Perventricular device closure of muscular ventricular septal defects on beating hearts: Initial experience in eight children

Gan, Changping; Lin, Kan; An, Qi; Tang, Hong; Song, Haibo; Lui, Raphael C.; Tao, Kaiyu; Zhuang, Zhongyun; Shi, Yujun

doi:10.1016/j.jtcvs.2008.09.010

Cited by 31 publications

(25 citation statements)

References 20 publications

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“…Among all the selected articles, 146 trials were conducted primarily in China 4–6,12,25–34,36–53,55–59,61,63,65–160,162,167,168,171–175,180,185,186 , 3 articles were conducted in other Asian countries (one each in India, South Korea and Turkey) 166,169,184 , 10 studies were conducted in the United States 11,62,64,163,170,176,178,179,181,182 , 5 studies were performed in European countries (one each in Austria, France, Germany, Poland, Russian Federation) 35,54,161,165,183 , 2 articles were conducted in South American countries (1 Brazil and 1 Chile) 164,177 , and 1 case-control study was performed in Australia 60 . A total of 108 articles were written in Chinese 5,12,26–29,31,32,36–43,46,70–132,134–159,174,175 , whereas 58 articles were written in English 4,6,11,25,30,33–35,44,45,47–69,133,160–163,165–173,176–186 , and the remaining article was written in Portuguese 164 .…”

Section: Resultsmentioning

confidence: 99%

“…Since then, many articles have described the use of TTDC with the Amplatzer occluder in VSD patients 52,57,64,181 . More recently, this technology has been widely applied throughout China 4–6,12,25–34,36–53,55–59,61,63,65–160,162,167,168,171–175,180,185,186 . Through this systematic review, we have attempted to compare the outcomes of TTDC versus COHS.…”

Section: Discussionmentioning

confidence: 99%

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Effects of transthoracic device closure on ventricular septal defects and reasons for conversion to open-heart surgery: A meta-analysis

Zhou

Liu

Zhao

et al. 2017

Sci Rep

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Transthoracic device closure (TTDC) is thought to be a promising technology for the repair of ventricular septal defects (VSDs). However, there is considerable controversy regarding the efficacy and safety of TTDC. The present study aimed to compare the benefits and safety of TTDC with those of conventional open-heart surgery (COHS) and analyze the associated factors causing complications, conversion to COHS and reoperation. Electronic database searches were conducted in PubMed, EMBASE, Cochrane Library, Clinicaltrials.gov and several Chinese databases. A total of 5 randomized controlled trials (RCTs), 7 cohort studies, 13 case-control studies, 129 case series and 13 case reports were included. Compared to COHS, TTDC exhibited superior efficacy with a significantly lower risk of post-operative arrhythmia; however, no significant differences in other outcomes were identified. Meta-regression analysis showed that perimembranous VSDs (pmVSDs), a smaller VSD, a smaller occluder, and a median or subxiphoid approach lowered the relative risk of several post-operative complications, conversion to COHS and reoperation. The current evidence indicates that TTDC is associated with a lower risk of post-operative arrhythmia and is not associated with an increased risk of complications. PmVSDs, a smaller VSD and occluder, and a median or subxiphoid approach correlate with better outcomes when using TTDC.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of transthoracic device closure on ventricular septal defects and reasons for conversion to open-heart surgery: A meta-analysis

Zhou

Liu

Zhao

et al. 2017

Sci Rep

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“…The poor results initially reported with intra-operative device closure (22–25), with high mortality (14–25%) and failure rates (20–40%) have recently become more encouraging in hospitals with advanced facilities for hybrid techniques (26–30). This alternative technique remains still an option under evaluation in selected institutions.…”

Section: Discussionmentioning

confidence: 99%

“…More recently institutions with advanced facilities for hybrid techniques have reported encouraging outcomes in selected series of multiple VDSs closure (26–30). …”

Section: Introductionmentioning

confidence: 99%

Multiple Ventricular Septal Defects: A New Strategy

Corno¹,

Kandakure²,

Dhannapuneni³

et al. 2013

Front. Pediatr.

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Introduction: A multicenter prospective study was conducted to evaluate a new strategy for multiple Ventricular Septal Defects (VSDs).Materials and Methods: From 2004 to 2012 17 consecutive children (3 premature, 14 infants), mean age 3.2 months (9 days–9 months), mean body weight 4.2 kg (3.1–6.1 kg), with multiple VSDs underwent Pulmonary Artery Banding (PAB) with an adjustable FloWatch-PAB®. Associated cardiac anomalies included patent ductus arteriosus (1), aortic coarctation (2), hypoplastic aortic arch (2), and left isomerism (3). Five patients (5/17 = 29.4%) required pre-operative mechanical ventilation, with a mean duration of 64 days (7–240 days)Results: There were no early or late deaths during a mean follow-up of 48 months (7–98 months), with either FloWatch removal or last observation as end-points. FloWatch-PAB® adjustments were required in all patients: a mean of 4.8 times/patient (2–9) to tighten the PAB, and a mean of 1.1 times/patient (0–3) to release the PAB with the patient’s growth. After a mean interval of 29 months (8–69 months) 10/17 (59%) patients underwent re-operation: 7/10 PAB removal, with closure of a remaining unrestrictive VSD in 6 (peri-membranous in 3 patients, mid-muscular in 2, and inlet in 1) and Damus–Kaye–Stansel, bi-directional Glenn, and atrial septectomy in 1; 3/9 patients required only PAB removal. All muscular multiple VSDs had closed in all 10 patients. PA reconstruction was required in 1/10 patient. In 5/7 of the remaining patients with the PAB still in situ, all muscular VSDs had already closed. The only 2 patients with persistent muscular multiple VSDs are the 2 patients with the shortest follow-up.Conclusion: This reproducible new strategy with an adjustable PAB simplifies the management of infants with multiple VSDs and provides the following advantages: (a) good results (0% mortality), delayed surgery with a high incidence (15/17 = 88%) of spontaneous closure of multiple muscular VSDs, and facilitated closure of residual unrestrictive VSD (peri-membranous, mid-muscular, or inlet) at an older age and higher body weight; PAB with FloWatch-PAB® and its subsequent removal can potentially be the only procedure required for Swiss cheese multiple VSDs without an associated peri-membranous unrestrictive VSD.

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“…Percutaneous-device closure is suitable in young children, but is impractical in infants due to limitations of the delivery system. The hybrid approach such as minimally invasive perventricular closure of the VSD, introduced by Amin and coworkers in the late 1990 [1], has developed into a safe and effective method [2-6], Previously, transesophageal echocardiography (TEE) was thought to be necessary to guide perventricular device closure [7,8], and sometimes intracardiac echocardiography was used in this setting [9]. Because transthoracic echocardiography (TTE) also provides clear visualization of cardiac anatomy using subcostal views in infants [10-12], we have used TTE as a guiding tool during placement of a perventricular device [13].…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive perventricular device closure of ventricular septal defect in infants under transthoracic echocardiograhic guidance: feasibility and comparison with transesophageal echocardiography

Zhang

Chen

Cao

et al. 2013

Cardiovasc Ultrasound

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BackgroundA hybrid approach to minimally invasive perventricular closure of VSD in infants is safe and effective, and has been performed under guidance of transesophageal echocardiography (TEE). We applied transthoracic echocardiographic (TTE) guidance to this hybrid approach, and compare results guided by TTE with those by TEE.MethodsFrom January 2011 to January 2012, 71 infants with VSD were enrolled to undergo a minimally invasive device closure. After evaluation of VSD by TTE, either TEE or TTE was used to guide the minimally invasive device closure. 30 patients had TEE guidance, and 41 patients had TTE. All patients were followed for 3 months after the operation.ResultsThe TEE group had a success rate of 93.3% (28/30) for device implantation, compared with 92.7% (38/41) in the TTE group. Two patients in the TEE group turned to surgical closure, one for involvement of the inlet area of VSD demonstrated by TEE, another for moderate aortic regurgitation after device implantation. Two patients in the TTE group also transferred to surgical closure, one for residual shunt, another for failure of the floppy wire across the defect. In addition, one patient in the TTE group experienced dropout of the occluder one day postoperatively. At 3-month follow-up, one patient had mild aortic regurgitation in the TEE group and in two patients in the TTE group. There were no episodes of cardiac block, thromboembolism, or device displacement in either group.ConclusionsTTE-guided VSD closure is feasible in infants, with results similar to those of TEE guidance, although caution is advisable.

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Perventricular device closure of muscular ventricular septal defects on beating hearts: Initial experience in eight children

Abstract: Perventricular device closure of muscular ventricular septal defects with or without coexisting congenital malformations appeared to be safe and efficacious. The outcomes of short-term follow-up are acceptable.

Cited by 31 publications

References 20 publications

Effects of transthoracic device closure on ventricular septal defects and reasons for conversion to open-heart surgery: A meta-analysis

Effects of transthoracic device closure on ventricular septal defects and reasons for conversion to open-heart surgery: A meta-analysis

Multiple Ventricular Septal Defects: A New Strategy

Minimally invasive perventricular device closure of ventricular septal defect in infants under transthoracic echocardiograhic guidance: feasibility and comparison with transesophageal echocardiography

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