SHEN Sheng,JIA Bing,CHEN Zhang-gen,et al.Treatment experience of Hybrid Approaches for Eighteen Children with Muscular Ventricular Septal Defects[J].Journal of Clinical Pediatric Surgery,,12():132-134.[doi:10.3969/j.issn.1671— 6353.2013.02.017]
Treatment experience of Hybrid Approaches for Eighteen Children with Muscular Ventricular Septal Defects
- Abstract:
- Objetive The purpose of this study is to describe our experience in hybrid approaches for the management of muscular ventricular septal defects( mVSDs)in infants. Methods From Jan 2010 to July 2012, we used hybrid approaches in 18 patients with mVSDs( 11 male and 7 female). Seventeen of the patients aged 1 to 17 months( mean, 10.8 months)with a mean weight of 8.9 kg( 4.8～11 kg ), and the other one aged at 9 years old. Two of the patients had multiple mVSDs( one male and one female)and the other had only one mVSDs. We made an incision and opened the middle and lower 1/3 of the sternum, did purse-string suture. We introduced a guide wire sheath to occlude the mVSDs. All patients did transthoracic echocardiography before discharge and did follow-up at out-patient department. Results We occlude the biggest mVSDs in two multiple mVSDs patients and each patient used only one occluder.Mean VSD diameter was 6.6 mm(4 to 12 mm). Esophageal ultrasonography found no marked residual shunt influencing heart function.No patient died during the procedure.The patients were follow ed up for 3 months to 1 years, during which none of them died.Tiny defect at the apex cord were found in the two multiple mVSDs patients. None of the patients had abnormal cardiac function afterwards. Conclusions Hybrid VSD device placement under direct vision for closure of mVSDs is more feasible and effective procedure with low rate of residual shunts and better cardiac function, which are common complications of traditional surgery, and thus is an ideal option for infant patients especially those with low weight babies.
References:
1 Kitagawa T, Durham LA III, Mosca RS, et al.Technique and results in the management of multiple ventricular septal defects[J]. J Thorac Cardiovasc Surg,1998,115:84 8— 856. 2Bacha EA, Cao QL, Starr JP, et al.Perventricular device closure of muscular ventricular septal defects on the beating heart: Technique and results[J]. J Thorac Cardiovasc Surg,2003,126:171 8— 1723. 3Kirklin JK, Castaneda AR, Keane JF, et al.Surgical management of multiple ventricular septal defects[J]. J Thorac Cardiovasc Surg, 1980,80:48 5— 493. 4Wollenek G, Wyse R, Sullivan I, et al.Closure of muscular ventricular septal defects through a left ventriculotomy[J]. Eur J Cardiothorac Surg,1996,10:59 5— 598. 5Mace L, Dervanian P, Bret EL, et al.“Swiss cheese” septal defects: Surgical closure using a single patch with intermediate fixings[J]. Ann Thorac Surg,1999,67:175 4— 1759. 6Kapoor L, Gan MD, Das MB, et al.Technique to repair multiple muscular ventricular septal defects[J]. J Thorac Cardiovasc Surg,1999,117:40 2— 404. 7Bacha EA, Marshall AC, Mc Elhinney DB, et al.Expand ing the hybrid concept in congenital heart surgery[J]. Sem in Thorac Cardiovasc Surg Pediatr Card Surg Ann, 2007, 10: 14 6— 150. 8Bacha EA, Hijazi ZM. Hybrid procedures in pediatric cardiacsurgery[J]. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann, 2005, 8: 7 8— 85. 9Bacha EA Cao,QL,Galantowicz ME,et al.Multicenter Experience with Perventricular Device Closure of Muscular Ventricular[J]. Pediatr Cardiol,2005,26:16 9— 175. 10Li F,Chen M,Qiu Z,et al.A new minimally invasive technique to occlude ventricular septal defect using an occluder device[J]. Ann Thorac Surg, 2008, 85:106 7— 1071.