PDF(Pubmed)
Abstract：
BACKGROUND: Ventricular septal defect (VSD) is the most common congenital cardiac malformation, accounting for approximately 30% of congenital heart defects. Conventional surgical repair using cardiopulmonary bypass is invasive and associated with morbidities and prolonged hospital stay. With the advent of interventional approaches and availability of different occluding devices, the technique of perventricular device closure is evolving and being implemented successfully in larger groups of patients. We present herein, our initial experience of perventricular device closure for the ventricular septal defects in children to assess risks and benefits.
METHODS: From March, 2023 to February, 2024, we have performed perventricular closure of ventricular septal defects in 13 children, under guidance of transesophageal echocardiography without cardiopulmonary bypass support. The median age at operation was 2 year (range 1.3-10 years) with the median body weight 11 kg (range 8.7-16.6 kg). Sixty-nine percent were males. The ventricular septal defect sizes ranged from 2.7 to 6 mm (mean 4.7 mm). Seven defects were perimembranous, four sub-aortic and two were muscular. One patient also underwent pulmonary artery de-banding with pulmonary artery balloon angioplasty and other one patent ductus arteriosus ligation, concomitantly. For defect closure, we used ventricular septal defect occlusion device (MemoPart™, Lepu Medical Technology Company, China) through a 3-cm skin incision in the lower- third of the sternum. The device sizes ranged from 5 to 8 mm (mean 6.9+-1.8 mm) and all patients except for two required symmetrical devices.
RESULTS: All patients underwent device closure successfully. The procedural duration ranged between 32 and 52 min. None of the patients required cardiopulmonary bypass. The mean ventilation time and intensive care unit stay was 3 and 24 h, respectively. None of the patients required inotropic support or blood transfusions. Moreover, no patients developed any arrhythmias including heart block. The average length of hospital stay was 4.4 days. At the latest follow up, there were no residual shunts, conduction disturbances, device dislodgement or major aortic or tricuspid valve complications seen in any patients. There was no mortality.
CONCLUSIONS: Perventricular device closure of ventricular septal defects is a less invasive, extremely safe and effective method in children. It is associated with very fast recovery, shorter hospitalization time and better cosmetic incision. Moreover, it avoids cardiopulmonary bypass. The modifications and refinements in the design, material and implantation techniques will help in expanding the indications and prevent complications in the long-term.
METHODS: From March, 2023 to February, 2024, we have performed perventricular closure of ventricular septal defects in 13 children, under guidance of transesophageal echocardiography without cardiopulmonary bypass support. The median age at operation was 2 year (range 1.3-10 years) with the median body weight 11 kg (range 8.7-16.6 kg). Sixty-nine percent were males. The ventricular septal defect sizes ranged from 2.7 to 6 mm (mean 4.7 mm). Seven defects were perimembranous, four sub-aortic and two were muscular. One patient also underwent pulmonary artery de-banding with pulmonary artery balloon angioplasty and other one patent ductus arteriosus ligation, concomitantly. For defect closure, we used ventricular septal defect occlusion device (MemoPart™, Lepu Medical Technology Company, China) through a 3-cm skin incision in the lower- third of the sternum. The device sizes ranged from 5 to 8 mm (mean 6.9+-1.8 mm) and all patients except for two required symmetrical devices.
RESULTS: All patients underwent device closure successfully. The procedural duration ranged between 32 and 52 min. None of the patients required cardiopulmonary bypass. The mean ventilation time and intensive care unit stay was 3 and 24 h, respectively. None of the patients required inotropic support or blood transfusions. Moreover, no patients developed any arrhythmias including heart block. The average length of hospital stay was 4.4 days. At the latest follow up, there were no residual shunts, conduction disturbances, device dislodgement or major aortic or tricuspid valve complications seen in any patients. There was no mortality.
CONCLUSIONS: Perventricular device closure of ventricular septal defects is a less invasive, extremely safe and effective method in children. It is associated with very fast recovery, shorter hospitalization time and better cosmetic incision. Moreover, it avoids cardiopulmonary bypass. The modifications and refinements in the design, material and implantation techniques will help in expanding the indications and prevent complications in the long-term.
摘要：
背景：室间隔缺损（VSD）是最常见的先天性心脏畸形，约占先天性心脏缺陷的30%。使用体外循环的常规手术修复是侵入性的，并且与发病率和住院时间延长有关。随着介入方法的出现和不同闭塞装置的可用性，脑室封堵器技术正在不断发展,并在更大的患者群体中成功实施.我们在此介绍，我们对儿童室间隔缺损进行室间隔封堵的初步经验,以评估风险和获益.
方法：从3月开始，2023年至2月,2024年，我们对13名儿童进行了室间隔缺损的室间隔封堵，在无体外循环支持的经食管超声心动图指导下。手术年龄中位数为2岁（范围1.3-10岁），体重中位数为11kg（范围8.7-16.6kg）。69%是男性。室间隔缺损大小为2.7至6mm（平均4.7mm）。七个缺陷是膜周，四个主动脉下和两个肌肉。一名患者还接受了肺动脉球囊血管成形术和其他一项动脉导管未闭结扎术的肺动脉去带术，同时。对于缺陷闭合,我们使用了室间隔缺损封堵器(MemoPart™，乐普医疗技术公司,中国）通过胸骨下部三分之一的3厘米皮肤切口。设备尺寸范围为5至8mm（平均6.9-1.8mm），所有患者均需要两个对称设备。
结果：所有患者均成功进行封堵器闭合。手术持续时间在32到52分钟之间。没有患者需要体外循环。平均通气时间和重症监护病房住院时间为3和24小时，分别。没有患者需要正性肌力支持或输血。此外，没有患者出现任何心律失常,包括心脏传导阻滞.平均住院时间为4.4天。在最新的后续行动中，没有残留的分流器，传导干扰,任何患者出现装置移位或主动脉瓣或三尖瓣严重并发症。没有死亡。
结论：室间隔缺损的室间隔装置闭合是一种较小的侵入性，在儿童非常安全和有效的方法。它与非常快的恢复有关，更短的住院时间和更好的美容切口。此外，它避免了体外循环。设计中的修改和完善，材料和植入技术将有助于扩大适应症并防止长期并发症。
方法：从3月开始，2023年至2月,2024年，我们对13名儿童进行了室间隔缺损的室间隔封堵，在无体外循环支持的经食管超声心动图指导下。手术年龄中位数为2岁（范围1.3-10岁），体重中位数为11kg（范围8.7-16.6kg）。69%是男性。室间隔缺损大小为2.7至6mm（平均4.7mm）。七个缺陷是膜周，四个主动脉下和两个肌肉。一名患者还接受了肺动脉球囊血管成形术和其他一项动脉导管未闭结扎术的肺动脉去带术，同时。对于缺陷闭合,我们使用了室间隔缺损封堵器(MemoPart™，乐普医疗技术公司,中国）通过胸骨下部三分之一的3厘米皮肤切口。设备尺寸范围为5至8mm（平均6.9-1.8mm），所有患者均需要两个对称设备。
结果：所有患者均成功进行封堵器闭合。手术持续时间在32到52分钟之间。没有患者需要体外循环。平均通气时间和重症监护病房住院时间为3和24小时，分别。没有患者需要正性肌力支持或输血。此外，没有患者出现任何心律失常,包括心脏传导阻滞.平均住院时间为4.4天。在最新的后续行动中，没有残留的分流器，传导干扰,任何患者出现装置移位或主动脉瓣或三尖瓣严重并发症。没有死亡。
结论：室间隔缺损的室间隔装置闭合是一种较小的侵入性，在儿童非常安全和有效的方法。它与非常快的恢复有关，更短的住院时间和更好的美容切口。此外，它避免了体外循环。设计中的修改和完善，材料和植入技术将有助于扩大适应症并防止长期并发症。
