Conclusion In selected patients with PM VSD and inlet extension ADOI device can be used safely and effectively to close the defect with no immediate or early complications.

Tailored management approach for critically sick children and late presenters with congenital heart disease

Background and objectives Re-conditioning before cardiac surgery in critically sick children is often needed. We report our experience using tailored management approach in these patients. Methods and patients The charts of patients with CHD who judged to have high operative risk were reviewed. Included were patients with: large left to right shunt and ventilation for longer than 2 months, significant left to right shunts at multiple levels combined with malnutrition or recent infection, severely impaired cardiac function needing inotropic support and antifailure medications, recent. RSV infection, severe malnutrition (body weight Results Six patients were included. The median age was 13 months (2–48 months) and median weight was 4.6 kg (2.3–12.6 kg). Two patients had multiple left to right shunts and ventilator dependency. One with huge VSD presented at four years of age. Another with low body weight, large VSD and impaired LV function.Two more with early postoperative complications and ventilator dependency. In the first category, staged approach was essential. This was done by transcatheter closure of the PDA, followed by pulmonary artery banding. This approach lead to extubation. After proper nutrition, total correction was done.The patient who presented at four years of age underwent banding of PA, later surgical repair of VSD. Because of long postoperative ICU stay, he needed percutaneous closure of his residual VSD and then discharged. The patient with large muscular VSD and impaired LV function underwent percutaneous VSD closure with good result despite low weight (4.2 kg).The last two patients; one needed balloon dilation of residual coarctation, the other because of severe obstruction to his bilateral Glenn anastomosis, underwent stenting of these stenosis. Both had good result. Conclusions In severely sick children and late presenter with multiple shunts, a tailored management including therapeutic catheterization and supportive measures are essential before cardiac surgery. Catheterization and possible intervention should be considered early during postoperative phase in severely sick patients.

Minimally invasive perventricular device closure of ventricular septal defect in infants under transthoracic echocardiograhic guidance: feasibility and comparison with transesophageal echocardiography

BackgroundA hybrid approach to minimally invasive perventricular closure of VSD in infants is safe and effective, and has been performed under guidance of transesophageal echocardiography (TEE). We applied transthoracic echocardiographic (TTE) guidance to this hybrid approach, and compare results guided by TTE with those by TEE.MethodsFrom January 2011 to January 2012, 71 infants with VSD were enrolled to undergo a minimally invasive device closure. After evaluation of VSD by TTE, either TEE or TTE was used to guide the minimally invasive device closure. 30 patients had TEE guidance, and 41 patients had TTE. All patients were followed for 3 months after the operation.ResultsThe TEE group had a success rate of 93.3% (28/30) for device implantation, compared with 92.7% (38/41) in the TTE group. Two patients in the TEE group turned to surgical closure, one for involvement of the inlet area of VSD demonstrated by TEE, another for moderate aortic regurgitation after device implantation. Two patients in the TTE group also transferred to surgical closure, one for residual shunt, another for failure of the floppy wire across the defect. In addition, one patient in the TTE group experienced dropout of the occluder one day postoperatively. At 3-month follow-up, one patient had mild aortic regurgitation in the TEE group and in two patients in the TTE group. There were no episodes of cardiac block, thromboembolism, or device displacement in either group.ConclusionsTTE-guided VSD closure is feasible in infants, with results similar to those of TEE guidance, although caution is advisable.

Hemolytic Hyperbilirubinemia After Percutaneous Device Closure of Left Ventricular Pseudoaneurysm: A Disregarded Complication

Surgical repair of a left ventricular pseudoaneurysm is challenging. Percutaneous closure with an AMPLATZER Septal Occluder (AGA Medical Corporation, Golden Valley, MN) has evolved to be an effective alternative to conventional surgery with less complication. We report a case of severe hemolytic hyperbilirubinemia and acute renal failure after percutaneous left ventricular pseudoaneurysm endoprothesis repair, which required conventional surgical repair through a left thoracotomy to treat this complication. The rationale and results of such an off-the-label usage of AMPLATZER Septal Occluder were reexamined. Residual leakages were not rare findings in the reviewed literature. The indications for this approach should be individualized.

Hybrid approach for closure of muscular ventricular septal defects

BackgroundThe complexity of ventricular septal defects in early infancy led to development of new mini-invasive techniques based on collaboration of cardiac surgeons with interventional cardiologists, called hybrid procedures. Hybrid therapies aim to combine the advantages of surgical and interventional techniques in an effort to reduce the invasiveness. The aim of this study was to present our approach with mVSD patients and initial results in the development of a mini-invasive hybrid procedure in the Gdansk Hybrid Heartlink Programme (GHHP) at the Department of Pediatric Cardiac Surgery, Pomeranian Centre of Traumatology in Gdansk, Poland.Material/MethodsThe group of 11 children with mVSDs was enrolled in GHHP and 6 were finally qualified to hybrid trans-ventricular mVSD device closure. Mean age at time of hybrid procedure was 8.22 months (range: from 2.7 to 17.8 months, SD=5.1) and mean body weight was 6.3 kg (range: from 3.4 to 7.5 kg, SD=1.5).ResultsThe implants of choice were Amplatzer VSD Occluder and Amplatzer Duct Occluder II (AGA Med. Corp, USA). The position of the implants was checked carefully before releasing the device with both transesophageal echocardiography and epicardial echocardiography. All patients survived and their general condition improved. No complications occurred. The closure of mVSD was complete in all children.ConclusionsHybrid procedures of periventricular muscular VSD closure appear feasible and effective for patients with septal defects with morphology unsuitable for classic surgical or interventional procedures. The modern strategy of joint cardiac surgical and interventional techniques provides the benefits of close cooperation between cardiac surgeon and interventional cardiologist for selected patients in difficult clinical settings.

Determinants of Immediate Extubation in the Operating Room after Total Thoracoscopic Closure of Congenital Heart Defects

Objective: This study was designed to assess the factors that influence immediate extubation following totally thoracoscopic closure of congenital heart defects. Subjects and Methods: Clinical and operational data of 216 patients (87 males, average age 13.6 ± 10.9 years) were retrospectively analyzed. Atrial (ASD, n = 90) or ventricular septal defects (VSD, n = 126) were closed via a totally thoracoscopic approach. Ultra-fast-track anesthesia (UFTA) was used in all patients. Results: Immediate extubation in the operating room was successfully performed in 156 (72.2%) patients. A delayed extubation was completed in the intensive care unit in the remaining 60 (27.8%) patients. There was no significant difference in the age, sex, body weight, or type of congenital heart defect between the immediate and delayed extubation groups (p > 0.05). However, more patients in the delayed extubation group had severe preoperational pulmonary hypertension [8 (13.3%) vs. 4 (2.3%), p < 0.05]. The cardiopulmonary bypass time, aortic clamp time, and total duration of the surgery in the immediate extubation group were shorter than in the delayed extubation group (p < 0.05). Multivariate logistic regression analysis showed that preoperational pulmonary hypertension, duration of the surgery or cardiopulmonary bypass, and dosage of fentanyl used during the surgery were independent predictors for immediate extubation. Conclusions: UFTA and immediate extubation in the operating room was feasible and safe in the majority of patients undergoing totally thoracoscopic closure of ASD or VSD. Preoperational pulmonary hypertension, duration of the surgery, and the dosage of fentanyl used for UFTA were the determining factors for immediate extubation.

Tetralogy of Fallot With Atrioventricular Septal Defect: Surgical Strategies for Repair and Midterm Outcome of Pulmonary Valve-Sparing Approach

Repair for tetralogy of Fallot (TOF) with complete atrioventricular septal defect (CAVSD) has been reported with good early and intermediate outcomes. Morbidity, however, remains significantly high. To date, repair of CAVSD/TOF using a pulmonary valve-sparing technique (PVS) and freedom from valve reoperation are not well defined. A study was undertaken to investigate outcomes. This study was conducted in as a retrospective investigation. Between January 1988 and December 2008, 13 consecutive patients with CAVSD/TOF were identified, and their records were reviewed retrospectively. Of these 13 patients, 9 had Rastelli type C CAVSD. Trisomy 21 was present in 9 cases (69 %; 7 with type C). Five patients had received a systemic-to-pulmonary shunt (SPS) before complete repair at a mean age 1.7 ± 0.6 months. All the patients survived until complete repair. At complete CAVSD/TOF repair, AVSD was corrected with a two-patch technique in all patients. For eight patients (61.5 %), PVS was used. The remaining five patients had transannular patch (TAP) repair. The mean age at complete repair was 6.3 ± 2.4 months. At complete repair, the mean cardiopulmonary bypass time was 173.5 ± 30.6 min, and the cross-clamp time was 134.7 ± 28.8 min. There was one hospitalization and no late deaths. The median follow-up period was 9.2 years [interquartile range (IQR), 4.7-13.3 years]. The actuarial survival was 90.0 ± 9.5 % at 1 year, 90 ± 9.5 % at 5 years, and 90 ± 9.5 % at 8 years. Of the 12 survivors, 6 had some reintervention during the follow-up period. Within the first 11 years after complete repair, two patients underwent left atrioventricular (AV) valve repair, and one patient had right AV valve repair. Two patients had residual VSD closure. Four patients underwent the first right ventricular outflow tract (RVOT) reintervention for critical insufficiency or stenosis at a mean interval of 6 ± 21) months. One patient had a second RVOT reoperation. Findings showed that CAVSD/TOF with PVS was related to significantly higher freedom from RVOT reintervention (100 % at 1, 5, and 8 years compared with 80 ± 17.9 % at 1 year, 60 ± 21.9 % at 5 years, and 40 ± 21.9 % at 8 years for CAVSD/TOF using TAP; P < 0.05). No patient who underwent PVS had left ventricular outflow tract obstruction requiring reoperation. Overall freedom from any reintervention was 90.9 ± 8.6 % at 1 year, 71.6 ± 14.0 % at 5 years, and 53.7 ± 8.7 % at 8 years in this group of patients. Correction of TOF with CAVSD can be performed at low risk with favorable intermediate-term survival and satisfactory freedom from reoperation. Use of TAP can be avoided in almost two thirds of patients and may influence freedom from early RVOT reintervention.

Effect of body weight on the outcome of ventricular septal defect repair

Low body weight and failure to thrive (FTT) often are considered limiting factors for open heart surgery. The purpose of our study is to asses the impact of FTT on ICU outcome of children undergoing ventricular septal defect repair. We conducted a retrospective chart review analysis of all children who had VSD closure by open heart surgery during the period 2002–2010. Children were divided into two groups based on their weight for age using standard growth charts. Those with normal or mild failure to thrive (Z score > −3) are labeled as group A. Group B included all children with severe failure to thrive (Z score ⩽ −3). Both groups were compared in term of early post operative course. One hundred and forty-five patients underwent open heart surgery for VSD closure during the study period. There were 58 cases in group A and 87 patients in group B. The age and weight in group A was (8 ± 5.16 months) and (6.31 ± 1.75 kg), respectively. The age and weight in group B was (7.6 ± 3.9 months) and (4.84 ± 1.12) kg, respectively. There were no significant differences between the two groups in terms of post operative course, and major complications. Failure to thrive was not associated with increase in ICU morbidity and mortality in children undergoing VSD closure. Attempt to optimize the body weight for age in children with CHD may not add any beneficial advantages in term of surgical risk or postoperative ICU outcome.

803 Effect of Body Weight on the Outcome of Ventricular Septal Defect Repair

IntroductionLow body weight and failure to thrive (FTT) often are considered limiting factors for open heart surgery. The purpose of our study is to asses the impact of FTT on...

Closure of perimembranous ventricular septal defects with aneurysmal tissue using the amplazter duct occluder I: Lessons learned and medium term follow up

The aim of this report is to describe our experience with closure of perimembranous ventricular septal defects (PMVSD) with aneurysm using the Amplatzer Duct Occluder I (ADO I). Atrio-ventricular block (AVB) remains the most troublesome complication of device closure of PMVSDs. Many PMVSDs are associated with an aneurysm that protrudes into the right ventricle. We believe that devices implanted entirely within the VSD aneurysm avoid the risk of AVB. A retrospective analysis of patients with PMVSD and aneurysm who underwent attempted ADO I device closure between 3/2004 and 8/2010 [Rady Children's Hospital-San Diego (n = 16), Mattel Children's Hospital at UCLA (n = 4), and Straub Hospital in Honolulu (n = 1)]. Twenty-one patients (16 male) with PMVSD and aneurysm underwent cardiac catheterization for the purpose of VSD closure using an ADO I. Nineteen patients had successful ADO I implantation with the following devices: 10/8 (n = 8), 8/6 (n = 7), 6/4 (n = 3) and 12/10 (n = 2). The procedure was aborted in 2 cases due to temporary AVB and ventricular ectopy during catheterization. One patient developed hemolysis due device malposition and had surgical device retrieval and VSD closure. One patient had new trivial tricuspid regurgitation and in 5/19 the tricuspid regurgitation improved post device closure. Transient accelerated junctional rhythm occurred within 24 hr in 4 patients and nonsustained slow ventricular tachycardia occurred in one patient. At latest follow-up (up to 6 years, median 1.9 years) 11/18 had no residual shunt, 4/18 had trivial and 3/18 small residual shunt. No AVB has been observed. Percutaneous closure of PMVSD with aneurysm using the ADO I appears to have acceptable efficacy and risk. Atrio-ventricular block in up to mid-term follow up was not encountered.

A successful percutaneous closure of ventricular septal defect following septal myectomy in patients with hypertrophic obstructive cardiomyopathy

Postoperative ventricular septal defect (post-op VSD) after septal myectomy in patients with hypertrophic obstructive cardiomyopathy is a rare and unexpected complication. We report a case of successful percutaneous closure of VSD following septal myectomy and mitral valve replacement in a patient with intrinsic mitral valve disease and severe mitral valve regurgitation together with hypertrophic obstructive cardiomyopathy.

Surgical Management of Congenital (Non-Ebstein) Tricuspid Valve Regurgitation

Congenital tricuspid valve regurgitation (TR) is a relatively uncommon condition that includes a heterogeneous group of lesions with a unique management strategy. There are wide anatomic variations that lead to congenital TR in patients without Ebstein malformation. Possible etiologies may include primary valve abnormalities (eg, congenital absence of chordae) or other forms of tricuspid valve dysplasia as in congenitally unguarded tricuspid valve, and patients with pulmonary atresia and intact ventricular septum, which can be similar to Ebstein's valves or secondary regurgitation in association with other anomalies as in atrioventricular septal defects, right ventricular outflow tract obstructive lesions (pulmonary stenosis or atresia with ventricular septal defect [VSD]), tricuspid valve annular dilatation in association with right ventricular volume overload lesions as in congenital coronary arterial fistula with secondary right ventricular enlargement, and Uhl's anomaly. Iatrogenic etiologies in the congenital population include TR secondary to previous VSD closure (chordal or leaflet injury), pacemaker or internal cardiac defibrillator lead-induced TR, and traumatic TR (ruptured chordae). Presentation depends on the severity of the disease and may be apparent in infancy, childhood, or adulthood.

Transcatheter closure of perimembranous and intracristal ventricular septal defects with the shsma occluder

The objective of this study was to evaluate the safety and efficacy of transcatheter closure of perimembranous ventricular septal defect (pmVSD) and intracristal VSD (icVSD) using the Shanghai Shape Memory Alloy (SHSMA) pmVSD occluder. There is still limited experience with transcatheter closure of pmVSD and icVSD. Between January 2003 and September 2010, 348 patients with pmVSD and 47 patients with icVSD underwent transcatheter closure using a SHSMA pmVSD occluder. The total successful closure rate in pmVSD and icVSD subjects was 97.4 and 78.7%, respectively. During the perioperative period, no death, major bleeding or hemolysis occurred in both groups. In pmVSD group, one case of occluder dislodgement, one case of pericardial tamponade, and two cases of thromboembolism occurred. None in icVSD group had these complications. During a median of 3.2 years of follow-up, there was no evidence of significant residual shunt and device-related valve regurgitation. None in icVSD group and 10 patients (2.9%) in pmVSD group had a persistent arrhythmia. Overall, only one patient (0.3%) with pmVSD acquired complete atrioventricular block requiring implantation of a permanent pacemaker. The rim from the tricuspid valve to the defect < 4 mm was the only predictor of arrhythmic complications after procedure (OR = 4.24; P = 0.021). Transcatheter closure of pmVSD in selected patients using the SHSMA occluder is effective and safe. Transcatheter closure of icVSD in experienced hands using this device is also feasible and safe.

Amplatzer septal occluder to treat iatrogenic cardiac perforations

Iatrogenic free wall cardiac perforation is a rare but serious complication encountered during percutaneous cardiac procedures, which usually leads to tamponade and death. Septal occluder devices have been developed for sealing intracardiac shunts but may be also used in this emergency setting. We report a small series of five consecutive cases of iatrogenic heart perforations that were treated with implantation of Amplatzer Septal Occluders (ASO). In the first case, iatrogenic left ventricle (LV) perforation occurred during LV biopsy and could be closed up with a 4 mm ASO. In the second case, a 4 mm ASO was used for sealing of a right atrial perforation allocated to Port-a-Cath dislodgment. The third case happened during transseptal puncture for implantation of a TandemHeart bVAD device in a patient suffering cardiogenic shock and was treated by implantation of a 5 mm ASO. The fourth patient was transferred to our facilities for percutaneous closure of an acute post-infarct VSD after anteroseptal myocardial infarction. This procedure was complicated by perforation of the posterolateral free wall and led to the deployment of 12 mm ASO. The last patient suffered from free LV wall perforation during investigation of a severe aortic stenosis and was treated by implantation of 4 mm ASO. All patients were alive after 24 hrs but the last patient died during the in-hospital stay of a right ventricular infarction complicated by multiple organ failure. Percutaneous device occlusion of iatrogenic heart perforation seems to be a safe and efficient method to treat iatrogenic heart perforation. In order to perform this elegant method, it is however imperative not to prematurely withdraw the perforating catheter to maintain access to the hole for closure.

Abstract 18187: Shone's Complex: Single Center Experience Over 22 Years

Background: Children with Shone's Complex (SC) have multiple levels of left heart obstruction and often require a number of left heart interventions. They are at risk of long-term morbidity and mortality. However, long-term outcomes in children with SC are limited. Methods: SC was defined as a mitral valve (MV) anomaly and ≥ 1 other left heart obstructive lesion including coarctation of the aorta (CoA), subvalvar, supravalvar and aortic valvar stenosis (AS). MV morphology type was classified as typical (MVtyp) - hypoplastic annulus, thickened leaflets; mitral ring (MVr); arcade or other papillary muscle anomaly (MVarc); parachute (MVpap); and other including double-orifice (MVo). Pts who underwent Norwood palliation were excluded. We reviewed overall outcomes and focused on the impact of pulmonary hypertension (PH) and pre-existing atrial septal defect (ASD) on left heart growth, number of interventions, and death/transplant (OHT). Results: A total of 129 SC pts presented at 35d (0d - 18yrs) of age and were followed for 7.0 ± 6.8 years. MV morphology included MVtyp (n=89, 68%), MVr (n=23, 18%), MVpap (n=21, 16%), MVarc (n=25, 19%). A total of 113 pts underwent 232 (median 2, 0-5) interventions including ASD closure (n=49), VSD closure (n=30), AVR (n=8), MVR (n=10), MV repair (n=39), AS repair (n=37), balloon valvuloplasty (n=36) and CoA dilation/repair (n=60). Pre-intervention, ASD was associated with lower mean LA pressure 11.7±5.6 vs 18.5±6.5 mmHg (p=0.02) and lower mitral gradient 5.3 ± 5.6 vs 10.9 ± 10.6 mmHg (p&lt;0.01) on catheterization. Following first surgical intervention, residual ASD was associated with decreased annular growth of AV (p=0.042) and MV (p=0.01), smaller increase in LVEDD (p=0.001) and LVESD (p=0.018). MVpap was associated with smaller MV (p&lt;0.001) and less MV annular growth by latest follow-up (p=0.001). Twenty-year OHT-free survival was 87%. By multivariate analysis, PH was associated with death/OHT (OR 6.8, 1.7-27.8). Survival in pts without residual ASD was 88% vs 77% with an ASD (p=0.017). Conclusions: SC pts with residual ASD have a higher rate of interventions. Left heart growth is optimized with ASD closure, while MVpap is associated with decreased growth. Pts who develop PH and have residual ASDs are at higher risk of mortality.

Feasibility of VSD Closure and Debanding Without Pulmonary Artery Patch Repair in VSD Patients After PA Banding

From 2004 to 2008, 64 infants with large ventricular septal defects were managed using a two-stage surgical approach. In the first stage, banding of the main pulmonary trunk was performed. The defect was then repaired months later. Debanding of pulmonary artery was accomplished without the need for pulmonary artery reconstruction.

Robotic totally endoscopic surgery for congenital cardiac anomalies

BACKGROUND: During the last decade totally endoscopic cardiac surgery became a reality in dedicated centers. Apart from totally endoscopic coronary bypass surgery and endoscopic mitral valve repair, totally endoscopic surgery for simple congenital cardiac anomalies is feasible. In this review we summarize the possibilities and the outcome of robotic surgery for congenital cardiac anomalies, and give an outline of future perspectives for the treatment of more complex cardiac congenital anomalies in a totally endoscopic fashion. METHODS: A PubMed search for the period 1990 to 2010 was conducted with the following key words: "robotic heart surgery", "endoscopic ASD", "robotic ASD", "congenital robotic surgery", "robotic VSD", "robotic patent ductus arteriosus". Additional information from our own database and experience concerning robotic cardiac surgery was included in this review. RESULTS: Several procedures for congenital cardiac anomalies have been performed endoscopically. Robotic ASD closure, endoscopical removal of dislocated Amplatzer devices, closure of patent ductus arteriosus and division of vascular rings are reported. After initial experimental experiences with VSD closure recently the first clinical cases have been reported. In experimental models even coarctation of the aorta has been repaired. CONCLUSIONS: Robotic cardiac surgery for congenital anomalies is feasible and represents an attractive option for selected patients. In the future, with further development and refinement of this technology, more complex congenital lesions will most likely be addressed with this approach.