Perventricular Device Closure of Ventricular Septal Defects: Results in Patients With Age Less 1 Year Old
Alexander Y. Omelchenko, Yuriy N. Gorbatykh, Gregory S. Zaitsev, Alexey N. Arkhipov.
Academician E.N. Meshalkin State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
OBJECTIVE: To present and share our experience in perventricular device closure of ventricular septal defects in patients less than 1 year old.
METHODS: Since 2012 till now , 51 patients less than 1 year old with ventricular septal defects were operated through minimal invasive transthoracic device closure under guidance of transesophageal echocardiography (TEE) without cardiopulmonary bypass(CBP). Median age at operation was 8,0±2,5 (8) months, mean body weight was 7,9±3,4 (7.6) kg, 7,3% (5) of patients had weight less than 5 kg. Qp/Qs ratio was 1,9±0,4 (1,8). VSD size differed from 3 to 9 mm, mean diameter was 5,7±1,6 (5) mm, 27,4% (14) of defects were subaortic, 66,7% (34) perimembraneous and 5,9% (3) were muscular. To close the defect, we used a 3-cm skin incision in the lower third of the sternum and a Memo PartTM tool by Shanghai Shape Memory Alloy Co., Ltd. (Lepu Medical Technology [Beijing] Co., Ltd., China),composed of a ventricular septal defect occlusion device SQFDQ I-IV and short occluder delivery system 7F.
RESULTS: The procedure success rate is 96,1% and there were 2 cases patients were convert to open-heart surgery (3,9%) during procedures. Operation time - «skin to skin» was 55,9±41,0 (40) min, 48,8% of cases were less than 40 min. ICU stay was 16,5±9,4 (18) hours, ventilation time was 3,2±3,5 (2) hours, all patients did not required inotropic support, blood transfusion and analgesia. 7,8% (4) of patients had residual shunt of 1 mm, there were no AV blocks, rhytm disturbances and other types of major complication in early postop period. Hospital stay was 5,6±3,2 (5) days. The 24-month follow-up examination revealed excellent cosmetic results in all patients with no shunts, conduction disturbances, or valve complications in any patient.
CONCLUSIONS: Perventricular device closure of ventricular septal defects showed high efficiency, safety in patients of young age with less trauma, comparing to conventional surgical repair with cardiopulmonary bypass, provided short period of rehabilitation and excellent cosmetic result.
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