Background: Transcatheter device closure of ventricular septal defect (VSD) is an alternative to conventional surgical closure. Device closure of moderate to large perimembranous VSD (pmVSD) is considered technically challenging in smaller children weighing 10 kg. Very few studies are published on the outcomes of the same. Methods: Descriptive single-center retrospective study. Data of 49 children 10 kg with moderate to large pmVSDs taken up for transcatheter device closure in our institute were analyzed and their follow-up details were reviewed. Results: Of the 87 patients referred for VSD closure, 49 patients qualified for the inclusion criteria. Median age was 18 months (interquartile range: 13-22). Successful device deployment was achieved in 42 (85.7%) patients. Mean VSD size by transthoracic echocardiography was 5.98 mm (range: 4-12 mm). Mean waist size of the device used was 8.26 mm (range: 4-14 mm). There was one device embolization, requiring catheter-directed retrieval from the left ventricle and subsequent surgical referral for VSD closure. Minor complications such as device-related persistent new aortic regurgitation was noted in one patient and mild tricuspid regurgitation and transient heart block occurred in two patients each. There was no mortality or complete heart block requiring permanent pacemaker implantation immediately or during midterm follow-up (mean follow-up: 20 months; range: 6-72.5 months). Conclusion: Device closure of moderate to large pmVSDs in children weighing 10 kg is feasible and safe with a success rate of 85.7%. Careful selection of patients and avoidance of oversizing the defect makes the immediate and midterm results acceptable. Keywords moderate to large perimembranous VSD (pmVSD), transcatheter device closure, success rate, complete heart block (CHB), aortic regurgitation (AR), children 10 kg
Acute severe mitral regurgitation (MR) is the commonest indication for emergency surgery following a balloon mitral valvuloplasty (BMV). It results in hemodynamic compromise with cardiogenic shock and or acute pulmonary edema. These patients deteriorate fast and often require respiratory and critical care support, followed by urgent mitral valve replacement (MVR). We analyzed the data of 1224 BMV procedures done over the 18-year period. We had 85 patients (6.9%) with acute severe MR and cardiogenic shock. The clinical profile, echocardiographic features and operative findings were studied. The echocardiography scores were compared for association with occurrence of MR. The immediate and long-term clinical outcomes of these acutely sick patients were studied. Of the 85 patients, 84 underwent MVR. Anterior mitral leaflet tear was observed in 65 (75%) cases, para-commissural with annular tear in 8 (9.4%), Chordal injury in 7 (8%) and torn posterior leaflet in 5 (5.8%). We documented severe MR in 88 patients (7.1%), with 85 (6.9%) among them developing features of cardiogenic shock. None of the echocardiographic scoring systems were predictive of the occurrence of MR. The 30-day mortality was 4.7%. The mean clinical follow-up period after discharge was 9.3 ± 0.9 years (range 2.2-17.8) with no late mortality. Acute severe MR had an incidence of 7% in this study. Injury to the anterior mitral leaflet was the commonest cause. The longterm outcomes were good with timely intervention and valve replacement surgery despite the fact that the majority (96%) presented with cardiogenic shock. None of the present valve scoring systems could predict the occurrence of severe MR.
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