Flap Valve Double Patch Closure of Ventricular Septal Defects in Children With Increased Pulmonary Vascular Resistance

Novick, William M.; Sandoval, Néstor; Lazorhysynets, Vasiliy V.; Castillo, V.; Baskevitch, Alexander; Mo, Xiomung; Reid, Robert W.; Marinović, Branko; Sessa, T

doi:10.1016/j.athoracsur.2004.06.107

Cited by 83 publications

(70 citation statements)

References 22 publications

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“…Partial closure of a defect with a one-way flap that permits right-to-left shunting could be a way of allowing decompression of the right ventricle during periods of raised pulmonary vascular resistance, especially in the postoperative period, while limiting flow and pressure stress to the pulmonary circulation. 49 Subsequent complete closure of the defect could be performed should pulmonary vascular resistance fall in response to longer term advanced ther- NYHA ϭ New York Heart Association MPAP ϭ mean pulmonary artery pressure ASD ϭ atrial septal defect PGI 2 ϭ prostacyclin PDA ϭ patent ductus arteriosus apy. Another staged approach could be the application of a pulmonary arterial band once pulmonary vascular resistance starts to decrease in response to chronic advanced therapy.…”

Section: Corrective Interventionsmentioning

confidence: 99%

“…42 Available data on closure of intra-or extracardiac communications in the presence of severe PAH, with or without the use of advanced therapies, are scarce and still limited to case reports (Table 1). [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] Closure of intracardiac defects after a positive response to advanced PAH therapies cannot therefore be generally recommended until hard evidence of its safety, efficacy, and durability becomes available. An essential step to adopting a treat-andrepair approach will be the appropriate selection of patients who may benefit from it.…”

Section: Corrective Interventionsmentioning

confidence: 99%

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Eisenmenger Syndrome: Not Always Inoperable

Liang

Zhou

2012

Respir Care

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Recently, advanced therapies for pulmonary arterial hypertension have become available, and have been effective in reducing pulmonary vascular resistance and symptoms in patients with Eisenmenger syndrome, previously thought to be inoperable. This review summarizes the current knowledge on the pathophysiology and treatment of Eisenmenger syndrome. The recent introduction of targeted therapies in pulmonary arterial hypertension has led to a renewed insight in the pathophysiology and treatment of Eisenmenger syndrome. Patients with Eisenmenger syndrome using a diagnostic-treatment-and-repair strategy are amenable to surgery after successful treatment with advanced therapy. With continued improvements in the diagnosis, preoperative management, refinement of surgical techniques and intra-and postoperative management strategies, the patients with Eisenmenger syndrome selected using a diagnostic-treatment-and-repair strategy are operable with safety and efficacy in the current era with advanced pulmonary arterial hypertension therapy. Future directions of Eisenmenger syndrome may be the combination of reversal of pulmonary vascular remodeling and correction.

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Section: Corrective Interventionsmentioning

confidence: 99%

Section: Corrective Interventionsmentioning

confidence: 99%

Eisenmenger Syndrome: Not Always Inoperable

Liang

Zhou

2012

Respir Care

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“…In the third patient with surgically palliated extreme Fallot's tetralogy, the predominantly right-left shunt and severe pulmonary hypertension formed strong contraindications for VSD closure [2,13]. Fenestrated VSD closure reduced shunt volume, while maintaining a safety communication between the two ventricles [23]. In combination with pulmonary artery stenting and medical therapy a reduction in PAP and increase in pulmonary flow was achieved, resulting in enhanced systemic oxygen supply, normalisation of haemoglobin level and long-term clinical improvement.…”

Section: Discussionmentioning

confidence: 91%

Tailored circulatory intervention in adults with pulmonary hypertension due to congenital heart disease

et al. 2016

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Background Adults with pulmonary hypertension associated with congenital heart disease (PH-CHD) often have residual shunts. Invasive interventions aim to optimise pulmonary flow and prevent right ventricular failure. However, eligibility for procedures strongly depends on the adaptation potential of the pulmonary vasculature and right ventricle to resultant circulatory changes. Current guidelines are not sufficiently applicable to individual patients, who exhibit great diversity and complexity in cardiac anomalies. Methods and ResultsWe present four complex adult PH-CHD patients with impaired pulmonary flow, including detailed graphics of the cardiopulmonary circulation. All these patients had an ambiguous indication for shunt intervention. Our local multidisciplinary Grown-Ups with Congenital Heart Disease team reached consensus regarding a patient-tailored invasive treatment strategy, adjacent to relevant guidelines. Interventions improved pulmonary haemodynamics and short-term clinical functioning in all cases. Conclusions Individual evaluation of disease characteristics is mandatory for tailored interventional treatment in PH-CHD patients, adjacent to relevant guidelines. Both strict

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“…In the initial 18 patients reported by Novick,[18] there were no early deaths and one late death occurred while the child was awaiting detailed evaluation for suspected pulmonary stenosis. In Novick's later experience[19] spread over more than 10 centers around the world, there were seven early deaths. These were due to technical errors (n = 3), pneumonia (n = 2), arrhythmia (n = 1) and hemorrhage following removal of PA line (n = 1).…”

Section: Resultsmentioning

confidence: 99%

“…The VSD patch was sewn into place orienting the patch in such a way that the flap valve was placed on the left ventricular (LV) side with the flap opening towards the LV apex to avoid subaortic obstruction. Novick et al .,[1819] recommend the use of this technique to improve the quality of life even for those patients who are declared inoperable and in whom alternative therapies for irreversible PAH, like heart-lung transplantation are not an option.…”

Section: Introductionmentioning

confidence: 99%

Unidirectional valved patches for closure of septal defects in patients with severe pulmonary hypertension

et al. 2008

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Pulmonary hypertension due to delay in presentation, diagnosis, referral, and surgery for septal defects is not uncommon in the developing world and translates into high morbidity and mortality following open heart surgery to close these defects. Leaving a small atrial communication may not always be effective. Extracorporeal membrane oxygenation and inhaled nitric oxide therapy in the immediate postoperative phase may not be available or may not be financially feasible in many institutions which are economically challenged. Unidirectional valved patch is emerging as a new and effective solution to this problem and promises to make at least the immediate postoperative results more predictable in this subset of patients.

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Flap Valve Double Patch Closure of Ventricular Septal Defects in Children With Increased Pulmonary Vascular Resistance

Cited by 83 publications

References 22 publications

Eisenmenger Syndrome: Not Always Inoperable

Eisenmenger Syndrome: Not Always Inoperable

Tailored circulatory intervention in adults with pulmonary hypertension due to congenital heart disease

Unidirectional valved patches for closure of septal defects in patients with severe pulmonary hypertension

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