Fu Xingpeng,Ye Jingjing,Yu Jin,et al.Comparative analysis of perimembranous and high ventricular septal defects closure via an ultra-minimal trans-intercostal incision guided by transesophageal echocardiography in children[J].Journal of Clinical Pediatric Surgery,,22():412-418.[doi:10.3760/cma.j.cn101785-202212030-003]
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Comparative analysis of perimembranous and high ventricular septal defects closure via an ultra-minimal trans-intercostal incision guided by transesophageal echocardiography in children

Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R] volume: 第22卷 Number: 2023 05 Page: 412-418 Column: 专题 Date of publication: 2023-05-28
Author(s):
Fu Xingpeng1;  Ye Jingjing1;  Yu Jin1;  Zhang Zewei2;  You Hairong1;  Tan Linhua3
1 Department of Ultrasonography, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China;
2 Department of Cardiac Surgery, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China;
3 Department of Surgical Intensive Care Unit, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
Keywords:
Heart Septal Defects;  Ventricular; Septal Occluder Device; Ultrasonography;  Doppler; Surgical Procedures;  Operative; Child
DOI:
10.3760/cma.j.cn101785-202212030-003
Abstract:
Objective To explore the characteristics and prognoses of perimembranous and high ventricular septal defects (VSD) closure via a ultra-minimal trans-intercostal incision (i.e.left parasternal intercostal ultra-minimal incision≤1 cm) in children guided by transesophageal echocardiography (TEE) and provide references for such mini-invasive surgery.Methods From January 2015 to December 2021,344 cases of VSD closure via a left parasternal ultra-minimal trans-intercostal incision in children guided by TEE.According to the location of VSD,they were divided into two groups of perimembranous VSD (239/344,69.5%) and high VSD (outflow tract & high membrane)(105/344,30.5%).Operative procedures,operative duration,postoperative complications,prognoses and other relevant data of two groups were compared.Results Among them,229 cases (229/239,95.8%) of perimembranous VSD and 100 cases (100/105,95.2%) of high VSD were successfully occluded.No significant difference existed in success rate (P>0.05).However,operative duration of perimembranous VSD was longer than that of high VSD (P<0.05).In both groups,diameter of VSD was correlated positively with diameter of occluder,but not with operative duration.Among 239 cases of perimembranous VSD and 105 cases of high VSD,12 cases (12/239,5.0%) and 5 cases (5/105,4.8%) were successfully re-occluded after adjusting or replacing occluder.No significant inter-group difference existed in success rate of re-occlusion (P>0.05).A total of 10 children in perimembranous VSD group failed to occlude,including 7 cases (7/239,2.9%) in which guide wire could not pass through VSD,2 cases (2/239,0.8%) in which occluder slipped off and 1 case of ventricular fibrillation.There were 5 cases of occlusion failure in high VSD group,including 1 case in which guide wire could not pass through VSD during operation (1/105,1.0%),1 case with occluder displacement during operation and 1 case post-operation (2/105,1.9%),1 case with aggravation of aortic regurgitation and 1 case with marked decrease in blood pressure.There was no significant inter-group difference in failure rate when guide wire could not pass through VSD and occluder slipped off or shifted(P>0.05).During a follow-up period of (1-4) days in perimembranous VSD group,there were 1 case of mild mitral regurgitation and 4 cases of mild-to-moderate tricuspid regurgitation.No change occurred during 6-month follow-ups.During a follow-up period of (1-4) days in high VSD group,one case developed right ventricular outflow tract obstruction and flow velocity declined during 6-month follow-ups.There were residual slight shunt (n=19),pericardial effusion (n=19) and pleural effusion (n=4) in two groups.They were self-cured during 6-month follow-ups.Conclusion Through a ultra-minimal trans-intercostal incision guided by TEE,perimembranous and high VSD closure offers a high success rate and an excellent postoperative recovery in children.Although operative duration of high VSD is shorter,diameter of VSD is not a sole influencing factor of operative duration.

References:

[1] 俞劲,蒋国平,叶菁菁.28772例先天性心脏病超声心动图诊断分析[J].中华流行病学杂志,2011,32(5):523-524.DOI:10.3760/cma.j.issn.0254-6450.2011.05.023. Yu J,Jiang GP,Ye JJ.Diagnosing congenital heart disease by echocardiography:a report of 28772 cases[J].Chin J Epidemiol,2011,32(5):523-524.DOI:10.3760/cma.j.issn.0254-6450.2011.05.023.
[2] Yu J,Ma LL,Ye JJ,et al.Doubly committed ventricular septal defect closure using eccentric occluder via ultraminimal incision[J].Eur J Cardiothorac Surg,2017,52(4):805-809.DOI:0.1093/ejcts/ezx269.
[3] 俞劲,施旭聪,张泽伟,等.食管超声引导下经肋间超微切口封堵小儿膜周部室间隔缺损[J].中华胸心血管外科杂志,2017,33(7):400-403.DOI:10.3760/cma.j.issn.1001-4497.2017.07.005. Yu J,Shi XC,Zhang ZW,et al.Perimembranous ventricular septal defect performed super mini-invasive trans-intercostal device closure under the guidance of transesophageal echocardiography in children[J].Chin J Thorac Cardiovasc Surg,2017,33(7):400-403.DOI:10.3760/cma.j.issn.1001-4497.2017.07.005.
[4] 俞劲,叶菁菁,张泽伟,等.经食管超声在经左侧肋间小切口封堵小儿高位室间隔缺损中的应用价值[J].中华超声影像学杂志,2019,28(10):849-853.DOI:10.3760/cma.j.issn.1004-4477.2019.10.004. Yu J,Ye JJ,Zhang ZW,et al.Application of transesophageal echocardiography in high ventricular septal defect closure via a small intercostal incision with eccentric occluder in children[J].Chin J Ultrasonogr,2019,28(10):849-853.DOI:10.3760/cma.j.issn.1004-4477.2019.10.004.
[5] 高强,马良龙,张泽伟,等.肋间超微创切口封堵干下型室间隔缺损[J].中华胸心血管外科杂志,2021,37(12):725-728.DOI:10.3760/cma.j.cn112434-20201209-00532. Gao Q,Ma LL,Zhang ZW,et al.Closing doubly committed ventricular septal defect through a super-minimal intercostal incision[J].Chin J Thorac Cardiovasc Surg,2021,37(12):725-728.DOI:10.3760/cma.j.cn112434-20201209-00532.
[6] Gao Z,Yu J,Zhang ZW,et al.Perimembranous ventricular septal defect closure via ultra-minimal trans intercostal incision in children[J].J Card Surg,2021,36(9):3131-3137.DOI:10.1111/jocs.15760.
[7] Gao Q,Jin J,Zhang ZW,et al.A study on eccentric occluder via ultra minimal incision of doubly committed subarterial ventricular septal defects[J].J Card Surg,2021,36(6):2055-2060.DOI:10.1111/jocs.15484.
[8] Yu J,Ye JJ,Zhang ZW,et al.Value of transesophageal echocardiography in device closure of perimembranous ventricular septal defects in children via ultra-minimal trans intercostal incision[J].J Card Surg,2022,37(5):1171-1179.DOI:10.1111/jocs.16311.
[9] 陈妙月,陈沅,李谧,等.小儿室间隔缺损3种不同手术方式的对比分析[J].重庆医科大学学报,2013,38(8):896-900.DOI:10.11699/cyxb20130819. Chen MY,Chen Y,Li M,et al.Comparing three procedures for treating ventricular septal defects in children[J].J Chongqing Med Univ,2013,38(8):896-900.DOI:10.11699/cyxb20130819.
[10] 邢泉生,泮思林,武钦,等.经胸微创非体外循环下封堵室间隔缺损:多中心经验和近中期随访结果[J].中华胸心血管外科杂志,2011,27(5):259-263.DOI:10.3760/cma.j.issn.1001-4497.2011.05.002. Xing QS,Pan SL,Wu Q,et al.Mini-invasive perventricular VSD closure without cardiopulmonary bypass mid-term results from multi-centers[J].Chin J Thorac Cardiovasc Surg,2011,27(5):259-263.DOI:10.3760/cma.j.issn.1001-4497.2011.05.002.
[11] 邢泉生,任悦义,段书华,等.经胸微创非体外循环下封堵膜部室间隔缺损[J].中国胸心血管外科临床杂志,2010,17(5):365-369. Xing QS,Ren YY,Duan SH,et al.Mini-invasive transthoracic closure of perimembranous ventricular septal defect without cardiopulmonary bypass[J].Chin J Clin Thorac Cardiov Surg,2010,17(5):365-369.
[9] 符芳永,胡世军,卜海松,等.经胸封堵先天性室间隔缺损临床疗效[J].中国临床研究,2018,31(3):326-330.DOI:10.13429/j.cnki.cjcr.2018.03.009. Fu FY,Hu SJ,Bu HS,et al.Clinical efficacy for transthoracic closure of congenital ventricular septal defect[J].Chin J Clin Res,2018,31(3):326-330.DOI:10.13429/j.cnki.cjcr.2018.03.009.
[10] Fang J,Xie SB,Ma LC,et al.Anatomic and surgical factors affecting the Switch from minimally invasive transthoracic occlusion to open surgery during ventricular septal defect repair[J].J Thorac Dis,2018,10(2):749-756.DOI:10.21037/jtd.2018.01.47.
[11] 刘垚,欧阳文斌,逄坤静,等.改良切口经胸微创封堵术治疗膜周室间隔缺损[J].中华小儿外科杂志,2016,37(2):81-84.DOI:10.3760/cma.j.issn.0253-3006.2016.02.001. Liu Y,Ouyang WB,Pang KJ,et al.Mini-invasive perventricular device closure of perimembranous ventricular septal defects via a modified skin approach[J].Chin J Pediatr Surg,2016,37(2):81-84.DOI:10.3760/cma.j.issn.0253-3006.2016.02.001.
[12] Yu J,Shi Z,Qian JJ,et al.Analysis and comparison of failure causes of minimally invasive surgical closure of ventricular septal defects in children[J].World J Pediatr Surg,2022,6(1):e000432.DOI:10.1136/wjps-2022-000432.
[13] 刘凌,刘君,高磊,等.膜周部室间隔缺损合并三尖瓣中、重度反流行介入治疗的疗效分析[J].中国循环杂志,2021,36(1):69-73.DOI:10.3969/j.issn.1000-3614.2021.01.013. Liu L,Liu J,Gao L,et al.Effect analysis of interventional therapy for perimembranous ventricular septal defect with moderate/severe tricuspid regurgitation[J].Chin Circul J,2021,36(1):69-73.DOI:10.3969/j.issn.1000-3614.2021.01.013.
[14] 刘凌,陈屿,郑庆厚,等.合并三尖瓣中重度反流的膜周部室间隔缺损介入封堵疗效评价[J].河北医科大学学报,2021,42(6):637-640.DOI:10.3969/j.issn.1007-3205.2021.06.004. Liu L,Chen Y,Zheng QH,et al.Evaluations of therapeutic effect of interventional occlusion for perimembranous ventricular septal defect with moderate-to-severe tricuspid regurgitation[J].J Hebei Med Univ,2021,42(6):637-640.DOI:10.3969/j.issn.1007-3205.2021.06.004.
[15] Hu GB,Zhu XM,Song F.Aortic valve prolapse misdiagnosed as aortic sinus aneurysm in patients with ventricular septal defect.Analysis of the echocardiographic findings[J].Saudi Med J,2017,38(4):431-434.DOI:10.15537/smj.2017.4.18761.
[16] Zhang S,Zhu D,An Q,et al.Minimally invasive perventricular device closure of doubly committed sub-arterial ventricular septal defects:single center long-term follow-up results[J].J Cardiothorac Surg,2015,10:119.DOI:10.1186/s13019-015-0326-6.

Memo

收稿日期:2022-12-13。
基金项目:浙江省公益技术应用研究项目(LGF22H180002)
通讯作者:谈林华,Email:chtlh@zju.edu.cn

Last Update: 1900-01-01