New Minimally Invasive Technique of Perpulmonary Device Closure of Patent Ductus Arteriosus Through a Parasternal Approach

Li, Hongxin; Guo, Wei; Zhu, Mei; Liang, Fei; Zhang, Wenlong; Mujahid, Haroon

doi:10.1016/j.athoracsur.2011.12.017

Cited by 10 publications

(8 citation statements)

References 10 publications

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“…The delivery system (Starway Medical Technology, Inc., Beijing, China) includes a long and short plastic sheath with a sidearm and a delivery cable, which is available in size of 7F to 14F [5–8]. The dilating sheath was used as a guiding sheath to cross the defect selectively in some patients.…”

Section: Methodsmentioning

confidence: 99%

Device closure of diverse layout of multi-hole secundum atrial septal defect: different techniques and long-term follow-up

Farhaj

Guo

et al. 2019

J Cardiothorac Surg

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Background There are no unanimous reports on different layouts and classifications of multi-hole secundum atrial septal defects (MHASD) and subsequent standardized occlusion techniques. The MHASD can be isolated or cribriform with variable inter-defects distance. In this retrospective study, experience-based classification and two approaches-based occlusion results are presented. Methods We retrospectively collected and analyzed data of 150 MHASD patients from 1320 patients who underwent atrial septal defect occlusion in our institute. The MHASD patients were categorized into 4 types; type A, B, C and D and occluded under exclusive transesophageal echocardiographic guidance. According to different types, 122 patients were occluded using peratrial approach and 28 patients via percutaneous approach. In type A, single device implantation is performed to occlude the large hole and squeeze the small one. For type B single or double-device deployment was performed depending on an inter-defects distance. In type C and D, a patent foramen-ovale (PF) device was selectively positioned to the central defect to occlude the central defect and cover the peripheral ones. In peratrial approach, 8 patients underwent inter-defects septal puncture technique to achieve single-device occlusion. The intracardiac manipulation time, procedural time, double device deployment, redeployment rate, residual shunt, and proportions were analyzed between (and within peratrial technique) two techniques. Results Successful occlusion was achieved in all 150 patients. Single device occlusion was applied in 78/84 type A and 22/37 type B patients ( p < 0.05). Double device occlusion was more applicable to type B than A patients ( p < 0.01). Sixteen of 21 type C and all type D patients used PF device for a satisfactory occlusion. Redeployment of the device occurred frequently in type B patients than A ( p < 0.01). The intracardiac manipulation time and procedural time were shorter in type A than B ( p < 0.05). The intracardiac manipulation time was also shortened in type A peratrial than type A percutaneous group ( p < 0.05). Complete occlusion rate for all patients at discharge was 70% and rose to 82% at 1 year follow up. Conclusions The diverse layouts and classification of MHASDs can help to choose different techniques and proper devices of different kinds to achieve better occlusion results.

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Section: Methodsmentioning

confidence: 99%

Device closure of diverse layout of multi-hole secundum atrial septal defect: different techniques and long-term follow-up

Farhaj

Guo

et al. 2019

J Cardiothorac Surg

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“…Thus, both conventional surgical treatment and percutaneous occlusion have their advantages and disadvantages ( 12 , 13 ). In recent years, numerous cardiac surgery centers have experimented with minimally invasive transthoracic occlusion, combining the features of both percutaneous occlusion and surgical treatment ( 14 , 15 ). Transthoracic occlusion avoids the need for cardiopulmonary bypass and allows for rapid postoperative recovery.…”

Section: Discussionmentioning

confidence: 99%

Clinical study of stand-alone transthoracic echocardiography-guided percutaneous occlusion of patent ductus arteriosus

Cao

Chen²,

Zhang³

et al. 2018

Anatol J Cardiol

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Objective:We aimed to investigate the feasibility and safety of stand-alone transthoracic echocardiography-guided percutaneous occlusion of patent ductus arteriosus (PDA) without the use of X-ray equipment.Methods:From January to December 2015, we performed stand-alone transthoracic echocardiography-guided percutaneous PDA occlusion using an occluder delivered via a delivery sheath introduced via femoral vein access without the use of X-ray equipment in 12 PDA patients.Results:PDA occlusion was successfully performed in all 12 patients. The procedure duration ranged from 30 to 110 min (50.4±22.8 min), and the size of the implanted occluder ranged from 12 to 20 mm (15.2±2.8 mm). No occluder migration, residual shunt, or thrombotic complications were observed in the perioperative period. There was no clinical death, hemolysis, infection, or embolism during patients’ hospitalization and the follow-up period.Conclusion:Stand-alone transthoracic echocardiography-guided percutaneous PDA occlusion without the use of X-ray equipment is a safe and effective procedure.

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“…(1) Because the parasternal approach provides better operative exposure in pediatric than in adult patients, the ICMT ( p > 0.05) and procedural time ( p < 0.01) were shorter in the younger than in the older age group. (2) The incision cannot be made too close to the left border of the sternum to avoid injuring the left internal mammary artery [ 18 ]. The exact location of the incision is determined according to the chest film and TTE.…”

Section: Discussionmentioning

confidence: 99%

Perventricular device closure of a doubly committed juxtaarterial ventricular septal defect through a left parasternal approach: midterm follow-up results

Guo

Liang

et al. 2015

J Cardiothorac Surg

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BackgroundIt is infeasible to occlude a doubly committed juxtaarterial ventricular septal defect (DCVSD) percutaneously. The previous perventricular device closure technique was performed through an inferior median sternotomy approach. The purpose of this study is to evaluate the feasibility, safety and efficacy of perventricular device closure of DCVSDs through a left parasternal approach.MethodsSixty-two patients, with the DCVSD of less than 6 mm in diameter, were enrolled in this study. The pericardial space was approached through a left parasternal mini-incision without entering into the pleural space. Two parallel pursestring sutures were placed on the right ventricular outflow tract for puncture. Under transesophageal echocardiographic guidance, a new delivery sheath loaded with the device was inserted into the right ventricle and advanced through the defect into the left ventricle. The device, connected with a device stay suture, was deployed subsequently.ResultsSuccessful device closure of the defects was achieved in 58/62 patients (94 %). The DCVSD failed to close in 4 (6 %) patients due to device-related aortic regurgitation and device migration. The mean DCVSD diameter was 3.4 ± 1.0 mm (range, 2.0 to 6.0 mm). The implanted device size was 5.2 ± 1.3 mm (range, 4 to 8 mm). Forty-four out of 58 patients (76 %) was implanted with an eccentric occluder. The mean intracardiac manipulation time was 14 ± 13 min (range, 2 to 60 min). The procedure time was 66 ± 15 min (range, 42 to 98 min). During the follow-up period of 180 to 1860 (median 880) days, new mild pulmonary regurgitation occurred in 2 patients. No other device-related complications were found. The complete closure rate was 95 % at discharge, 98 % at 1-, 6- and 12-month, 96 % at 2-year, and 100 % at 3-year follow-up.ConclusionsPerventricular device closure of a DCVSD through a left parasternal approach is feasible, safe, and efficacious in selected patients. This minimally invasive technique permits easy defect crossing and accurate device positioning.

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New Minimally Invasive Technique of Perpulmonary Device Closure of Patent Ductus Arteriosus Through a Parasternal Approach

Cited by 10 publications

References 10 publications

Device closure of diverse layout of multi-hole secundum atrial septal defect: different techniques and long-term follow-up

Device closure of diverse layout of multi-hole secundum atrial septal defect: different techniques and long-term follow-up

Clinical study of stand-alone transthoracic echocardiography-guided percutaneous occlusion of patent ductus arteriosus

Perventricular device closure of a doubly committed juxtaarterial ventricular septal defect through a left parasternal approach: midterm follow-up results

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