title: Perventricular device closure of residual muscular ventricular septal defects after repair of complex congenital heart defects in pediatric patients.
abstract: Residual muscular ventricular septal defects are surgical challenges, especially after the repair of complex congenital heart defects. We investigated perventricular device closure as a salvage technique in pediatric patients who had postoperative residual muscular ventricular septal defects. From February 2009 through June 2011, 14 pediatric patients at our hospital had residual muscular ventricular septal defects after undergoing surgical repair of complex congenital heart defects. Ten patients met our criteria for perventricular device closure of the residual defects: significant left-to-right shunting (Qp/Qs >1.5) or substantial hemodynamic instability (a defect ≥2 mm in size). The patients' mean age was 20.4 ± 13.5 months, and their mean body weight was 10 ± 3.1 kg. The median diameter of the residual defects was 4.2 mm (range, 2.5-5.1 mm). We deployed a total of 11 SQFDQ-II Muscular VSD Occluders (Shanghai Shape Memory Alloy Co., Ltd.; Shanghai, China) in the 10 patients, in accord with conventional techniques of perventricular device closure. The mean procedural duration was 31.1 ±9.1 min. We recorded the closure and complication rates perioperatively and during a 12-month follow-up period. Complete closure was achieved in 8 patients; 2 patients had persistent trivial residual shunts. No deaths, conduction block, device embolism, or other complications occurred throughout the study period. We conclude that perventricular device closure is a safe, effective salvage treatment for postoperative residual muscular ventricular septal defects in pediatric patients. Long-term studies with larger cohorts might further confirm this method's feasibility.
authors.affiliation: Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, People's Republic of China.
authors.forename: Da
authors.initials: D
authors.lastname: Zhu
authors.affiliation: Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, People's Republic of China.
authors.forename: Kaiyu
authors.initials: K
authors.lastname: Tao
authors.affiliation: Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, People's Republic of China.
authors.forename: Qi
authors.initials: Q
authors.lastname: An
authors.affiliation: Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, People's Republic of China.
authors.forename: Shuhua
authors.initials: S
authors.lastname: Luo
authors.affiliation: Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, People's Republic of China.
authors.forename: Changping
authors.initials: C
authors.lastname: Gan
authors.affiliation: Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, People's Republic of China.
authors.forename: Ke
authors.initials: K
authors.lastname: Lin
mesh_terms: D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D011474:Prosthesis Design; D012189:Retrospective Studies; D055989:Septal Occluder Device; D016896:Treatment Outcome; D016276:Ventricular Function
keywords: Cardiac surgical procedures/instrumentation/methods; equipment design; heart defects, congenital/adverse effects; heart septal defects, ventricular/complications/pathology/therapy; hemodynamics; postoperative complications; prostheses and implants; surgical procedures, minimally invasive/methods; treatment outcome