Ventricular septal defect associated with aortic valve incompetence: Results of two surgical managements

Chauvaud, Sylvain; Sérraf, Alain; Mihǎileanu, Serban; Soyer, R; Blondeau, P; Dubost, C; Carpentier, Alain

doi:10.1016/0003-4975(90)90859-5

Cited by 52 publications

(25 citation statements)

References 20 publications

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“…It is located in the infundibular septum and close to the pulmonary valve and aortic valve annulus. Due to the lack of muscular Pediatr Cardiol support and the Venturi pulling effect on the leaflet, the aortic valve tends to prolapse into the defect, resulting in aortic insufficiency [1,2]. Where spontaneous closure of other types of VSD is estimated to be between 25 and 50 % in patients followed up from birth, spontaneous closure of dcVSD is extremely rare [16].…”

Section: Discussionmentioning

confidence: 98%

Transfemoral Device Occlusion and Minimally Invasive Surgical Repair for Doubly Committed Subarterial Ventricular Septal Defects

Chen

Pan

et al. 2015

Pediatr Cardiol

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Transfemoral device occlusion and minimally invasive surgical repair are performed for doubly committed subarterial ventricular septal defect (dcVSD) to reduce the invasiveness of the conventional surgical repair through a median sternotomy. However, few studies have compared them in terms of effectiveness and cost. Inpatients with isolated dcVSD who had undergone transfemoral device occlusion or minimally invasive surgical repair from January 2011 to June 2014 were reviewed for a comparative investigation between the two procedures. Procedure success was achieved in 36 transfemoral (75 %) and in 36 surgical (100 %) procedures (p = 0.001). Transfemoral patients were older, with a VSD size similar to that of surgical patients (14.5 ± 11.7 vs 4.4 ± 2.9 years, p < 0.001; 4.5 ± 1.5 vs 4.4 ± 1.3 mm, p = 0.577, respectively). No significant difference was observed in complication rates between the two treatment groups (p = 1). No large residual shunt was observed. Small residual shunt was noted in two transfemoral patients and four surgical patients (p = 0.674). All these small residual shunts closed spontaneously during follow-up. The surgical repair costs 26 % less than the device occlusion (Yuan 22063.2 ± 343.9 vs Yuan 29970.1 ± 1335.2, p < 0.001), where most of the cost was attributed to the occluder in the amount of Yuan 19,500. Compared with device occlusion, minimally invasive surgical repair can provide superior efficacy and comparable complication rates. In addition, it is 26 % cheaper than device occlusion. In low-income countries where healthcare resources are limited, medical resources must be judiciously allocated to the treatment that allows for effective treatment of the largest number of patients.

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Section: Discussionmentioning

confidence: 98%

Transfemoral Device Occlusion and Minimally Invasive Surgical Repair for Doubly Committed Subarterial Ventricular Septal Defects

Chen

Pan

et al. 2015

Pediatr Cardiol

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“…One potential problem associated with device occlusion for dcVSD is the interface between the device and the aortic and pulmonary valves. In several long-term followup studies, surgical repair has been proved to be an effective and safe procedure, which does not predispose to clinically significant late pulmonary and aortic valve dysfunction [2][3][4]21]. Studies regarding device occlusion for dcVSD have also demonstrated that the procedure does not induce aortic insufficiency [11][12][13][14][15].…”

Section: Commentmentioning

confidence: 97%

“…Doubly committed subarterial ventricular septal defect (dcVSD), also referred to as supracristal, subpulmonary, or infundibular VSD, is a unique type of VSD with a high incidence in Asian populations, accounting for as many as one quarter of defects requiring surgical closure [2]. Because of the lack of muscular support and the Venturi pulling effect on the leaflet, the aortic valve tends to prolapse into the defect, resulting in aortic insufficiency [3,4]. Whereas spontaneous closure of other types of VSD is estimated to be between 25% and 50% in patients followed up from birth, spontaneous closure of dcVSD is extremely rare.…”

mentioning

confidence: 99%

Transfemoral and Perventricular Device Occlusions and Surgical Repair for Doubly Committed Subarterial Ventricular Septal Defects

Yang

Cao

et al. 2015

The Annals of Thoracic Surgery

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“…Ventricular septal defects (VSDs) account for 20% of all forms of congenital heart defects, and approximately 5-7% of VSD cases are doubly committed subarterial VSDs (dcsVSDs) in Asian populations, which have a low tendency for spontaneous closure and a high incidence of aortic valve prolapse [1][2][3][4]. Early intervention is recommended for patients with dcsVSDs.…”

Section: Introductionmentioning

confidence: 99%

A meta-analysis of perventricular device closure of doubly committed subarterial ventricular septal defects

Huang

Kim

Huang

et al. 2020

J Cardiothorac Surg

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Background: To investigate the safety and efficacy of perventricular device closure of doubly committed subarterial ventricular septal defects (dcsVSDs). Methods: PubMed and Scopus were searched for studies in English that focused on perventricular device closure of dcsVSDs and were published up to the end of September 2019. We used a random-effects model to obtain pooled estimates of the success and complication rates. Results: A total of 9 publications including 459 patients with dcsVSDs were included. The median follow-up duration ranged from 2 months to 5 years, with the mean age of patients ranging from 6.1 months to 4.5 years. The pooled estimate of the overall success rate of device closure in the 9 studies was 0.89 (95% CI: 0.86-0.93, I 2 = 26.5%, P = 0.208). Further meta-regression analysis indicated no significant correlation between the success rate and the following factors: publication year, sample size, study type, mean age, mean weight, mean VSD size, and ratio of device size/weight. The pooled rate of postoperative aortic regurgitation was 0.045 (95% CI: 0.018-0.071, I 2 = 50.96%, P = 0.000). The pooled rate of follow-up aortic regurgitation (AR) was 0.001 (95% CI, − 0.003-0.004, I 2 = 63.00%, P = 0.009.) The pooled estimated rate of severe intraoperative complications was 0.106 (0.073-0.140, I 2 = 70.7%, P = 0.208). Postoperative and follow-up complications were rare. No occurrence of a complete atrioventricular block was reported up to the last follow-up visit. Conclusions: Perventricular device closure may be an alternative to conventional surgical repair in selected patients with dcsVSDs. The success rate was stable regarding the publication year and sample size, suggesting a relatively short learning curve and the technique's potential for application.

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Ventricular septal defect associated with aortic valve incompetence: Results of two surgical managements

Cited by 52 publications

References 20 publications

Transfemoral Device Occlusion and Minimally Invasive Surgical Repair for Doubly Committed Subarterial Ventricular Septal Defects

Transfemoral Device Occlusion and Minimally Invasive Surgical Repair for Doubly Committed Subarterial Ventricular Septal Defects

Transfemoral and Perventricular Device Occlusions and Surgical Repair for Doubly Committed Subarterial Ventricular Septal Defects

A meta-analysis of perventricular device closure of doubly committed subarterial ventricular septal defects

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