Detachment of the septal tricuspid leaflet during transatrial closure of isolated ventricular septal defect

Frenckner, B.; Olin, Christian; Bomfim, Vollmer; Bjarke, B.; Wallgren, C. Göran; Björk, Viking Olov

doi:10.1016/s0022-5223(19)39276-1

Cited by 25 publications

(6 citation statements)

References 3 publications

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“…Since then, some other groups have recommended this technique as it is regarded as reliable and easy to perform. [2,3] If septal leaflet detachment does not provide proper exposure or the tissue around the defect has chordal attachments which obscure the margins, chordal detachment can be done concomitantly. Kapoor et al [4] described this technique and reported good results.…”

Section: Discussionmentioning

confidence: 99%

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The chordal detachment method in a ventricular septal defect repair operation

Şahin¹

2012

Turk Gogus Kalp Dama

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Ventriküler septal defekt (VSD), tipik olarak genellikle perimembranöz tip olan VSD'lerin belirlenmesi ve tamirinde iyi bir görüş sağlayan transatriyal yaklaşım ile tamir edilir. Fibroz ve kordal yapışıklıklar lezyonu çevreleyebilir ve bu anormal yapılar VSD'lere ulaşmayı güçleştirebilir. Bu yazıda, perimembranöz tip VSD'si olan ve defektin triküspid septal yaprakcık ve çok kalın pek çok kordal yapışıklıklarla çevrelendiği bir olgu sunuldu. Kordal yapışıklıklar dikkatle diseke edildi ve VSD başarılı bir şekilde ortaya çıkarıldı. Defekt, Gore-Tex yama kullanılarak tamir edildi. Anah tar söz cük ler: Kordal ayrışma; ventriküler septal defekt tamiri. Ventricular septal defect (VSD) is typically repaired via a transatrial approach, which usually provides a good exposure for the assessment and repair of VSDs, generally the perimembranous type. Fibrosis and chordal fusion may surround the lesion, and these malstructures may compromise to reach VSDs. In this article, we present a case with the perimembraneous-type of VSD surrounded by a tricuspid septal leaflet and many thick chordal attachments. The attachments were carefully dissected, and the VSD was successfully exposed. The defect was then repaired using a Gore-Tex patch.

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Section: Discussionmentioning

confidence: 99%

“…[1,2] This procedure has been proven to be safe in various clinical studies. [2,3] In some cases, the VSD may be heavily fibrotic or accompanied by chordal attachments. The chorda tendinea may fuse and thicken, probably because of high blood flow or infective episodes.…”

mentioning

confidence: 99%

The chordal detachment method in a ventricular septal defect repair operation

Şahin¹

2012

Turk Gogus Kalp Dama

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“…Although several reports confirmed the safety of the technique, it was not widely followed, possibly because of fear of postoperative tricuspid regurgitation. [3][4][5][6][7] An alternative technique of detaching the chordae to improve exposure and reattaching them after closure of the VSD has been described. 8 However, we feel that detachment of the leaflet at its annulus is less risky than trying to reattach the delicate chordae, especially in infants.…”

Section: Discussionmentioning

confidence: 99%

Tricuspid Valve Detachment for Transatrial Closure of Ventricular Septal Defects

Koshy¹,

Sunil²,

Anil

et al. 2002

Asian Cardiovasc Thorac Ann

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Tricuspid leaflet detachment improves visualization and accuracy of closure of ventricular septal defects via the transatrial route. Between July 1998 and March 2001, surgical correction was performed in 296 cases of isolated ventricular septal defect, 215 cases of tetralogy of Fallot, and 16 cases of double-outlet right ventricle. Of these, 132 patients (79 with isolated ventricular septal defect, 49 with tetralogy of Fallot, and 4 with double-outlet right ventricle) underwent transatrial repair with temporary detachment of tricuspid leaflets for ventricular septal defect closure. The septal leaflet was detached in most cases, with anterior or posterior leaflets being detached when indicated. Median duration of intensive care was 3.6 days, and median hospital stay was 7 days. There was no incidence of tricuspid regurgitation attributable to leaflet detachment, as confirmed by postoperative echocardiography. Reoperation was not required for a residual defect or tricuspid regurgitation. The benefits of temporary leaflet detachment for transatrial repair of various difficult defects far outweigh the risk of postoperative tricuspid regurgitation.

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“…The impact of TVD on valve function and postoperative morbidity has been investigated at short-term follow-up in multiple previous studies [2,3,8], but few have investigated this impact at long-term follow-up. Although limited by its retrospective design, this study shows that TVD can be utilized to improve VSD visualization with low morbidity and no significant impact on long-term valve function compared with traditional VSD repair.…”

Section: Commentmentioning

confidence: 99%

“…However, in some cases, the chordal attachments and leaflets of the triscuspid valve (TV) may impair visualization of the entirety of VSD margins. Therefore, as has been described in previous studies, annular detachment of the TV can be employed as a method to improve intraoperative visualization of perimembranous VSDs that are difficult to visualize entirely due to valvular obstruction [1][2][3]. Partial TV detachment (TVD) improves visualization and also may obviate the need for excessive valve retraction necessary to achieve a complete repair, as this may result in injury to the valve and postoperative dysrhythmias.…”

mentioning

confidence: 99%