Value of echocardiography for mini-invasive per-atrial closure of perimembranous ventricular septal defect

Abstract

The purpose of this study was to assess the value of echocardiography for intraoperative guidance during closure of perimembranous ventricular septal defects (pmVSD) and to assess outcomes of these patients. We identified and assessed 78 patients who underwent 2-and 3-dimensional echocardiography-guided mini-invasive per-atrial closure of pmVSD in the cardiac surgery department of our institution, from February 2016 to August 2018, and 76 patients who underwent transcatheter closure of VSD guided by fluoroscopy at the pediatric department (percutaneous control group). All the patients underwent echocardiography. Their clinical data were retrospectively reviewed and analyzed. All patients were followed up using transthoracic echocardiography (TTE) for a maximum of 24 months after the closure. All patients underwent successful device implantation. Echocardiography showed that the major immediate complications included residual shunt, pericardial effusion, and tricuspid regurgitation in the per-atrial group. During the mid-term follow-up period, TTE revealed that the most common complication was tricuspid regurgitation (non-preexisting). There were no cases of VSD recurrence, device displacement, valvular injury, malignant arrhythmias, hemolysis, or death. Moreover, according to the TTE data, the intracardiac structure of the patients were improved. Compared to the control group, the intracardiac manipulation time was shorter and the number of patients with residual shunts, redeployment of devices, or immediate new tricuspid regurgitations was fewer when using 2-and 3-dimensional echocardiography. However, the procedure time in the per-atrial group was slightly longer than that in the control group. Two-and 3-dimensional echocardiography are feasible monitoring tools during mini-invasive per-atrial VSD closure. The short-and mid-term follow-up showed satisfactory results compared to fluoroscopy.

Value of transesophageal echocardiography in device closure of perimembranous ventricular septal defects in children via ultra‐minimal trans intercostal incision

“…PmVSD closure via an ultra‐minimal trans intercostal incision under TEE guidance has a high success rate and few complications. Compared with the transcatheter approach, TEE‐guided surgery can avoid radiation exposure, 11 and a short perpendicular entry route can prevent inferior vena cava and aorta injury because it avoids the establishment of an arteriovenous guidewire loop 1–3 . The clear display of defects and devices by TEE can increase the success rate of PmVSD closure, especially complex PmVSDs, and can markedly reduce the occurrence of atrioventricular block 3,12 …”

“…[1][2][3] The clear display of defects and devices by TEE can increase the success rate of PmVSD closure, especially complex PmVSDs, and can markedly reduce the occurrence of atrioventricular block. 3,12 Preoperative TEE in the operating room can provide an accurate diagnosis. Evaluation of PmVSDs includes the defect itself, adjacent structures, and intracardiac structures.…”

“…Compared with the transcatheter approach, TEE-guided surgery can avoid radiation exposure, 11 and a short perpendicular entry route can prevent inferior vena cava and aorta injury because it avoids the establishment of an arteriovenous guidewire loop. [1][2][3] The clear display of defects and devices by TEE can increase the success rate of PmVSD closure, especially complex PmVSDs, and can markedly reduce the occurrence of atrioventricular block. 3,12 Preoperative TEE in the operating room can provide an accurate diagnosis.…”

“…Transesophageal echocardiography (TEE) has developed rapidly due to its clear imaging capability 1–4 . The widespread use of TEE has promoted the development of perimembranous ventricular septal defect (PmVSD) closure via a transthoracic minimally invasive incision in children 1–8 . Our team performed PmVSD closure in children via an ultra‐minimal trans intercostal incision (≤1 cm) 1,2 .…”