Minimally invasive experiences and medium-long-term results of perventricular device closure of ventricular septal defects in 783 children: A retrospective analysis in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LU Xuning , LIU Yuhang , ZHU Quanwei , WANG Ning ,  WEN Ping

Department of Heart Center, Children’s Hospital of Dalian Medical University, Dalian, 116012, Liaoning, P. R. China;

Corresponding author：

WEN Ping, Email: 13504115999@163.com

Keywords：

Congenital heart disease; ventricular septal defect; minimally invasive surgery; cardiac surgical procedures

DOI：

10.7507/1007-4848.202011059

Video：

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Objective To summarize the minimally invasive experiences and medium-long-term results of perventricular device closure of ventricular septal defects (VSD) under transesophageal echocardiography (TEE) guidance.Methods We retrospectively analyzed the clinical data and medium-long-term follow-up results of 783 patients who undertook perventricular device closure under TEE guidance in Dalian Children’s Hospital from July 2011 to January 2020, in which perimembrane VSD were found in 598 patients, VSD with aortic valve prolapse in 135 patients and muscular VSD in 2 patients. There were 463 males and 320 females at age of 5 months to 13 years with average age of 3.3±1.2 years, and body weight of 5.9-51.0 (15.9±8.3) kg. The left ventricular defect diameter of the VSD ranged from 5.0 to 11.0 mm, with an average of 6.3±1.2 mm. The right ventricular defect diameter of the VSD ranged from 2.3 to 8.0 mm, with an average of 4.3±0.9 mm.Results The procedures were completed successfully in 753 patients. The device of 1 patient (0.1%) fell off and embedded in the right pulmonary artery after the operation, and the occluder was taken out and the VSD was closed with cardiopulmonary bypass (CPB) in the secondary operation. One patient (0.1%) appeared Ⅲ degree atrioventricular block in 2 years after operation. The device was taken out and VSD was closed with CPB in the secondary operation, and the patient gradually reached to sinus rhythm in post-operation. Eight patients (1.1%) presented delayed pericardial effusion in 1 week after operation, and were cured by pericardiocentesis with ultrasound-guided. Symmetric occluders were used in 580 patients, eccentric occleders were used in 171 patients and muscular occluders were used in 2 patients. The follow-up time was 9 months to 9 years. The rate of loss to follow-up was 96.7% (704/728). No residual shunt, occlude-loss or arrhythmia was found during follow-up. Conclusion The minimally invasive penventricular device closure of VSD guided by TEE is safe and availabe. Medium-long-term follow-up results are satisfactory, it is worthy of clinical promotion, and longer term follow-up is still needed.

Citation： LU Xuning, LIU Yuhang, ZHU Quanwei, WANG Ning, WEN Ping. Minimally invasive experiences and medium-long-term results of perventricular device closure of ventricular septal defects in 783 children: A retrospective analysis in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(9): 1161-1165. doi: 10.7507/1007-4848.202011059 Copy

1.	Dr Penny DJ, Vick GW. Ventricular septal defect. Lancet, 2011, 377(9771): 1103-1112.
2.	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.
3.	Song XY, Xing QS, Qin W, et al. Transthoracic device closure of Juxta arterial ventricular septal defects: Midterm follow-up results. Ann Thorac Surg, 2017, 104(3): 841-846.
4.	卢绪宁, 文平, 刘宇航, 等. 镶嵌治疗室间隔完整型肺动脉膜性闭锁及重度肺动脉瓣狭窄. 中华小儿外科, 2019, 40(9): 801-805.
5.	Hong Z, Chen Q, Huang L, et al. A meta-analysis of perventricular device closure of perimembranous ventricular septal defect. J Cardiothorac Surg, 2019, 14: 119.
6.	Wang SZ, Ouyang WB, Liu Y, et al. Transcatheter perimembranous ventricular septal defect closure under transthoracic echocardiographic guidance without fluoroscopy. J Thorac Dis, 2018, 10(9): 5222-5231.
7.	中国医师协会心血管外科医师分会. 经胸微创室间隔缺损封堵术中国专家共识. 中华胸心血管外科杂志, 2011, 27(9): 516-518.
8.	You T, Yi K, Ding ZH, et al. Transcatheter closure, mini-invasive closure and open-heart surgical repair for treatment of perimembranous ventricular septal defects in children: A protocol for a network meta-analysis. BMJ Open, 2017, 7(6): e015642.
9.	Li DX, Zhang Z, Li MS. Comparisons of periventricular device closure, conventional surgical repair, and transcatheter device closure in patients with congenital ventricular septal defects. Medicine (Baltimore), 2020, 99(4): e18901.
10.	Garg P, Kumar Bishnoi A, Lakhia K, et al. Transverse sternal split: A safe mini-invasive approach for perventricular device closure of ventricular septal defect. Braz J Cardiovasc Surg, 2017, 32(3): 184-190.
11.	Gan CP, Peng L, Liang ZL, et al. Percutaneous perventricular device closure of ventricular septal defect: From incision to pinhole. Ann Thorac Surg, 2017, 103(1): 172-177.
12.	Wu LY, Tanidir CI, Ye DT, et al. Hybrid transthoracic periventricular device closure of ventricular septal defects: Single- Center experience. Braz J Cardiovasc Surg 2021, 36(1): 48-56.
13.	Lun K, Li H, Leung MP, et al. Analysis of indications for surgical closure of subarterial ventricular septal defect without associated aortic cusp prolapse and aortic regurgitation. Am J Cardiol, 2001, 87: 1266-70.
14.	Pan S, Xing Q, Cao Q, et al. Perventricular device closure of doubly committed subarterial ventral septal defect through left anterior minithoracotomy on beating hearts. Ann Thorac Surg, 2012, 94: 2070-2075.
15.	Xing QS, 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): 1409-15.
16.	Adan A, Eleyan L, Zaidi M, et al. Ventricular septal defect: Diagnosis and treatments in the neonates: A systematic review. Cardiol Young, 2020, 17: 1-6.

1. Dr Penny DJ, Vick GW. Ventricular septal defect. Lancet, 2011, 377(9771): 1103-1112.
2. 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.
3. Song XY, Xing QS, Qin W, et al. Transthoracic device closure of Juxta arterial ventricular septal defects: Midterm follow-up results. Ann Thorac Surg, 2017, 104(3): 841-846.
4. 卢绪宁, 文平, 刘宇航, 等. 镶嵌治疗室间隔完整型肺动脉膜性闭锁及重度肺动脉瓣狭窄. 中华小儿外科, 2019, 40(9): 801-805.
5. Hong Z, Chen Q, Huang L, et al. A meta-analysis of perventricular device closure of perimembranous ventricular septal defect. J Cardiothorac Surg, 2019, 14: 119.
6. Wang SZ, Ouyang WB, Liu Y, et al. Transcatheter perimembranous ventricular septal defect closure under transthoracic echocardiographic guidance without fluoroscopy. J Thorac Dis, 2018, 10(9): 5222-5231.
7. 中国医师协会心血管外科医师分会. 经胸微创室间隔缺损封堵术中国专家共识. 中华胸心血管外科杂志, 2011, 27(9): 516-518.
8. You T, Yi K, Ding ZH, et al. Transcatheter closure, mini-invasive closure and open-heart surgical repair for treatment of perimembranous ventricular septal defects in children: A protocol for a network meta-analysis. BMJ Open, 2017, 7(6): e015642.
9. Li DX, Zhang Z, Li MS. Comparisons of periventricular device closure, conventional surgical repair, and transcatheter device closure in patients with congenital ventricular septal defects. Medicine (Baltimore), 2020, 99(4): e18901.
10. Garg P, Kumar Bishnoi A, Lakhia K, et al. Transverse sternal split: A safe mini-invasive approach for perventricular device closure of ventricular septal defect. Braz J Cardiovasc Surg, 2017, 32(3): 184-190.
11. Gan CP, Peng L, Liang ZL, et al. Percutaneous perventricular device closure of ventricular septal defect: From incision to pinhole. Ann Thorac Surg, 2017, 103(1): 172-177.
12. Wu LY, Tanidir CI, Ye DT, et al. Hybrid transthoracic periventricular device closure of ventricular septal defects: Single- Center experience. Braz J Cardiovasc Surg 2021, 36(1): 48-56.
13. Lun K, Li H, Leung MP, et al. Analysis of indications for surgical closure of subarterial ventricular septal defect without associated aortic cusp prolapse and aortic regurgitation. Am J Cardiol, 2001, 87: 1266-70.
14. Pan S, Xing Q, Cao Q, et al. Perventricular device closure of doubly committed subarterial ventral septal defect through left anterior minithoracotomy on beating hearts. Ann Thorac Surg, 2012, 94: 2070-2075.
15. Xing QS, 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): 1409-15.
16. Adan A, Eleyan L, Zaidi M, et al. Ventricular septal defect: Diagnosis and treatments in the neonates: A systematic review. Cardiol Young, 2020, 17: 1-6.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Minimally invasive experiences and medium-long-term results of perventricular device closure of ventricular septal defects in 783 children: A retrospective analysis in a single center

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