Changping Gan

Perventricular Device Closure of Ventricular Septal Defects: Six Months Results in 30 Young Children

BACKGROUND Both surgical repair and transcatheter closure of isolated ventricular septal defects are known to have limitations in children. This report describes the short-term results of perventricular device closure of nonmuscular ventricular septal defects without cardiopulmonary bypass in young children. METHODS Thirty patients who had nonmuscular ventricular septal defects underwent perventricular closure by minimally invasive technique without cardiopulmonary bypass. A subxiphoid minimally invasive incision was performed. Under the continuous guidance of transesophageal echocardiography, the free wall of the right ventricle was punctured and a guidewire was introduced into the left ventricle through the defect. A delivery sheath was advanced over the wire and through the defect into the left ventricle. The device was released. RESULTS Closure was successful in 27 patients (90%). There was no mortality or atrioventricular block perioperatively or during the entire follow-up period. Three patients developed incomplete right bundle branch blocks and seven patients developed new trace or mild tricuspid regurgitation after the closure. The mean hospital stay was 3.6 +/- 0.7 days (range, 3 to 5 days) and no patient needed any blood or blood products. Follow-up at 6 months showed that two of the three patients had persistent incomplete right bundle branch block and three of the seven patients had persistent closure-related trace or mild tricuspid regurgitation. CONCLUSIONS Perventricular device closure of isolated ventricular septal defects without cardiopulmonary bypass appeared to be safe and efficacious in selected young children. The outcomes of short-term follow-up are acceptable.

Perventricular device closure of perimembranous ventricular septal defects in 61 young children: Early and midterm follow-up results

OBJECTIVES Perventricular device closure of perimembranous ventricular septal defect as a novel technique has recently been described in several small series with initial experience. Further studies with larger cohorts and longer-term follow-up are needed to confirm the validity of this new approach. This report describes our recent experience with perventricular device closure of perimembranous ventricular septal defects on beating hearts in 61 young children with over 1 year of follow-up. METHODS Between April 2007 and April 2008, 61 patients with perimembranous ventricular septal defects were enrolled for a prospective study of perventricular device closure of their defects. The hospital course and the immediate and midterm complications during follow-up were herein reported. RESULTS The defects were closed successfully with devices in 57 (93.4%) patients without mortality or major morbidity. Four (6.6%) patients were converted to surgical repair when device closure was deemed unsuccessful; the failure of device closure was associated with the subaortic rim (odds ratio = 21.471; P = .038). Residual shunt was observed in 4 (6.6%) patients during the procedure. One of them was converted into surgical repair, and the residual shunt of the other 3 resolved during the 6-month follow-up period. Two (3.3%) patients had complete atrioventricular block develop in the operating room or during follow-up. One was converted into surgical repair and the other patient converted to sinus rhythm after treatment with steroids. CONCLUSIONS Perventricular device closure of ventricular septal defect is a safe and efficacious treatment option with acceptable midterm outcomes. For infants with poor vascular access, it might be the procedure of choice.

Perventricular device closure of muscular ventricular septal defects on beating hearts: Initial experience in eight children

OBJECTIVE The conventional surgical repair and transcatheter closure of muscular ventricular septal defects are known to have undesirable limitations. This communication describes the short-term results of perventricular device closure of muscular ventricular septal defects with the heart beating in 8 children with 15 muscular ventricular septal defects, with or without other congenital malformations. METHODS A subxiphoid minimally invasive incision was used in 3 children with isolated muscular ventricular septal defects whereas standard full median sternotomies were used in the other 5 children who required subsequent correction of coexisting malformations. Under the continuous guidance of transesophageal echocardiography, the free wall of the right ventricle was punctured, and a guidewire was introduced into the left ventricle through the defect. A delivery sheath was advanced over the wire and through the defect into the left ventricle. The device was released. RESULTS A total of 14 muscular ventricular septal defects were successfully closed perventricularly without cardiopulmonary bypass. There was no mortality perioperatively or during the entire follow-up period. At 6-month follow-up, there was no detectable residual shunt, arrhythmia, or new mitral or tricuspid insufficiency. Other than 5 children with the coexisting malformations, none of the other children required any blood or blood products. The average hospital stay was 7.9 +/- 2.2 days (range, 5-11 days). CONCLUSION Perventricular device closure of muscular ventricular septal defects with or without coexisting congenital malformations appeared to be safe and efficacious. The outcomes of short-term follow-up are acceptable.

Hybrid perventricular device closure of doubly committed subarterial ventricular septal defects: Mid-term results

Doubly committed Subarterial ventricular septal defect (VSD) is a specific anatomic type of VSD located just beneath the aortic valve. The purpose of this study was to evaluate the safety and feasibility of using minimal invasive perventricular device closure in managing this type of VSD.

Perventricular Device Closure of Perimembranous Ventricular Septal Defect in Pediatric Patients: Technical and Morphological Considerations

BACKGROUND We report our experience of using perventricular device closure (PVDC) in treating perimembranous ventricular septal defect (pm-VSD) with emphasis on technical and morphological considerations. METHOD Thirty-one pediatric patients with pm-VSD who underwent successful PVDC were enrolled in this study. The pm-VSDs were divided into three different types (type I: tunnel shape; type II: with subaortic rim < 2 mm; type III: membranous aneurysm formation). Four closure strategies were utilized, corresponding to the morphology of the pm-VSD. RESULTS Mean age of the patients was 2.1 years with mean VSD diameter 5.8 mm. Seven patients had type I VSD, nine presented with type II, and 15 had type III. Twenty-two concentric and nine eccentric devices were used with mean device size 7.3 mm. Complete closure was achieved in 97% of cases during follow-up. Procedure-induced tricuspid regurgitation (TR) was noted in nine patients at discharge; four resolved. Multivariable analysis showed that the procedure-induced TR was associated with the device size (odds ratio = 5.059; 95% confidence interval = 1.431-17.880). CONCLUSION Different closure strategies allow for PVDC of various types of pm-VSDs in selected pediatric patients.

Modified Cavoatrial Anastomosis in Warden Procedure

The Warden procedure was introduced for surgical repair of partial anomalous pulmonary venous connection to the higher portion of the superior vena cava in an attempt to decrease the incidence of postoperative sinoatrial node dysfunction and pulmonary venous obstruction. However, postoperative cavoatrial channel stenosis and obstruction up to 20% and 10%, respectively, requiring catheter intervention has been reported. In this article, we describe a modified cavoatrial anastomotic technique to avoid postprocedural superior vena cava stenosis.

An asymptomatic lipoma of the right atrium in a neonate.

A 1-month-old boy was incidentally found to have a mass in the right atrium without any symptoms. The tumor was resected uneventfully 2 years later. Histologic examination showed intramyocardial lipoma, which is very rare in children. To date, cardiac lipoma has not been reported in neonates. We describe such a case herein.

How to choose an occluder for two nearby muscular ventricular septal defects

Multiple muscular ventricular septal defects treated with a single device have been reported before, but the way of choosing a suitable occluder is not well described. Implantation of an oversized device might lead to potential side effects. We described our experience with a single device to close two nearby muscular ventricular septal defects perventricularly, and specifically the decision-making process used to choose the suitable occluder.

Perventricular device closure of a doubly committed subarterial ventricular septal defect

A doubly committed subarterial ventricular septal defect (VSD) used to be a contraindication for device closure. Perventricular device closure has been widely applied in China in the past years, but not in a doubly committed subarterial VSD. Chinese surgeons are now beginning to try this procedure also in a doubly committed subarterial VSD in selected patients. The technique of closure of the perimembranous defect has been described previously in this journal, but we hereby present some additional information on this procedure performed in a doubly committed subarterial VSD.

One-Stage Hybrid Procedure to Treat Aortic Coarctation Complicated by Intracardiac Anomalies in Two Adults

The traditional approach for treating aortic coarctation with intracardiac anomalies in adults is surgery using 2 surgical incisions or a two-stage hybrid method with a peripheral artery pathway that requires intervention. This paper reports a one-stage hybrid procedure to treat this type of congenital heart disease using 1 surgical incision combined with an ascending aorta puncture intervention approach as transaortic intervention approach. Here, we present 2 aortic coarctation cases; 1 complicated by ventricular septal defect and patent ductus arteriosus, and another complicated by an incomplete atrioventricular septal defect and mitral valve cleft. Both were successfully treated by our one-stage hybrid approach.