Percardiac closure of large apical ventricular septal defects in infants: Novel modifications and mid-term results.
J Card Surg
; 36(3): 928-938, 2021 Mar.
Article
em En
| MEDLINE
| ID: mdl-33503678
ABSTRACT
BACKGROUND/AIM:
Both open heart surgery and percutaneous approaches retain several limitations in closing large apical muscular ventricular septal defects (AmVSD) in infants. We present probe-assisted percardiac device closure (PDC), an exclusively transoesophageal-echocardiography guided technique, as an alternative with midterm results.METHODS:
Thirty-six infants with large AmVSDs (single or multiple-holed) underwent PDC in our department. Mean AmVSD for single and multiple-holed measured 7.2 ± 2.4 mm and 6.3 ± 3.4 mm, respectively. Subjects presented with a spectrum of cardiopulmonary sequelae and growth retardation, either alone or combined. Some were ventilator dependent and re-do cases. In addition, AmVSDs were categorized cylindrical, tunnel and cave-like shaped as per color Doppler interrogation. Pursuant to cardiac access and deployment technique, subjects were apportioned group A; inferior median sternotomy (perventricular), B; right mini-thoracotomy (peratrial) and C; complete median sternotomy (perventricular). Under exclusive echocardiography, the Z- or J probe-assisted delivery system was utilized to access AmVSDs and implant device(s) via aforementioned techniques.RESULTS:
Forty-two muscular ventricular septal devices (8.4 ± 2.6 mm) were implanted in 36 subjects uneventfully. Seventeen "complex," and 10 cylindrical or straight tunnel-shapedAmVSDs (including 2 re-do patients) suited perventricular and peratrial techniques respectively. Comparatively, group B exhibited shorter procedural indices than A (p < .01). Five of 15 multiple-holed AmVSDs (four Swiss cheese) required two or three devices for a satisfactory occlusion. Nevertheless, post occlusion insignificant residual shunts( ≤ 2 mm) seldom achieved spontaneous closure, and at 36-month follow-up complete closure was 67%. Residual shunt persisted amongst multiple-holed. All patients improved during follow up.CONCLUSION:
PDC is feasible, safe and effective alternative technique for AmVSD in infants.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Dispositivo para Oclusão Septal
/
Comunicação Interventricular
Tipo de estudo:
Observational_studies
/
Prognostic_studies
Limite:
Humans
/
Infant
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article