Safety and Efficacy of Perventricular Device Closure of Subarterial Ventricular Septal Defect_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YINSen-lin ^1,2 , LIXiao ¹ , ZHUDa ¹ , LINKe ¹ , ANQi ¹ ,  TANGMeng-lin ¹

1. Pediatric Cardiovascular Surgical Center, Department Of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

TANGMeng-lin, Email: menglin_tang@163.com

Keywords：

Ventricular septal defect; Perventricular closure; Safety; Efficacy

DOI：

10.7507/1007-4848.20140178

Video：

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Objective To assess the safety and efficacy of a new surgical strategy, perventricular device closure, for the treatment of subarterial ventricular septal defect (VSD). Methods Thirty-nine patients younger than 10 years with subarterial VSD who received surgical repair in West China Hospital from November 2010 to May 2012 were included in this study. There were 18 male and 21 female patients with their age of 5.9±3.2 years. Perventricular device closure was performed with eccentric device under the guidance of transesophageal echocardiography (TEE). Residual shunt, valvular regurgitation (including aortic regurgitation)and arrhythmias during perioperative period and follow-up were analyzed. Results Thirty-three patients successfully received perventricular device closure, and 6 patients received conversion to open surgical repair. Postoperative ICU stay was 2.2±0.8 days, and length of hospital stay was 4.8±1.8 days. Major postoperative complications included residual shunt and mild or less aortic regurgitation. Mean follow-up duration was 7±2 months. No obvious arrhythmia, moderate or severe valvular regurgitation was observed during follow-up. Conclusion Perventricular device closure is safe, efficacious and minimally invasive for the treatment of subarterial VSD in pediatric patients with suitable anatomic characteristics with good mid-term results.

Citation： YINSen-lin, LIXiao, ZHUDa, LINKe, ANQi, TANGMeng-lin. Safety and Efficacy of Perventricular Device Closure of Subarterial Ventricular Septal Defect. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(5): 628-631. doi: 10.7507/1007-4848.20140178 Copy

1.	Griffin ML, Sullivan ID, Anderson RH, et al. Doubly committed subarterial ventricular septal defect:new morphological criteria with echocardiographic and angiocardiographic correlation. Br Heart J, 1988, 59(4):474-479.
2.	Sim EK, Grignani RT, Wong ML, et al. Outcome of surgical closure of doubly committed subarterial ventricular septal defect. Ann Thorac Surg, 1999, 67(3):736-738.
3.	Minette MS, Sahn DJ. Ventricular septal defects. Circulation, 2006, 114(20):2190-2197.
4.	劉靈, 韓玲, 陸萍, 等. 272例動脈干下型室間隔缺損臨床分析.中華兒科雜志, 2002, 40(3):157-160.
5.	馬旺扣, 周玉篇, 顧懋棟, 等.干下漏斗部室間隔缺損的外科治療.中華胸心血管外科雜志, 1995(3):138-139, 190.
6.	Chen Q, Chen LW, Wang QM, et al. Intraoperative device closure of doubly committed subarterial ventricular septal defects:initial experience. Ann Thorac Surg, 2010, 90(3):869-873.
7.	Pan SL, Xing QS, Cao Q, et al. Perventricular device closure of doubly committed subarterial ventral septal defect through left anterior minithor-acotomy on beating hearts. Ann Thorac Surg, 2012, 94(6):2070-2075.
8.	蘇肇伉.先天性心臟病微創手術的發展趨勢.中國胸心血管外科臨床雜志, 2005, 12(4):229-231.
9.	Tweddell JS, Pelech AN, Frommelt PC. Ventricular septal defect and aortic valve regurgitation:pathophysiology and indications for surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2006, 9(1):147-152.
10.	De Leval MR, Pozzi M, Starnes V, et al. Surgical management of doubly committed subarterial ventricular septal defects. Circulation, 1988, 78(5 Pt 2):Ⅲ40-Ⅲ46.
11.	Gersony WM. Natural history and decision-making in patients with ventricular septal defect. Prog Pediatr Cardiol, 2001, 14(2):125-132.
12.	Lock JE, Block PC, Mckay RG, et al. Transcatheter closure of ventricular septal defects. Circulation, 1988, 78(2):361-368.
13.	Szkutnik M, Qureshi SA, Kusa J, et al. Use of the amplatzer muscular ventricular septal defect occluder for closure of perimembranous ventricular septal defects. Heart, 2007, 93(3):355-358.
14.	Becker P, Frangini P, Heusser F, et al. New surgical approach to device closure of multiple apical ventricular septal defects. Revista Espa?ola de Cardiología (English Edition), 2004, 57(12):1238-1240.
15.	Crossland DS, Wilkinson JL, Cochrane AD, et al. Initial results of primary device closure of large muscular ventricular septal defects in early infancy using perventricular access. Catheter Cardiovasc Interv, 2008, 72(3):386-391.
16.	Amin Z, Berry JM, Foker JE, et al. Intraoperative closure of muscular ventricular septal defect in a canine model and application of the technique in a baby. J Thorac Cardiovasc Surg, 1998, 115(6):1374-1376.
17.	Bacha Emile-a, Cao QL, Starr JP, et al. Perventricular device closure of muscular ventricular septal defects on the beating heart:technique and results. J Thorac Cardiovasc Surg, 2003, 126(6):1718-1723.
18.	Amin Z, Danford DA, Lof J, et al. Intraoperative device closure of perimembranous ventricular septal defects without cardiopulmonary bypass:preliminary results with the perventricular technique. J Thorac Cardiovasc Surg, 2004, 127(1):234-241.
19.	Gan CP, An Qi, Lin Ke, et al. Perventricular device closure of ventri-cular septal defects:six months results in 30 young children. Ann Thorac Surg, 2008, 86(1):142-146.
20.	Zeng XJ, Sun SQ, Chen XF, et al. Device closure of perimembranous ventricular septal defects with a minimally invasive technique in 12 patients. Ann Thorac Surg, 2008, 85(1):192-194.
21.	Liu L, Zhao TL, Yang YF, et al. Intraoperative device closure of subaortic ventricular septal defects. J Card Surg, 2013, 28(4):456-460.

1. Griffin ML, Sullivan ID, Anderson RH, et al. Doubly committed subarterial ventricular septal defect:new morphological criteria with echocardiographic and angiocardiographic correlation. Br Heart J, 1988, 59(4):474-479.
2. Sim EK, Grignani RT, Wong ML, et al. Outcome of surgical closure of doubly committed subarterial ventricular septal defect. Ann Thorac Surg, 1999, 67(3):736-738.
3. Minette MS, Sahn DJ. Ventricular septal defects. Circulation, 2006, 114(20):2190-2197.
4. 劉靈, 韓玲, 陸萍, 等. 272例動脈干下型室間隔缺損臨床分析.中華兒科雜志, 2002, 40(3):157-160.
5. 馬旺扣, 周玉篇, 顧懋棟, 等.干下漏斗部室間隔缺損的外科治療.中華胸心血管外科雜志, 1995(3):138-139, 190.
6. Chen Q, Chen LW, Wang QM, et al. Intraoperative device closure of doubly committed subarterial ventricular septal defects:initial experience. Ann Thorac Surg, 2010, 90(3):869-873.
7. Pan SL, Xing QS, Cao Q, et al. Perventricular device closure of doubly committed subarterial ventral septal defect through left anterior minithor-acotomy on beating hearts. Ann Thorac Surg, 2012, 94(6):2070-2075.
8. 蘇肇伉.先天性心臟病微創手術的發展趨勢.中國胸心血管外科臨床雜志, 2005, 12(4):229-231.
9. Tweddell JS, Pelech AN, Frommelt PC. Ventricular septal defect and aortic valve regurgitation:pathophysiology and indications for surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2006, 9(1):147-152.
10. De Leval MR, Pozzi M, Starnes V, et al. Surgical management of doubly committed subarterial ventricular septal defects. Circulation, 1988, 78(5 Pt 2):Ⅲ40-Ⅲ46.
11. Gersony WM. Natural history and decision-making in patients with ventricular septal defect. Prog Pediatr Cardiol, 2001, 14(2):125-132.
12. Lock JE, Block PC, Mckay RG, et al. Transcatheter closure of ventricular septal defects. Circulation, 1988, 78(2):361-368.
13. Szkutnik M, Qureshi SA, Kusa J, et al. Use of the amplatzer muscular ventricular septal defect occluder for closure of perimembranous ventricular septal defects. Heart, 2007, 93(3):355-358.
14. Becker P, Frangini P, Heusser F, et al. New surgical approach to device closure of multiple apical ventricular septal defects. Revista Espa?ola de Cardiología (English Edition), 2004, 57(12):1238-1240.
15. Crossland DS, Wilkinson JL, Cochrane AD, et al. Initial results of primary device closure of large muscular ventricular septal defects in early infancy using perventricular access. Catheter Cardiovasc Interv, 2008, 72(3):386-391.
16. Amin Z, Berry JM, Foker JE, et al. Intraoperative closure of muscular ventricular septal defect in a canine model and application of the technique in a baby. J Thorac Cardiovasc Surg, 1998, 115(6):1374-1376.
17. Bacha Emile-a, Cao QL, Starr JP, et al. Perventricular device closure of muscular ventricular septal defects on the beating heart:technique and results. J Thorac Cardiovasc Surg, 2003, 126(6):1718-1723.
18. Amin Z, Danford DA, Lof J, et al. Intraoperative device closure of perimembranous ventricular septal defects without cardiopulmonary bypass:preliminary results with the perventricular technique. J Thorac Cardiovasc Surg, 2004, 127(1):234-241.
19. Gan CP, An Qi, Lin Ke, et al. Perventricular device closure of ventri-cular septal defects:six months results in 30 young children. Ann Thorac Surg, 2008, 86(1):142-146.
20. Zeng XJ, Sun SQ, Chen XF, et al. Device closure of perimembranous ventricular septal defects with a minimally invasive technique in 12 patients. Ann Thorac Surg, 2008, 85(1):192-194.
21. Liu L, Zhao TL, Yang YF, et al. Intraoperative device closure of subaortic ventricular septal defects. J Card Surg, 2013, 28(4):456-460.

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