scholarly journals A Novel Approach for Transcatheter Management of Perimembranous Ventricular Septal Defect with a Subaortic Ridge

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Hussein A. Wahab ◽  
Hussein A. Alsalkhi ◽  
Khalid A. Khalid ◽  
Ahmmed F. Abusuda
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Interventricular Septum ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Type I ◽  
Female Ratio ◽  
Surgical Closure ◽  
Perimembranous Ventricular Septal Defect ◽  
The Mean

Introduction. Surgical closure of the perimembranous ventricular septal defect (PM VSD) and resection of the subaortic ridge are the standard methods of management, but there is no definitive agreement regarding the timing of surgery. Objectives. To evaluate the safety and efficacy of the management of patients with PM VSD and subaortic ridge with or without AR via transcatheter closure of the defect and compressing the ridge against the ventricular septum using Amplatzer ductal occluder type I (ADO-I). Patients and Methods. We introduced a new approach for transcatheter management of PM VSD and subaortic ridge by closing the VSD and capturing or compressing the ridge against the interventricular septum (IVS) using the ADO-I device. Thirty-eight (9.5%) of 398 patients with a PM VSD were found to have subaortic ridge and were enrolled in this study from August 1, 2014, to February 1, 2018, at the Ibn Albitar Center for Cardiac Surgery, Baghdad, Iraq. Results. The ages and weights of patients ranged from 1.5 to 25 years and 7 to 73 kg, respectively. The male-to-female ratio was 2.2 : 1. The VSD sizes ranged from 4 to 8 mm, and the median distance of the ridge from the proximal edge of the VSD was 2.5 mm. Prior to closure, 13 patients (34.2%) had mild and mild-to-moderate aortic regurgitation (AR), and nine patients (23.7%) had mild-to-moderate left ventricular outflow tract (LVOT) obstruction. The mean AR pressure half-time increased significantly after intervention (from 385 ± 38 ms to 535 ± 69 ms (significant P value, 0.001)), and the mean of the peak pressure gradient across the LVOT decreased from 33 ± 7 mmHg to 15 ± 2.4 mmHg (significant P value, 0.001). Successful procedures were achieved in 33 patients (86.8%). Conclusion. Transcatheter management of patients with PM VSD and subaortic ridges with or without AR is feasible and effective.

scholarly journals Midterm Results of Transaxillary Occluder Device Closure of Perimembranous Ventricular Septal Defect Guided Solely by Transesophageal Echocardiography

2019 ◽  
Vol 22 (2) ◽  
pp. E112-E118
Author(s):  
Weijie Liang ◽  
Sijie Zhou ◽  
Taibin Fan ◽  
Shub Song ◽  
Bin Li ◽  
...  
Keyword(s):  
Adverse Events ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Device Closure ◽  
Bundle Branch Block ◽  
Surgical Closure ◽  
Perimembranous Ventricular Septal Defect ◽  
Occluder Device ◽  
The Mean

Background: Perimembranous ventricular septal defect (pmVSD) is a common congenital heart disease. Transaxillary occluder device closure of the pmVSD has been proved effective and an alternative to surgical closure. The study aimed to evaluate the immediate operation outcomes and the early and midterm follow-up outcomes of transaxillary occluder device closure. Methods: From January 2014 to December 2017, we retrospectively analyzed the patients who underwent transaxillary device closure of the pmVSD. All patients underwent transthoracic echocardiography (TTE), chest x-ray, and electrocardiogram (ECG) before and after the procedure (before discharging). Follow-up evaluation was completed at the time of 3, 6, 12 months and yearly thereafter in outpatient setting with TTE and ECG. Results: A total of 428 patients (216 male, 212 female) underwent transaxillary occluder device closure of the pmVSD under the guidance of transesophageal echocardiography (TEE). The mean age at the operation time was 2.2 ± 1.5 year (range 0.5-16.2 year). The mean weight was 8.5 ± 4.1 kg (range 6-61 kg). The mean size of the occluder implanted in the operation was 5.3 ± 1.4 (range 4-8 mm), matching the mean defect size of 4.2 ± 1.1 (range 3-6 mm). The device closure operation was successfully achieved in 422 pmVSD patients (98.6%), and 6 patients failed in occluding and were converted to open surgery because of a great residual shunt and obvious device-related aortic regurgitation . Immediate complete closure was detected by postoperative TEE in all, but 3 patients had trivial residual shunting. Total early adverse events emerged in 47 patients (11.1%). New mild tricuspid and aortic regurgitation occurred in 17 and 3 patients and disappeared in follow-up. Abnormal atrioventricular conduction events emerged in 23 patients, including left anterior block, complete right bundle branch block (CRBBB), incomplete right bundle branch block (IRBBB), administrated with close follow-up. Pericardial effusion occurred in 2 other patients, managed with puncture drainage. During a median follow-up period of 26.8 months (range 6-48 months), no serious adverse event and later-on complete atrioventricular block were encountered. Conclusion: In our experience, transaxillary device closure was performed via right infra-axillary mini-incision (invisible) guided by TEE, with low incidence of postoperative adverse events, confirming that transaxillary device closure of the pmVSD under the guidance of TEE is an effective alternative to surgical closure in well-selected pmVSD patients.

The Gerbode Defect: The Significance of a Left Ventricular to Right Atrial Shunt

2009 ◽  
Vol 19 (S2) ◽  
pp. 96-99 ◽  
Author(s):  
Angela M. Kelle ◽  
Luciana Young ◽  
Sunjay Kaushal ◽  
C. Elise Duffy ◽  
Robert H. Anderson ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Tricuspid Valve ◽  
Right Atrium ◽  
Septal Defect ◽  
Left Ventricular ◽  
Right Atrial ◽  
Surgical Closure ◽  
The Mean ◽  
The Right ◽  
Membranous Septum

AbstractBackgroundThe so-called Gerbode ventriculo-atrial defect is a rare defect that permits shunting from the left ventricle to the right atrium. It takes 2 forms, either a deficiency of the atrioventricular membranous septum, or shunting initially through a ventricular septal defect, with atrial shunting occurring through a deficiency in the septal leaflet of the tricuspid valve. In this review, we describe the natural history and outcomes of surgical repair for the variant with shunting through a deficiency at the site of the atrioventricular membranous septum.MethodsFrom 1990 to 2008, we identified 6 patients from our departmental database who had undergone surgical closure of a congenital defect of the atrioventricular component of the membranous septum. Median age at repair was 1.6 years, with a range, from 0.4 to 19 years. All patients were symptomatic, with 3 having congestive cardiac failure, 2 failing to thrive, and 2 having intolerance to exercise. All had a dilated right atrium demonstrated by echocardiogram, with a mean preoperative gradient measured by echocardiogram to be 109 millimetres of mercury, with a range from 65 to 150 millimetres of mercury.ResultsThere was no operative or late mortality. The mean size of the defect was 6.2 ± 2.0 millimetres, with a range from 4 to 8 millimetres. All were closed by insertion of a patch. The mean period of cardiopulmonary bypass was 90.5 ± 11.3 minutes, the mean time of aortic cross-clamping 54.8 ± 6.9 minutes, and the mean length of stay in hospital 4.3 ± 1.0 days. No patient had a residual defect, and only trivial regurgitation of the tricuspid valve was evident by postoperative echocardiography. There were no complications or reoperations.ConclusionThe membranous ventriculo-atrial defect can be recognized echocardiographically on the basis of dilation of the right atrium in the setting of an unusually high Doppler echocardiogram gradient compared to the ventricular septal defect with shunting only at ventricular level. Since all patients in our series were symptomatic, we recommend surgical closure of all these defects.

scholarly journals Case Report of Ventricular Septal Defect Complicating Transcatheter Aortic Valve Implant for Aortic Regurgitation: Novel Complication and Technical Considerations

2021 ◽  
Author(s):  
Jack Hartnett ◽  
Lisa Brandon ◽  
Deirdre Waterhouse ◽  
Ross T Murphy ◽  
Kevin P Walsh ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Ventricular Septal Defect ◽  
Aortic Regurgitation ◽  
Septal Defect ◽  
Interventricular Septum ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Left Ventricular Outflow ◽  
Traumatic Ventricular Septal Defect

Abstract Background Transcatheter aortic valve implantation (TAVI) has proven efficacy in the treatment of aortic stenosis (AS). Understandably there is increasing enthusiasm for its use to treat aortic regurgitation (AR). However, there are significant anatomical differences between AS and AR which make TAVI for AR more complex. Case Summary We present the case of technically challenging TAVI for severe AR, which was complicated by a traumatic ventricular septal defect (VSD) that required percutaneous closure. To our knowledge this is the first published case of VSD post TAVI for AR. Discussion This unanticipated complication highlights anatomical differences between TAVI use in AS and AR. Lack of aortic valve calcification and excessive annular compliance made stable deployment of a self-expanding valve extremely challenging. Despite device oversizing, repeated embolization of the prosthesis into the left ventricular outflow tract (LVOT) traumatised the interventricular septum.

Cardiovascular events in perimembranous ventricular septal defect with left ventricular volume overload: a French prospective cohort study (FRANCISCO)

2021 ◽  
pp. 1-6
Author(s):  
Lisa Guirgis ◽  
Estibaliz Valdeolmillos ◽  
Guy Vaksmann ◽  
Clément Karsenty ◽  
Ali Houeijeh ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Volume Overload ◽  
Ventricular Volume ◽  
Left Ventricular ◽  
Surgical Closure ◽  
Perimembranous Ventricular Septal Defect ◽  
New Information ◽  
Hypertension In Children

Brief summary The long-term prospective multi-centre nationwide (French) observational study FRANCISCO will provide new information on perimembranous ventricular septal defect with left ventricular overload but no pulmonary hypertension in children older than 1 year. Outcomes will be compared according to treatment strategy (watchful waiting, surgical closure, or percutaneous closure) and anatomic features of the defect. The results are expected to provide additional guidance about the optimal treatment of this specific population, which is unclear at present.

Echocardiographic Evaluation of Cardiac Remodeling After Surgical Closure of Ventricular Septal Defect in Different Age Group

2017 ◽  
Vol 2 (2) ◽  
pp. 69-74
Author(s):  
Mohammad Aminullah ◽  
Fahmida Akter Rima ◽  
Asraful Hoque ◽  
Mokhlesur Rahman Sazal ◽  
Prodip Biswas ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Ejection Fraction ◽  
Cardiac Remodeling ◽  
Septal Defect ◽  
Left Ventricular ◽  
Age Group ◽  
Surgical Closure ◽  
Group A ◽  
Group B ◽  
Fractional Shortening

Background: Cardiac remodeling is important issue after surgical closure of ventricular septal defect.Objective: The purpose of the present study was to evaluate cardiac remodeling by echocardiography by measuring the ejection fraction, fractional shortening, left ventricular internal diameter during diastole (LVIDd) and left ventricular internal diameter during systole (LVIDs) after surgical closure of ventricular septal defect in different age group. Methodology: This prospective cohort studies was conducted in the Department of Cardiac Surgery at National Institute of Cardiovascular Disease (NICVD), Dhaka. Patient with surgical closure of VSD were enrolled into this study purposively and were divided into 3 groups according to the age. In group A (n=10), patients were within the age group of 2.0 to 6.0 years; age of group B (n=8) patients were 6.1-18.0 years and the group C (n=6) aged range was 18.1-42.0 years. Echocardiographic variables such as ejection fraction, fractional shortening, LVIDd, LVIDs were taken preoperatively and at 1st and 3rd month of postoperative values. Result: A total number of 24 patients was recruited for this study. The mean ages of all groups were 12.60±12.09. After 1 month ejection fraction were decreased by 5.97%, 6.71% and 5.66% in group A, group B and group C respectively. After 3 months ejection fraction were increased by 6.13%, 5.13% and 5.14% in group A, group B and group C respectively. After 1 month fractional shortening were decreased by 13.55%, 9.30% and 9.09% in group A, group B and group C respectively. After 3 months fractional shortening were increased by 7.23%, 7.35% and 4.55% in group A, group B and group C respectively. After 1 month LVIDd were increased by 1.97%, 1.91% and 1.32% in group A, group B and group C respectively. After 3 months LVIDd were decreased by 10.84%, 9.89% and 7.34% in group A, group B and group C respectively. After 1 month LVIDs were increased by 2.19%, 2.86% and 1.98% in group A, group B and group C respectively. After 3 months LVIDs were decreased by 11.68%, 10.97% and 8.87% in group A, group B and group C respectively.Conclusion: Cardiac remodeling occurred after surgical closure of ventricular septal defect and remodeling were more significant in younger age group. Journal of National Institute of Neurosciences Bangladesh, 2016;2(2):69-74

Arterial Switch Operation With Neoaortic Valve Replacement in a 13-Year Old Patient With Transposition of Great Arteries With Ventricular Septal Defect and Left Ventricular Outflow Tract Obstruction—A Case Report

2018 ◽  
Vol 11 (4) ◽  
pp. NP190-NP194
Author(s):  
Kuntal Roy Chowdhuri ◽  
Manoj Kumar Daga ◽  
Subhendu Mandal ◽  
Pravir Das ◽  
Amanul Hoque ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Valve Replacement ◽  
Septal Defect ◽  
Left Ventricular Outflow Tract ◽  
Arterial Switch Operation ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Transposition Of Great Arteries ◽  
Switch Operation ◽  
Left Ventricular Outflow

The surgical management of d-transposition of great arteries (d-TGAs) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO) is ever evolving and still remains a challenge because of wide anatomic variability, age of presentation, surgical options available, and their variable long-term results in different series. We describe a patient with d-TGA, VSD, and LVOTO who presented to us at 13 years of age and underwent an arterial switch operation along with neoaortic valve replacement with a mechanical prosthesis. The postoperative course was uneventful, and at hospital discharge, the echocardiogram was satisfactory. We present the pros and cons of this hitherto undescribed treatment option.

scholarly journals Doubly committed subarterial ventricular septal defect with prolapsed right coronary cusp with moderate aortic regurgitation

2017 ◽  
Vol 10 (4) ◽  
pp. 240
Author(s):  
Redoy Ranjan ◽  
Asit Baran Adhikary ◽  
Mohammad Rashal Chowdhury ◽  
Md. Kabiruzzaman ◽  
Md. Mushfiqur Rahman
Keyword(s):  
Ventricular Septal Defect ◽  
Aortic Regurgitation ◽  
Septal Defect ◽  
Systolic Pressure ◽  
Failure To Thrive ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Coronary Cusp ◽  
Right Coronary Cusp

<p>A 4 year old girl was presented with the respiratory tract infection, breathlessness after taking meal, failure to thrive, abnormal movement of the chest on left side overlying the area of heart and systolic murmur. She developed these symptoms gradually for the last 3.5 years. Echocardiography revealed doubly committed subarterial ventricular septal defect with moderate aortic regurgitation. The size of the ventricular septal defect was 7 x 9 mm at the left ventricular outflow tract. The right coronary cusp of the aortic valve was prolapsed. Left atrium and left ventricle were dilated. The pulmonary artery systolic pressure was 35 mm Hg. The ventricular septal defect was closed with the standard surgical procedure using cardiopulmonary bypass followed by aortotomy and right atriotomy. Immediate post-operative period of this case was uneventful and the patient was discharged on 9<sup>th</sup> post-operative day. Follow-up echocardiography showed no residual ventricular septal defect or aortic regurgitation and the ventricular function was good.</p>

Surgical repair of interrupted aortic arch with ventricular septal defect

1998 ◽  
Vol 8 (2) ◽  
pp. 217-220 ◽  
Author(s):  
Lindsey D Allan ◽  
Howard D Apfel ◽  
Yosef Levenbrown ◽  
Jan M Quaegebeur
Keyword(s):  
Ventricular Septal Defect ◽  
Aortic Arch ◽  
Septal Defect ◽  
Ventricular Outflow Tract ◽  
Interrupted Aortic Arch ◽  
Left Ventricular ◽  
Subaortic Stenosis ◽  
Current Debate ◽  
Aortic Orifice

AbstractBackgroundInterrupted aortic arch is often associated with subaortic narrowing and hypoplasia of the aortic orifice. The best surgical strategy for the management of these additional lesions is a matter of current debate.Methods and ResultsBetween 1986 and 1996, 19 patients underwent repair of interrupted aortic arch with closure of ventricular septal defect in a single stage, with no attempt at subaortic resection, irrespective of the dimensions of the left ventricular outflow tract. There was no perioperative hospital mortality, and all patients were alive at 1 year. Follow-up ranges from 0.75 −10 years, with a mean 4.2 ± 3.0 years. Seven patients (37%) have required reintervention for relief of subaortic stenosis, 2 of whom have died.ConclusionsOur results suggest that primary one-stage biventricular repair can be accomplished with low perioperative mortality without addressing the subaortic region. Further long-term follow-up will determine whether this is accomplished at the expense of later morbidity and mortality.

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