Permanent chronotropic impairment after closure of atrial or ventricular septal defect

Objectives. Atrial and ventricular septal defects are commonly closed surgically with low rates of post-operative morbidity, and the long-term outcome has widely been described as benign. Nevertheless, there is an increasing understanding of late morbidity, and the possibility of postoperative chronotropic impairment is continuously questioned. Furthermore, potentially abnormal chronotropic responses may be associated with the recently demonstrated overrepresentation of late arrhythmias. We conducted this review to methodically describe the potential effects of surgical defect closure on the chronotropic response to exercise. Methods. We performed a search protocol based on the 'Preferred Reporting Items for Systematic Reviews and Meta- Analyses' (PRISMA) guidelines. A data collection form was specifically developed and data were extracted from the included studies by a primary reviewer and crosschecked by a secondary reviewer. Results. A search of electronic databases revealed 16 publications, which consistently reported an abnormal heart rate responses to exercise after surgical closure. In contrast, these and other studies convincingly showed normal chronotropic response in un-operated patients as well as after percutaneous closure. Potential mechanisms include disturbances in the sinoatrial or atrioventricular conduction system and denervation in the proximity of the aorta during the surgical procedure. Discussion. ASD and VSD patients have abnormal heart rate responses to exercise after surgical closure, which indicates a need of change in the preoperative information given to these patients and their parents before surgical defect closure. Although there may not be any alternatives to surgery, patients should still be informed about potential long-term consequences, including the risk of chronotropic incompetence. Moreover, this review suggests that ‘specialized’, long-term follow up may be indicated.     

Impaired ventilatory efficiency after closure of atrial or ventricular septal defect

Objectives: Atrial and ventricular septal defects are the most common congenital heart defects and the closing procedures share important similarities. Generally, the postoperative outcome is considered benign, but there is growing concern regarding late ventilatory function. Therefore, the aim of this review was to describe the ventilatory function in patients with open as well as percutaneously or surgically closed atrial and ventricular septal defects. Methods: We performed a search protocol based on the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines. A data collection form was specifically developed and data were extracted from the included studies by a primary reviewer and cross-checked by the secondary reviewer. Results: We found an increasing evidence of late impairment in ventilatory efficiency, and despite that ventilatory function is commonly normal at rest, abnormalities were disclosed during exercise. There are indices that surgical closure plays an important role. Discussion: Atrial septal defect and ventricular septal defect patients have persisting, long-term impairment in ventilatory efficiency during exercise. Although the pathogenesis behind this finding may be multifactorial, there are indices that the surgical procedure may play an important role. Nevertheless, the literature is this field is sparse, and additional studies are needed.     

Surgical closure of atrial septal defect

Background: Closure of ostium secundum atrial septal defect (ASD) vis median sternotomy (MS) is a simple procedure for most cardiac surgeons. Minimally invasive cardiac surgery (MICS) has recently been applied in the management of intracardiac lesions. Methods: We report our experience in surgical closure of isolated ASD via MICS in 60 patients and via MS in 58 patients. There was no difference between these two groups in gender, age, body weight, ratio of systemic to pulmonary blood flow, and pulmonary arterial pressure. Results: The duration of cardiopulmonary bypass was significantly longer in the MICS group than in the MS group [27 to 126 min (42 ± 12) and 14 to 158 min (27 ± 11), respectively; (p < 0.001]. However, the length of incision, incidence of temporary pacemaker wire insertion rate, duration of endotracheal intubation, timing of oral intake, postoperative day drainage amount, incidence of parenteral analgesic injection, postoperative length of stay, and return to normal activity interval were significant shorter and lower in patients of the MICS group than in those of the MS group. All the patients recovered rapidly from the surgery. Follow-up was complete in all patients, with no late complications and no residual shunt. Conclusion: Our results suggest that MICS is a good option for surgical closure of ASD. Received: 4 June 1997/Accepted: 29 October 1997     

Transcatheter closure of secundum atrial septal defect

Since the introduction of transcatheter closure of atrial septal defect, device closure has become the alternative treatment of selected atrial defects. Although excellent results have been reported for transcatheter closure, concerns have arisen regarding complications, including residual shunt, systemic or pulmonary embolization of the device, and erosion and perforation of the cardiac chamber. Those complications are rare but potentially serious adverse events that may require immediate surgical intervention. This review summarizes the current trends in patient selection, result of device closure and typical complications. Comparison between transcatheter device closure and surgical closure is also made.     

多发性房间隔缺损介入治疗

目的本文报告1998年10月-2006年11月13例多发性ASD介入治疗体会。方法13例中男3例,女10例。年龄4~60岁,平均(26.1±4.2)岁。13例中9例2处缺损,3例3处缺损,1例4处缺损。合并房间隔膨出瘤2例,1例合并心房纤颤和心包积液。结果13例中11例应用一个闭合器功闭合,闭合器型号12~40 mm,2例应用两个闭合器闭合缺损,型号均为18/8 mm,2例术后残余分流。无其它并发症。结论多发性ASD介入治疗,必用TEE监测,确定ASD数目、直径和间距,尽量用1个闭合器闭合多处缺损。     

Pericardial patch for atrial septal defect closure

Pericardium is an eminently suitable material for the closure of atrial septal defects. However, when it is not treated with glutaraldehyde, it is difficult to handle because of curling in of the edges. A technique is described by which pericardium can be used to close atrial septal defects with minimal handling and assistance, and without chemical pretreatment.     

膜周部室间隔缺损的微创封堵术

目的 探讨经胸壁微创室间隔缺损(VSD)封堵术对膜周部室间隔缺损(PVSD)的治疗效果及安全性.方法 2011年1月至12月,治疗129例PVSD患者(儿),男60例,女69例;年龄9个月～57岁.PVSD直径1.4～9.0 mm,均经胸骨中下1/3段3～5 cm正中小切口行微创VSD封堵术.术后密切随访观察,定期复查超声心动图和心电图.结果 114例封堵成功,15例术中转体外循环下行VSD修补术.其中应用等边封堵伞96枚,偏心封堵伞20枚.术后随访期间均无严重并发症发生.结论 经胸壁微创VSD封堵术治疗PVSD的近期治疗效果满意,具有良好的应用前景.目前尚缺乏长期的随访资料,有待进一步的随访观察.     

Complications in atrial septal defect device closure

Atrial septal defect (ASD) is a common congenital cardiac anomaly. Even though surgery is the gold standard, percutaneous device closure is gaining popularity because of the short learning curve, cosmetic advantage and relative safety. The long-term implications are open to question. We report here two cases where surgical intervention was required during attempted percutaneous closure and briefly review the relevant literature.     

Interventricular septal hematoma in ventricular septal defect patch closure

We report a case of interventricular septal hematoma after patch closure of a perimembranous ventricular septal defect in a 4-month-old infant. On postoperative day 1, echocardiography showed a voluminous intramural hematoma causing severe thickening of the ventricular septum. Surgical revision was necessary immediately to drain the hematoma.     

Transaortic closure of residual intramural ventricular septal defect

BACKGROUND: Residual intramural ventricular septal defect is an unusual cause of left-to-right shunt after biventricular repair of conotruncal anomalies. It results from the insertion of the patch within the trabeculated right ventricular free wall related to the ventriculoinfundibular fold creating a communication through the intertrabeculated spaces to the right ventricular cavity. This complication often leads to unsuccessful reoperations unless the exact mechanism of the shunt has been identified. METHODS AND RESULTS: Five patients presented with residual intramural ventricular septal defects. Three had double outlet right ventricle, one pulmonary atresia with ventricular septal defect, and one tetralogy of Fallot. One patient was unsuccessfully reoperated on for closure of the residual ventricular septal defect through the right ventricular approach. The surgical treatment, which consisted of patch closure of the residual intramural ventricular septal defect through aortotomy, was successful in 3 patients. In the 2 remaining patients the hemodynamically insignificant residual intramural ventricular septal defect remained untouched. No mortality or morbidity occurred. CONCLUSIONS: Residual intramural ventricular septal defect should be suspected in presence of a residual ventricular septal defect after biventricular repair of conotruncal anomalies. It is not accessible through either atriotomy or right ventriculotomy. The transaortic approach allows an easy treatment of this rare complication.     

经心室穿刺封堵婴幼儿非肌部室间隔缺损39例

目的 探讨经心室穿刺封堵婴幼儿非肌部室间隔缺损(VSD)的临床效果.方法 2007年4月至2008年2月,治疗39例非肌部VSD病儿,男16例,女23例.年龄12～36个月,平均(14.5±7.8)个月;体重8.5～18.0 kg,平均(12.4±2.3)kg.其中膜周部VSD 34例、干下型3例、嵴内型2例.缺损直径3.0～11.0mm,平均(6.1±2.0)mm.均接受非体外循环下经右心室穿刺封堵VSD治疗.结果 全组均无需输血.37例封堵成功,2例因发生中度主动脉瓣反流改行直视手术.置入封堵器直径4～12 mm,平均(8.2±2.0)mm.术后膜周部VSD者中三尖瓣反流程度减轻3例,新出现微量至轻度三尖瓣反流8例;6例出现不完全性右柬支传导阻滞.术后住院3～5 d,平均(3.4±0.4)d.结论 经心室穿刺行VSD封堵术对婴幼儿非肌部VSD而言是一种有效和安全的治疗手段.