ObjectiveTo summarize the application and clinical effect of left anterior minimally invasive thoracotomy to surgical repair of subarterial ventricular septal defect (VSD) in children.MethodsFrom October 2015 to April 2019, 21 children with subarterial VSD underwent surgical repair via left anterior minimally invasive thoracotomy. There were 13 males and 8 females, aged 5-13 (9.1±2.2) years, and weighing 22-55 (35.6±9.5) kg. The diameter of subarterial VSD was 4-15 (9.1±3.3) mm. Eight patients had right coronary valve prolapse, and 4 aortic valve regurgitation (3 mild and 1 mild-to-moderate). The minimally invasive surgery was performed via left parasternal thoracotomy through the second or third intercostal space. The peripheral perfusion was performed with femoral arterial and venous cannulation. After aortic cross-clamp (ACC), subarterial VSD was performed with direct suture of patch closure through an incision on the root of pulmonary artery.ResultsAll patients successfully underwent surgical repair (patch closure, n=15; direct suture, n=6) of subarterial VSD through left anterior minimally invasive thoracotomy. The cardiopulmonary bypass time was 45-68 (57.1±6.3) min. The ACC time was 23-40 (32.6±4.7) min. The postoperative ventilation time was 5-9 (6.3±1.3) h, postoperative in-hospital time was 5-8 (5.7±1.0) d and drainage volume was 33-105 (57.5±17.7) mL in postoperative 24 h. No death, residual VSD shunt, atrioventricular block, wound infection or thoracic deformity occurred during the perioperation or follow-up. Only one patient still had trivial aortic valve regurgitation.ConclusionLeft anterior minimally invasive thoracotomy could be safely and effectively applied to surgical repair of subarterial VSD in children, with satisfactory early- and mid-term outcomes.
ObjectiveTo analyze the clinical efficacy of right midaxillary straight incision surgery in the treatment of doubly committed subarterial ventricular septal defect. MethodsThe clinical data of children with doubly committed subarterial ventricular septal defect who received surgeries in our hospital from August 2020 to July 2023 were analyzed retrospectively. All the children underwent surgical repair and were divided into two groups according to the incision position, including a right midaxillary straight incision group and a median incision group. The outcomes were compared between the two groups. ResultsA total of 187 patients were enrolled. There were 102 patients in the right midaxillary straight incision group, including 55 males and 47 females with a median age of 26.0 (5.0, 127.0) months and a median weight of 12.5 (5.1, 32.8) kg at surgery. There were 85 patients in the median incision group, including 37 males and 48 females with a median age of 4.0 (2.0, 168.0) months and a median weight of 6.7 (4.8, 53.9) kg at surgery. No mortality occurred in the study. There was no statistical difference between the two groups in the cardiopulmonary bypass time [(50.0±18.4) min vs. (46.1±15.7) min] or aortic cross-clamping time [(31.3±18.6) min vs. (26.3±17.5) min] (P>0.05). Compared to the median incision group, the time from the end of cardiopulmonary bypass to the closure of chest [(22.3±15.6) min vs. (37.1±13.4) min, P<0.001], postoperative hospital stay [(6.9±3.9) d vs. (8.6±3.6) d, P=0.002], the length of incision [(4.3±2.7) cm vs. (8.5±3.2) cm, P<0.001], drainage volume [(79.0±32.2) mL vs. (100.2±43.1) mL, P<0.001], and the pain score on the 2nd and the 3rd day after the operation were statistically better in the right midaxillary straight incision group (P<0.05). The medical experience and incision satisfaction scores at discharge of the right midaxillary straight incision group were higher (P<0.05). During the follow-up of 21.0 (1.0, 35.0) months, no residual shunt was detected and all patients in both groups had a normal cardiac function and mild or less valve regurgitation. ConclusionCompared to the median incision, minimally invasive right midaxillary straight incision for the repair of doubly committed subarterial ventricular septal defect offers comparable efficacy and reliability, with the added advantages of being minimally invasive, cosmetically superior, and promoting faster postoperative recovery.
ObjectiveTo summarize the mid-term outcomes and surgical experience of transthoracic device closure for doubly committed subarterial ventricular septal defect (dcsVSD) in our center. MethodsPatients with dcsVSD who underwent transthoracic device closure in the Department of Cardiovascular Surgery, West China Hospital, Sichuan University, from January 2013 to October 2025 were retrospectively enrolled. Baseline characteristics, perioperative data, and follow-up data were analyzed. ResultsA total of 68 patients were enrolled, including 35 (52.9%) males and 33 (47.1%) females, with a median age of 1.8 (1.0, 3.0) years and a median VSD diameter of 4.0 (3.0, 5.0) mm. The defects were successfully closed using eccentric VSD occluders in all patients, with a median operative time of 24.0 (20.0, 40.0) min and a median eccentric VSD occluder diameter of 7.0 (6.0, 8.0) mm. The median follow-up duration was 59.0 (29.5, 74.3) months. New-onset aortic regurgitation during follow-up was observed in 5 (7.4%) patients, among whom 1 patient underwent reoperation. No patient had residual shunt at the latest follow-up. No occluder displacement, new-onset atrioventricular block, or left/right ventricular outflow tract obstruction occurred during the follow-up. ConclusionTransthoracic device closure for dcsVSD yields relatively satisfactory mid-term outcomes. Meticulous preoperative evaluation and more stringent patient selection are crucial to avoid new-onset aortic regurgitation during the follow-up.
ObjectiveTo evaluate the safety, feasibility, and short-term surgical outcomes of a modified right vertical infra-axillary thoracotomy (MRVIAT, single 2-5 cm incision without peripheral cannulation) for the treatment of doubly committed subarterial ventricular septal defect in patients of all ages, and to summarize relevant surgical techniques. MethodsThis study retrospectively included patients of all ages with doubly committed subarterial ventricular septal defect who underwent surgical repair via MRVIAT from January 2022 to June 2025, all receiving a single 2-5 cm incision without peripheral cardiopulmonary bypass. The perioperative and follow-up data were analyzed. ResultsA total of 241 patients were enrolled, comprising 92 males and 149 females with a median age of 1.2 (0.5, 3.5) years [including 11 (4.6%) patients aged ≥18 years] and a median weight of 10.5 (7.0, 16.4) kg. Preoperative left ventricular ejection fraction was 66.9%±4.2%, and the mean defect size was (7.6±2.8) mm. All surgeries were successfully completed without conversion to median sternotomy or in-hospital mortality. Cardiopulmonary bypass time was (55.4±13.3) min, aortic cross-clamping time was (34.8±10.1) min, postoperative hospital stay was (6.5±1.9) d, ventilation time was (6.5±6.1) h, intensive care unit stay was (39.7±24.1) h, and postoperative left ventricular ejection fraction was 67.8%±7.6%. Postoperative complications included mild residual shunt in 3 (1.2%) patients, incision infection in 2 (0.8%) patients, and pulmonary infection in 1 (0.4%) patient. The median follow-up time was 1.7 years (range, 0.3-3.5 years), during which no surgery-related chest deformities or moderate-to-severe valvular regurgitation were observed. ConclusionThe MRVIAT is safe and feasible for treating doubly committed subarterial ventricular septal defect in patients of all ages, offering a smaller and more concealed incision without the need for peripheral cardiopulmonary cannulation, and may be considered an alternative to median sternotomy.
