目的 观察和评价采用偏心型封堵器导管介入治疗干下型室间隔缺损的近期疗效和安全性。 方法 2011年8月－12月，6例经无主动脉瓣脱垂的干下型室间隔缺损（直径≤7 mm）患者（年龄＞3岁）在杂交手术室接受介入治疗。造影评估后，建立动静脉轨道，在保留导丝的情况下置入合适型号的国产偏心型室间隔缺损封堵器，并于术后定期随访复查。 结果 6例患者缺损直径4～7 mm（平均5.3 mm），其中5例成功地接受了导管介入封堵治疗，置入封堵器直径5～9 mm（平均6.4 mm）。仅1例因封堵器置入后出现主动脉瓣受压影响关闭，即改由外科微创经胸封堵成功。所有患者在随访期内，无栓塞、残余分流、瓣膜功能障碍、房室传导阻滞、死亡等并发症。 结论 无主动脉瓣脱垂的干下型室间隔缺损患者接受导管介入封堵治疗是安全、可行的，且短期随访结果良好。
ObjectiveTo summarize clinical results and experience of subarterial ventricular septal defect (sVSD) closure through a minimal right vertical infra-axillary incision in children, and evaluate the feasibility of this technique. MethodsClinical data of 27 sVSD patients who underwent surgical repair through a minimal right vertical infra-axillary incision from March 2009 to January of 2013 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. There were 20 male and 7 female patients with their age of 1.1-11.0 (4.4±2.8) years and body weight of 7.6-28.0 (14.6±5.3) kg. After induction of anesthesia, the patients were placed in a 90 degree left lateral position. The incision was performed along right midaxillary line vertically between the superior border of the third rib and inferior border of the fifth rib. The thoracic cavity was entered through the fourth intercostal space. The pericardium was opened 2 cm anterior to the phrenic nerve and suspended to elevate the heart and great vessels by the pericardial traction sutures. Cardiopulmonary bypass (CPB) was established after cannulation of the ascending aorta, superior vena cava and inferior vena cava. Closure of sVSD was performed through longitudinal pulmonary incision. After procedures under CPB finished, the aortic cannula was removed and the pericardium was closed with interrupted sutures. The thoracic drainage tube was placed through the sixth intercostal space. All the patients were followed up 3, 6 and/or 12 months after surgery. Satisfactory degree of the patients and their relatives were evaluated. Chest X-ray, electrocardiography and echocardiography were examined. ResultsSurgical repair of sVSD was performed in all the patients through this incision without any difficulty, incision prolongation or conversion to another incision. There was no in-hospital death, reexploration for bleeding, postoperative atelectasis, pulmonary infection, pleural effusion, impairment of central nervous system, phrenic nerve damage, poor wound healing, wound infection or pericardial effusion. Incision length was 4.4-7.0 (5.07±0.66) cm. Echocardiography before discharge showed no residual shunt in all the patients. All the patients were followed up 3, 6 and/or 12 months at the outpatient department or via the phone. During follow-up, there was no late death, residual shunt or chest asymmetry. The short incision under the armpit was obscured and provided favorable cosmetic results. All the patients and their relatives were satisfied with the cosmetic results. ConclusionRepair of sVSD through a minimal right vertical infra-axillary incision is feasible and safe for children. The advantages of this technique are favorable for children with sVSD.
Doubly committed sub-arterial ventricular septal defect (VSD) is a unique type of VSD which is located beneath both the aortic and pulmonary valve. Open-heart repair is traumatic especially for pediatric patient while trans-catheter device closure is also not suitable for this type of VSD. Minimally invasive per-ventricular device closure has been introduced as an alternative method in the treatment of doubly committed VSD with encouraging results. In the review, we will illustrate the surgical technique as well as perioperative management strategy as for this technique in treating doubly committed VSD.
ObjectiveTo summarize the application and clinical effect of left anterior minimally invasive thoracotomy to surgical repair of subarterial ventricular septal defect (VSD) in children.MethodsFrom October 2015 to April 2019, 21 children with subarterial VSD underwent surgical repair via left anterior minimally invasive thoracotomy. There were 13 males and 8 females, aged 5-13 (9.1±2.2) years, and weighing 22-55 (35.6±9.5) kg. The diameter of subarterial VSD was 4-15 (9.1±3.3) mm. Eight patients had right coronary valve prolapse, and 4 aortic valve regurgitation (3 mild and 1 mild-to-moderate). The minimally invasive surgery was performed via left parasternal thoracotomy through the second or third intercostal space. The peripheral perfusion was performed with femoral arterial and venous cannulation. After aortic cross-clamp (ACC), subarterial VSD was performed with direct suture of patch closure through an incision on the root of pulmonary artery.ResultsAll patients successfully underwent surgical repair (patch closure, n=15; direct suture, n=6) of subarterial VSD through left anterior minimally invasive thoracotomy. The cardiopulmonary bypass time was 45-68 (57.1±6.3) min. The ACC time was 23-40 (32.6±4.7) min. The postoperative ventilation time was 5-9 (6.3±1.3) h, postoperative in-hospital time was 5-8 (5.7±1.0) d and drainage volume was 33-105 (57.5±17.7) mL in postoperative 24 h. No death, residual VSD shunt, atrioventricular block, wound infection or thoracic deformity occurred during the perioperation or follow-up. Only one patient still had trivial aortic valve regurgitation.ConclusionLeft anterior minimally invasive thoracotomy could be safely and effectively applied to surgical repair of subarterial VSD in children, with satisfactory early- and mid-term outcomes.
ObjectiveTo evaluate the mid-term safety, efficacy and feasibility of perventricular device closure for subarterial ventricular septal defect.MethodsClinical data of 97 patients diagnosed with subarterial ventricular septal defect through echocardiography in West China Hospital from September 2013 to December 2015 were retrospectively analyzed. There were 66 males and 31 females aged 3 (1.8, 5.9) years. All the patients underwent perventricular device closure under the guidance of transesophageal echocardiography using eccentric occlusion device. Possible complications such as residual shunt, valvular regurgitation, atrioventricular conduction block and arrhythmias were recorded during the 1-year, 3-year and 5-year follow-up.ResultsAll the patients received perventricular device closure successfully except that 1 patient underwent open surgical repair under cardiopulmonary bypass 3 months later because of the migration of device. So the rate of complete closure was 99.0%. No residual shunt, moderate or severe valvular regurgitation, atrioventricular conduction block or arrhythmias were observed 5 years later.ConclusionTreating subarterial ventricular septal defect through perventricular device closure exhibits remarkable mid-term efficacy, safety and feasibility with high success rate.
ObjectiveTo analyze the clinical efficacy of right midaxillary straight incision surgery in the treatment of doubly committed subarterial ventricular septal defect. MethodsThe clinical data of children with doubly committed subarterial ventricular septal defect who received surgeries in our hospital from August 2020 to July 2023 were analyzed retrospectively. All the children underwent surgical repair and were divided into two groups according to the incision position, including a right midaxillary straight incision group and a median incision group. The outcomes were compared between the two groups. ResultsA total of 187 patients were enrolled. There were 102 patients in the right midaxillary straight incision group, including 55 males and 47 females with a median age of 26.0 (5.0, 127.0) months and a median weight of 12.5 (5.1, 32.8) kg at surgery. There were 85 patients in the median incision group, including 37 males and 48 females with a median age of 4.0 (2.0, 168.0) months and a median weight of 6.7 (4.8, 53.9) kg at surgery. No mortality occurred in the study. There was no statistical difference between the two groups in the cardiopulmonary bypass time (50.0±18.4 min vs. 46.1±15.7 min) or aortic cross-clamping time (31.3±18.6 min vs. 26.3±17.5 min) (P>0.05). Compared to the median incision group, the time from the end of cardiopulmonary bypass to the closure of chest (22.3±15.6 min vs. 37.1±13.4 min, P=0.001), postoperative hospital stay (6.9±3.9 d vs. 8.6±3.6 d, P=0.002), the length of incision (4.3±2.7 cm vs. 8.5±3.2 cm, P=0.001), drainage volume (79.0±32.2 mL vs. 100.2±43.1 mL, P=0.001), and the pain score on the 2nd and the 3rd day after the operation were statistically better in the right midaxillary straight incision group (P<0.05). The medical experience and incision satisfaction scores at discharge were higher than those in the median incision group (P<0.05). During the follow-up of 21.0 (1.0, 35.0) months, no residual shunt was detected and all patients in both groups had a normal cardiac function and mild or less valve regurgitation. ConclusionCompared to the median incision, minimally invasive right midaxillary straight incision is equally safe and reliable in the treatment of doubly committed subarterial ventricular septal defect with the advantages of cosmetic and fast recovery.