Download PDF
Thorac Cardiovasc Surg 2015; 63(05): 409-418
DOI: 10.1055/s-0035-1546297
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Treatment of Perimembranous Ventricular Septal Defect in Children Weighing Less than 15 kg: Minimally Invasive Periventricular Device Occlusion versus Right Subaxillary Small Incision Surgical Repair

Xueqin Zhang
1   Heart Center, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, Shandong, China
2   Department of Cardiac Surgery, People's Hospital of Jilin Province, Changchun, China
,
Quansheng Xing
1   Heart Center, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, Shandong, China
,
Qin Wu
1   Heart Center, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, Shandong, China
› Author Affiliations
Further Information

Publication History

07 October 2014

31 December 2014

Publication Date:
13 March 2015 (online)

    Permissions and Reprints All articles of this category

Abstract

Background To compare the treatment outcomes between minimally invasive periventricular device occlusion (MIPDO) and right subaxillary incision surgical repair (RSISR) on perimembranous ventricular septal defect (PmVSD) in children weighing less than 15 kg.

Methods From January 2010 to January 2013, 538 infants (age < 3 years, weight < 15 kg) with PmVSD were randomly divided into two groups according to different treatment methods. Group 1 (265 cases) had periventricular device occlusion through a lower partial median sternotomy under transesophageal echocardiography (TEE); group 2 (265 cases) underwent surgical repair on cardiopulmonary bypass (CPB) through a right subaxillary incision. A prospective randomized controlled study was performed regarding success rate, operation time, volume of blood loss and transfusion, length of intubation and intensive care unit (ICU) stay, complications, expenses, and follow-up results.

Results All patients had effective treatment with no death or serious life-threatening complications. In group 1, 255 cases (96.23%) underwent successful periventricular device occlusion. The remaining 10 cases (3.77%) were successfully converted to conventional operation. Different arrhythmias arose in 30 cases (11.76%), trivial residual shunt (RS) in 18 cases (7.06%), and new trivial tricuspid regurgitation (TR) in 29 cases (11.37%). In group 2, all patients (100%) underwent successful surgical repair. Different arrhythmias occurred in 116 cases (43.77%), trivial RS in 16 cases (6.04%), new trivial TR in 11 cases (4.15%), and heart dysfunction in 17 patients (6.42%). All patients were followed for more than 12 months. The final treatment effects were similar in both groups, but group 1 was significantly superior to group 2 regarding operation time, volume of blood loss, length of intubation and ICU stay, hospitalizations, and costs (all p < 0.05). TR incidence was higher in group 1 (p < 0.05), and that of right bundle branch block was higher in group 2 (p < 0.05). The incision was longer in group 2, but in a less exposed location. CPB was not needed in group 1, but anticoagulants were required for 3 to 6 months.

Conclusion Both RSISR and MIPDO are effective treatment methods for PmVSD. Though having some limitations, MIPDO not only minimized the surgical trauma to patients but also ensured safety to the maximum extent. However, patient selection is vital. For selected patients, especially those with moderate PmVSDs with obvious clinical symptoms and no valve regurgitation, it seems an ideal approach.

Keywords

vetricular septal defect - periventricular closure - occlusion device - cardiac operation - infant - cardiopulmonary bypass
 

  • References

  • 1 Anderson RH, Becker AE, Tynan M. Description of ventricular septal defects—or how long is a piece of string?. Int J Cardiol 1986; 13 (3) 267-278
    CrossrefPubMedGoogle Scholar
  • 2 Kirklin JW, Barrat-Boyes BG. Ventricular septal defect. In: Kirklin JW, Barrat-Boyes BG, , eds. Cardiac Surgery. 2nd ed. New York, NY: Churchill Livingstone; 1993: 749-824
    Google Scholar
  • 3 Gessler P, Schmitt B, Prètre R, Latal B. Inflammatory response and neurodevelopmental outcome after open-heart surgery in children. Pediatr Cardiol 2009; 30 (3) 301-305
    CrossrefPubMedGoogle Scholar
  • 4 Tiete AR, Sachweh JS, Kozlik-Feldmann R, Netz H, Reichart B, Daebritz SH. Minimally invasive surgery for congenital heart defects in paediatric patients. Thorac Cardiovasc Surg 2002; 50 (5) 271-275
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Mihaljevic T, Cohn LH, Unic D, Aranki SF, Couper GS, Byrne JG. One thousand minimally invasive valve operations: early and late results. Ann Surg 2004; 240 (3) 529-534 , discussion 534
    CrossrefPubMedGoogle Scholar
  • 6 Kadner A, Dodge-Khatami A, Dave H, Knirsch W, Bettex D, Prêtre R. Closure of restrictive ventricular septal defects through a right axillary thoracotomy. Heart Surg Forum 2006; 9 (6) E836-E839
    CrossrefPubMedGoogle Scholar
  • 7 Dave HH, Comber M, Solinger T, Bettex D, Dodge-Khatami A, Prêtre R. Mid-term results of right axillary incision for the repair of a wide range of congenital cardiac defects. Eur J Cardiothorac Surg 2009; 35 (5) 864-869 , discussion 869–870
    CrossrefPubMedGoogle Scholar
  • 8 Chessa M, Carminati M, Butera G , et al. Early and late complications associated with transcatheter occlusion of secundum atrial septal defect. J Am Coll Cardiol 2002; 39 (6) 1061-1065
    CrossrefPubMedGoogle Scholar
  • 9 Lim DS, Forbes TJ, Rothman A, Lock JE, Landzberg MJ. Transcatheter closure of high-risk muscular ventricular septal defects with the CardioSEAL occluder: initial report from the CardioSEAL VSD registry. Catheter Cardiovasc Interv 2007; 70 (5) 740-744
    CrossrefPubMedGoogle Scholar
  • 10 O'Donnell C, Neutze JM, Skinner JR, Wilson NJ. Transcatheter patent ductus arteriosus occlusion: evolution of techniques and results from the 1990s. J Paediatr Child Health 2001; 37 (5) 451-455
    CrossrefPubMedGoogle Scholar
  • 11 Zeng XJ, Sun SQ, Chen XF , et al. Device closure of perimembranous ventricular septal defects with a minimally invasive technique in 12 patients. Ann Thorac Surg 2008; 85 (1) 192-194
    CrossrefPubMedGoogle Scholar
  • 12 Quansheng X, Silin P, Zhongyun Z , et al. Minimally invasive perventricular device closure of an isolated perimembranous ventricular septal defect with a newly designed delivery system: preliminary experience. J Thorac Cardiovasc Surg 2009; 137 (3) 556-559
    CrossrefPubMedGoogle Scholar
  • 13 Zhang GC, Chen Q, Cao H, Chen LW, Yang LP, Chen DZ. Minimally invasive perventricular device closure of ventricular septal defect in infants under transthoracic echocardiograhic guidance: feasibility and comparison with transesophageal echocardiography. Cardiovasc Ultrasound 2013; 11: 8
    CrossrefPubMedGoogle Scholar
  • 14 Xing Q, Pan S, An Q , et al. Minimally invasive perventricular device closure of perimembranous ventricular septal defect without cardiopulmonary bypass: multicenter experience and mid-term follow-up. J Thorac Cardiovasc Surg 2010; 139 (6) 1409-1415
    CrossrefPubMedGoogle Scholar
  • 15 Carminati M, Butera G, Chessa M , et al; Investigators of the European VSD Registry. Transcatheter closure of congenital ventricular septal defects: results of the European Registry. Eur Heart J 2007; 28 (19) 2361-2368
    CrossrefPubMedGoogle Scholar
  • 16 Sullivan ID. Transcatheter closure of perimembranous ventricular septal defect: is the risk of heart block too high a price?. Heart 2007; 93 (3) 284-286
    CrossrefPubMedGoogle Scholar
  • 17 Wu Q, Xing Q, Chen Z, Pan S, Ren Y. Successful off-pump device closure of an isolated perimembraneous ventricular septal defect using a series of six occluders in a 5 kg infant via a minimally invasive approach. Eur Heart J 2010; 31 (21) 2659
    CrossrefPubMedGoogle Scholar
  • 18 Michel-Behnke I, Ewert P, Koch A , et al; Investigators of the Working Group Interventional Cardiology of the German Association of Pediatric Cardiology. Device closure of ventricular septal defects by hybrid procedures: a multicenter retrospective study. Catheter Cardiovasc Interv 2011; 77 (2) 242-251
    CrossrefPubMedGoogle Scholar
  • 19 Aboulhosn J, Levi D, Sopher M, Johnson A, Child JS, Laks H. Perventricular closure of a large ventricular septal defect in congenitally corrected transposition of the great arteries. Congenit Heart Dis 2010; 5 (1) 60-65
    CrossrefPubMedGoogle Scholar
  • 20 Vaksmann G, Fournier A, Chartrand C, Stanley P, Davignon A. [Arrhythmia disorders after repair of ventricular septal defects. Comparison of atrial and ventricular approaches]. Arch Mal Coeur Vaiss 1989; 82 (5) 731-735
    PubMedGoogle Scholar
  • 21 Abe T, Komatsu S. Conduction disturbances and operative results after closure of ventricular septal defects by three different surgical approaches. Jpn Circ J 1983; 47 (3) 328-335
    CrossrefPubMedGoogle Scholar
  • 22 Butera G, Carminati M, Chessa M , et al. Percutaneous closure of ventricular septal defects in children aged <12: early and mid-term results. Eur Heart J 2006; 27 (23) 2889-2895
    CrossrefPubMedGoogle Scholar
  • 23 Predescu D, Chaturvedi RR, Friedberg MK, Benson LN, Ozawa A, Lee KJ. Complete heart block associated with device closure of perimembranous ventricular septal defects. J Thorac Cardiovasc Surg 2008; 136 (5) 1223-1228
    CrossrefPubMedGoogle Scholar
  • 24 Zhou K, Hua Y, Qiao L. A case of late-onset sustained ventricular tachycardia following deployment of Amplatzer-type perimembranous VSD occluder. Catheter Cardiovasc Interv 2014; 83 (2) 256-260
    CrossrefPubMedGoogle Scholar
  • 25 Li X, Li L, Wang X, Zhao HB, Zhang SY. Clinical analysis of transcatheter closure of perimembranous ventricular septal defects with occluders made in China. Chin Med J (Engl) 2011; 124 (14) 2117-2122
    PubMedGoogle Scholar

    • Commentary References

    • 1 Schreiber C, Vogt M, Kühn A , et al. Periventricular closure of a perimembranous VSD: treatment option in selected patients. Thorac Cardiovasc Surg 2012; 60 (1) 78-80
      Article in Thieme ConnectPubMedGoogle Scholar
    • 2 Heinemann MK. From bygones to perspectives. Thorac Cardiovasc Surg 2012; 60 (1) 1-2
      Article in Thieme ConnectPubMedGoogle Scholar
    • 3 Xing Q, Pan S, An Q , et al. Minimally invasive perventricular device closure of perimembranous ventricular septal defect without cardiopulmonary bypass: multicenter experience and mid-term follow-up. J Thorac Cardiovasc Surg 2010; 139 (6) 1409-1415
      CrossrefPubMedGoogle Scholar
    • 4 Zhu D, Gan C, Li X , et al. Perventricular device closure of perimembranous ventricular septal defect in pediatric patients: technical and morphological considerations. Thorac Cardiovasc Surg 2013; 61 (4) 300-306
      Article in Thieme ConnectPubMedGoogle Scholar
    • 5 Zhang X, Xing Q, Wu Q. Treatment of Perimembranous Ventricular Septal Defect in Children Less than 15 Kilograms: Minimally Invasive Perventricular Device Occlusion versus Right Subaxillary Small Incision Surgical Repair. Thorac Cardiovasc Surg 2015; [online]
      PubMedGoogle Scholar