Techniques and results in the management of multiple ventricular septal defects

Kitagawa, Tetsuya; Durham, Lucian A.; Mosca, Ralph S.; Bove, Edward L.

doi:10.1016/s0022-5223(98)70366-6

Cited by 148 publications

(186 citation statements)

References 11 publications

(12 reference statements)

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“…In a recent study, 16 multiple VSDs were the only risk factors related to early mortality in patients who had double-outlet right ventricle. Kitagawa et al 17 recently published the operative results of MVSD closure in 33 patients. Despite impressive results, 10 patients had residual VSDs, and 5 required reoperation.…”

Section: Discussionmentioning

confidence: 99%

New Device for Closure of Muscular Ventricular Septal Defects in a Canine Model

Amin

Berry

et al. 1999

Circulation

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Background-Repair of muscular ventricular septal defects (MVSDs) has always been challenging to the surgeon.Long-term morbidity and mortality are significantly increased if the defects are closed via left ventriculotomy or if they are associated with other complex congenital anomalies. The purpose of this study was to close MVSDs with the Amplatz ventricular septal defect device. This device is constructed from 0.004-in nitinol wire mesh filled with polyester fibers. It is retrievable, repositionable, self-centering, and of low profile. Methods and Results-MVSDs were created with the help of a sharp punch in 10 dogs. The location of the defects was anterior muscular (nϭ3), midmuscular (nϭ3), apical (nϭ3), and inlet muscular (nϭ1). The diameter of the defects ranged from 6 to 14 mm. All defects were closed in the catheterization laboratory. The device was placed with the help of transesophageal echocardiography and fluoroscopy. A 7F sheath was used to deploy the device from the right ventricular side in 8 and the left ventricular side in 2 dogs. Placement was successful in all animals. The complete closure rate was 30% (3/10) immediately after placement and 100% at 1-week follow-up. Pathological examination of the heart revealed complete endothelialization of the device in dogs killed after 3 months. Conclusions-The Amplatz ventricular septal defect device appears highly efficacious in closing MVSDs. The advantages include a small delivery sheath, complete retrievability before release, and the fact that it is self-centering and self-expanding, thereby making it an attractive option in smaller children. (Circulation. 1999;100:320-328.)

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Section: Discussionmentioning

confidence: 99%

New Device for Closure of Muscular Ventricular Septal Defects in a Canine Model

Amin

Berry

et al. 1999

Circulation

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“…[1][2][3][4][5][6] Accordingly, in many of these challenging patients, transcatheter device closure of unrepaired VSDs was undertaken as 1 element of a combined (surgical and interventional catheterization) management strategy. The remainder of our cohort had either intentionally fenestrated VSD patches, which we have discussed in a separate report, 24 or postoperative residual defects along the margin of patches used to close VSDs in the membranous or outflow portions of the septum.…”

Section: Effectiveness Of Transcatheter Device Closure Of Vsdsmentioning

confidence: 99%

“…Similarly challenging are postoperative residual VSDs, which are often clinically significant yet difficult to close surgically. [1][2][3][4][5][6] Transcatheter device closure is an alternative strategy for management of both complex muscular and postoperative residual VSDs.…”

mentioning

confidence: 99%

Transcatheter Device Closure of Congenital and Postoperative Residual Ventricular Septal Defects

et al. 2004

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Background-Our purpose was to describe a 13-year experience with patients undergoing transcatheter device closure of unrepaired congenital or postoperative residual ventricular septal defects (VSDs). Methods and Results-Since 1989, 170 patients (median age, 3.9 years) have undergone catheterization for closure of 1 or more congenital (nϭ92) or postoperative (nϭ78) residual VSDs using successive generations of STARFlex-type devices. Outcomes included echocardiographic assessment of residual flow and device position, assessment of VSD shunt/severity, and adverse events. Among 168 patients in whom device implantation was performed, between 1 and 7 devices were placed per patient (median, 1), with multiple devices placed in 40%. There was a significant decrease in left-to-right shunting after device implantation (PϽ0.001) and significant improvement in VSD size/severity, and device position proved stable. Of 332 adverse events, 39 were related to the device and 261 were related to the catheterization; all but 5 occurred in the periprocedural period. At a median follow-up of 24 months (0 to 154 months), 14 patients had died and 18 had device(s) explanted. Conclusions-Congenital

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“…It is often necessary to divide some of the coarse muscular trabeculations on the right ventricular surface of the septum to expose the true margins of the VSD. [3][4][5] The coarse multiple trabeculations on the right ventricular side of the septum, including the moderator band and lower end of the septal band, can be divided to facilitate accurate exposure of midmuscular VSDs as necessary. This technique can facilitate successful closure of defects that may appear to be multiple but are in fact single defects with more than one opening on the right ventricular side.…”

Section: Midmuscular Vsd or Midventricular Vsdmentioning

confidence: 99%

“…This technique can facilitate successful closure of defects that may appear to be multiple but are in fact single defects with more than one opening on the right ventricular side. 5 Common options for closure of midmuscular VSDs include surgical closure via a right atriotomy, surgical closure via a right ventriculotomy, and transcatheter device closure. These defects can usually be approached surgically through the right atrium using a standard right atriotomy ( Fig.…”

Section: Midmuscular Vsd or Midventricular Vsdmentioning

confidence: 99%

Operative Techniques for Repair of Muscular Ventricular Septal Defects

Jacobs

2010

Operative Techniques in Thoracic and Cardiovascular Surgery

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Techniques and results in the management of multiple ventricular septal defects

Cited by 148 publications

References 11 publications

New Device for Closure of Muscular Ventricular Septal Defects in a Canine Model

New Device for Closure of Muscular Ventricular Septal Defects in a Canine Model

Transcatheter Device Closure of Congenital and Postoperative Residual Ventricular Septal Defects

Operative Techniques for Repair of Muscular Ventricular Septal Defects

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