Minimally invasive perventricular device closure of ventricular septal defect in infants under transthoracic echocardiograhic guidance: feasibility and comparison with transesophageal echocardiography

Abstract

BackgroundA hybrid approach to minimally invasive perventricular closure of VSD in infants is safe and effective, and has been performed under guidance of transesophageal echocardiography (TEE). We applied transthoracic echocardiographic (TTE) guidance to this hybrid approach, and compare results guided by TTE with those by TEE.MethodsFrom January 2011 to January 2012, 71 infants with VSD were enrolled to undergo a minimally invasive device closure. After evaluation of VSD by TTE, either TEE or TTE was used to guide the minimally invasive device closure. 30 patients had TEE guidance, and 41 patients had TTE. All patients were followed for 3 months after the operation.ResultsThe TEE group had a success rate of 93.3% (28/30) for device implantation, compared with 92.7% (38/41) in the TTE group. Two patients in the TEE group turned to surgical closure, one for involvement of the inlet area of VSD demonstrated by TEE, another for moderate aortic regurgitation after device implantation. Two patients in the TTE group also transferred to surgical closure, one for residual shunt, another for failure of the floppy wire across the defect. In addition, one patient in the TTE group experienced dropout of the occluder one day postoperatively. At 3-month follow-up, one patient had mild aortic regurgitation in the TEE group and in two patients in the TTE group. There were no episodes of cardiac block, thromboembolism, or device displacement in either group.ConclusionsTTE-guided VSD closure is feasible in infants, with results similar to those of TEE guidance, although caution is advisable.

Effects of transthoracic device closure on ventricular septal defects and reasons for conversion to open-heart surgery: A meta-analysis

“…A total of 108 articles were written in Chinese 5,12,26–29,31,32,36–43,46,70–132,134–159,174,175 , whereas 58 articles were written in English 4,6,11,25,30,33–35,44,45,47–69,133,160–163,165–173,176–186 , and the remaining article was written in Portuguese 164 . All trials were published between 1998 and 2016.…”

“…This procedure-related complication may be caused by a lack of experience with TTDC. In another study of the increasing risk of post-operative arrhythmia with TTDC 33 , all cases of post-operative transient sinus or superventricular arrhythmia were reversed to a sinus rhythm within 48-72 h after surgery. This finding may be attributable to early procedure-related inflammation or the limited number of cases in the TTDC group.…”

“…4 and a case-control study by Hu et al . 33 did not include limitations regarding the position and size of the VSD or other specific clinical conditions. In the study by Hu et al .…”

Transthoracic closure of atrial septal defect and ventricular septal defect without cardiopulmonary bypass

“…The transcatheter approach eliminates the trauma of CPB and has advantages such as producing small wounds, quicker recovery, less pain, shorter hospital stay, and a high cure rate. However, with this approach, the conveyor passes through many important structures of heart over a long distance, potentially causing vascular injury (Xing et al, 2011;Zhang et al, 2013) and leakage. Moreover, it is harmful for patients and surgeons to be exposed to X-rays for a long time, especially children (Hu et al, 2009).…”

Penutupan Defek Septum Ventrikel Secara Transtorakalis Minimal Invasif dengan Panduan Transesophageal Echocardiography (TEE)

“…Metode ini memiliki banyak keuntungan antara lain: tidak terdapat komplikasi potensial akibat pemakaian mesin cardiopulmonary bypass (CPB), trauma pembedahan minimal, lama perawatan lebih singkat, dan insisi pembedahan lebih kecil sehingga nyeri pascaoperasi lebih rendah serta masa pemulihan lebih cepat. [4][5][6][7][8] Suatu uji perbandingan terhadap 80 pasien di China menunjukkan hasil jangka pendek metode minimal invasif lebih baik dibanding dengan metode konvensional, meskipun untuk hasil jangka panjang efektivitas metode ini masih harus dikonfirmasi lebih lanjut.…”