Percardiac closure of large apical ventricular septal defects in infants: Novel modifications and mid‐term results

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.

Effects of Right Ventricular Non-Apical Pacing and Right Ventricular Apical Pacing on Left Ventricular Function: A Systematic Review and Meta-Analysis

“…Zhu's research has shown that for patients with permanent pacemaker implantation whose basal state LVEF is reduced (≤40 %-45 %) or who have been followed up for >1 y, RVNA pacing has less impact on postoperative LVEF than RVA pacing. The conclusions are similar [32,33] .…”

Better outcomes depend on surgeons joining cardiologists

“…Closure of apical VSDs in infants is challenging for surgeons and interventional cardiologists. Although a hybrid approach has been used for some time, Changwe et al 2 describe a novel surgical technique to close apical VSDs that uses a probe‐assisted delivery system. This is done through a chest incision with the aid of transesophageal echocardiography.…”