Ventricular Septal Dysfunction After Surgical Closure of Multiple Ventricular Septal Defects

Matsuhisa, Hironori; Yoshimura, Naoki; Higuma, Tomonori; Misaki, Takuro; Onuma, Yoshiko; Ichida, Fukiko; Oshima, Yoshihiro; Okita, Yutaka

doi:10.1016/j.athoracsur.2013.05.013

Cited by 21 publications

(22 citation statements)

References 17 publications

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“…Various imaging techniques have proven their value for intraoperative identification of the defects. Either cross‐sectional or three‐dimensional color Doppler echocardiography, including transesophageal imaging, and echocardiographic en‐face reconstruction of the right ventricular septal surface, have emerged as superior diagnostic modalities 1–72 …”

Section: Resultsmentioning

confidence: 99%

“…The causes of death were due to intractable pulmonary hypertensive crises, residual defects, and congestive cardiac failure. The requirement of reoperation for residual defects has been between 6% and 13%, with a reoperative mortality of around 33% 1–15,29–62 . The STS Congenital Heart Surgery Spring 2017 Database provides results from 116 participating centers on 7322 operations for ventricular septal defects over 4 years with mean operative mortality of 0.6%, mean cardiopulmonary bypass time of 77 min, and cross‐clamp time of 49 min 29–32 .…”

Section: Resultsmentioning

confidence: 99%

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A review of the therapeutic management of multiple ventricular septal defects

Chowdhury

Anderson

Spicer

et al. 2022

Journal of Cardiac Surgery

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Background and Aim We showed in our anatomical review, ventricular septal defects existing as multiple entities can be considered in terms of three major subsets. We address here the diagnostic challenges, associated anomalies, the role and techniques of surgical instead of interventional closure, and the outcomes, including reinterventions, for each subset. Methods We reviewed 80 published investigations, noting radiographic findings, and the results of clinical imaging elucidating the location, number, size of septal defects, associated anomalies, and the effect of severe pulmonary hypertension. Results Overall, perioperative mortality for treatment of residual multiple defects has been cited to be between 0% and 14.2%, with morbidity estimated between 6% and 13%. Perioperative mortality is twice as high for perimembranous compared to muscular defects, with the need for reoperation being over four times higher. Perventricular hybrid approaches are useful for the closure of high anterior or apical defects. Overall, the results have been unsatisfactory. Pooled data reveals incidences between 2.8% and 45% for device‐related adverse events. Currently, however, outcomes cannot be assessed on the basis of the different anatomical subsets. Conclusions We have addressed the approaches, and the results, of therapeutic treatment in terms of coexisting discrete defects, the Swiss‐cheese septum, and the arrangement in which a solitary apical muscular defect gives the impression of multiple defects when viewed from the right ventricular aspect. Treatment should vary according to the specific combination of defects.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A review of the therapeutic management of multiple ventricular septal defects

Chowdhury

Anderson

Spicer

et al. 2022

Journal of Cardiac Surgery

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“…Because of all these considerations, some argue that the risks, in the long-term, are unacceptable, since they include apical dyskinesia, aneurysm formation, left ventricular dysfunction, ventricular arrhythmia, and the need for cardiac transplantation. 2,[30][31][32][57][58][59][60][61]65,66 The mechanisms identified that result in left ventricular dysfunction and aneurysm formation have included damage to epicardial coronary arteries, the myocardium, and the left ventricular conduction system. 11,58,60,61 It is also the case that the precise anatomic location and orientation of the ventriculotomy has great impact on the results.…”

Section: Discussionmentioning

confidence: 99%

“…[19][20][21][22][23][24][25][26][27][28][51][52][53][54][55] Orthotopic cardiac transplantation Cardiac transplantation has been recommended for extremely large apical septal defects with severe biventricular dysplasia, and persistent ventricular dysfunction following closure of Swiss-cheese septal defects through apical left ventriculotomy. 6,8,[29][30][31][32]41,42,47,[56][57][58][59][60]…”

Section: Hybrid Closure Of Multiple Apical Muscular Septal Defectsmentioning

confidence: 99%

“…Although favorable short-and long-term results have been reported by some investigators, others have reported left ventricular dysfunction apical aneurysm formation, and ventricular arrhythmia in long-term survivors undergoing left ventriculotomy. 2,41,43,46,47,[57][58][59][60]61,65 Recent results of use of devices inserted percutaneously to close multiple septal defects have allegedly been encouraging. [19][20][21][22][23][24][25][26][27][28]54,55,66,75,76 In terms of outcomes, nonetheless, in some of these small series rates of mortality have been between 14 and 24%, with rates of failure between 20 and 40%.…”

Section: Short-and Long-term Outcomesmentioning

confidence: 99%

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A Review of the Therapeutic Management of Multiple Ventricular Septal Defects

Chowdhury

Anderson

Spicer

et al. 2021

Preprint

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Background and Aim: We showed in our anatomical review, ventricular septal defects existing as multiple entities can be considered in terms of three major subsets. We address here the diagnostic challenges, associated anomalies, the role and techniques of surgical instead of interventional closure, and the outcomes. including reinterventions, for each subset. Methods: We reviewed 80 published investigations, noting radiographic findings, and the results of clinical imaging elucidating the location, number, size of septal defects, and associated anomalies, and the effect of severe pulmonary hypertension. Results: Overall, perioperative mortality for treatment of residual multiple defects has been cited to be between zero and 14.2%, with morbidity estimated between 6% to 13%. Perioperative mortality is twice as high for perimembranous compared to muscular defects, with need for reoperation is over four times higher. Perventricular hybrid approaches are useful for closure of high anterior or apical defects. Overall, results have been unsatisfactory. Pooled data reveals incidences between 2.8% and 45% for device-related adverse events. Currently, however, outcomes cannot be assessed on the basis of the different anatomical sub-sets. Conclusions: We have addressed the approaches, and the results, of therapeutic treatment in terms of co-existing discrete defects, the Swiss-cheese septum, and the arrangement in which a solitary apical muscular defect gives the impression of multiple defects when viewed from the right ventricular aspect. Treatment should vary according to the specific combination of defects.

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Does Surgically Induced Right Bundle Branch Block Really Effect Ventricular Function in Children After Ventricular Septal Defect Closure?

et al. 2014

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In this prospective study, we aimed to assess left and right ventricular function in terms of the presence of right bundle branch block (RBBB) in the cases with repaired ventricular septal defect (VSD). Fifty-three patients who had VSD surgery at least 1-year preceding admission and 52 healthy controls were enrolled into the study. All the participants underwent electrocardiographic and echocardiographic examination. The cases with RBBB were determined. The conventional and tissue Doppler echocardiographic measurements of the patients with and without RBBB were compared with each other and healthy controls. Twenty-eight of VSD repair groups were male and 25 were female. Control group consisted of 30 males and 22 females. The mean age of the study and control groups was 7.5 ± 5.0 and 6.9 ± 4.3 years, respectively. RBBB was detected in 20 of 53 (37.7 %) operated patients. The only significant difference between the cases with and without RBBB was decreased right ventricular fractional area change (%) in the former group (33 ± 7 vs. 39 ± 5 p < 0.05). When compared to controls, operated group had statistically lower [corrected] tricuspid annular plane systolic excursion (p < 0.05), lower systolic, early diastolic, and late diastolic myocardial velocities, higher left and right ventricular myocardial performance indices, irrespective of the presence of RBBB. The ratios of mitral or tricuspid inflow to left or right ventricular myocardial in early diastolic velocities measured from lateral annular levels were increased in operated group (all p values <0.05). In conclusion, RBBB in the cases with surgical VSD repair might be associated with right ventricular dysfunction. Biventricular systolic and diastolic dysfunction may develop following VSD repair irrespective of the presence of RBBB. Tissue Doppler-derived myocardial performance indices are useful in detection of those subclinical dysfunctions.

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Ventricular Septal Dysfunction After Surgical Closure of Multiple Ventricular Septal Defects

Cited by 21 publications

References 17 publications

A review of the therapeutic management of multiple ventricular septal defects

A review of the therapeutic management of multiple ventricular septal defects

A Review of the Therapeutic Management of Multiple Ventricular Septal Defects

Does Surgically Induced Right Bundle Branch Block Really Effect Ventricular Function in Children After Ventricular Septal Defect Closure?

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