School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, LiverpoolL69 3GE, UK.
Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK.
Cardiol Young. 2021 May;31(5):756-761. doi: 10.1017/S1047951120004576. Epub 2020 Dec 17.
Medical advancements have encouraged minimally invasive surgical repair of congenital heart defects such as ventricular septal defects (VSDs), and the diagnostic process can now be carried out using non-traditional techniques such as pulse oximetry. This, in turn, has improved clinical outcomes with reduced complication rates post-surgery. However, the variations in type of VSDs, age of patient, comorbidities, and access to closure devices may limit the efficacy of surgical advancements.
Articles were identified amongst Scopus, MEDLINE, and PubMed using various relevant search strings using PRISMA guidelines. Of the 115 articles initially extracted, 10 were eventually reviewed after duplicates and irrelevant studies were removed.
Of the 24 eligible articles, 10 papers were selected for analysis. Minimally invasive approaches to VSD repair was associated with satisfactory short-term outcomes when compared to open repair. For diagnosis of congenital VSD, whilst recent advances such as pulse oximetry method and genome analysis are more sensitive, the limited availability and access to such investigatory methods must be recognised.
Pulse oximetry and fetal echocardiography are established non-invasive diagnostic tools for VSD. The recent advances in minimally invasive treatment options including periventricular approach and transcatheter techniques have improved patient outcomes, yet at the expense of higher residual rates. Careful patient selection for each technique and follow-up should be planned through multidisciplinary team meetings.
医学的进步鼓励了微创心脏修复术,如室间隔缺损(VSD)的修复,现在可以使用非传统技术,如脉搏血氧饱和度测定法来进行诊断。这反过来又改善了临床结果,降低了手术后的并发症发生率。然而,VSD 的类型、患者年龄、合并症以及闭合装置的可及性等方面的差异可能限制了手术进展的效果。
使用 PRISMA 指南,通过各种相关搜索词在 Scopus、MEDLINE 和 PubMed 中确定文章。在最初提取的 115 篇文章中,在去除重复和不相关的研究后,最终有 10 篇文章进行了回顾。
在 24 篇合格的文章中,有 10 篇文章被选中进行分析。与开放修复相比,微创 VSD 修复方法与令人满意的短期结果相关。对于先天性 VSD 的诊断,尽管脉搏血氧饱和度测定法和基因组分析等最近的进展更敏感,但必须认识到这些研究方法的有限可用性和可及性。
脉搏血氧饱和度测定法和胎儿超声心动图是 VSD 的既定非侵入性诊断工具。微创治疗选择的最新进展,包括经脑室途径和经导管技术,改善了患者的预后,但代价是残余率较高。应通过多学科团队会议,为每种技术的患者选择和随访制定详细的计划。