Department of Cardiac Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Echocardiography, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
J Card Surg. 2021 Sep;36(9):3131-3137. doi: 10.1111/jocs.15760. Epub 2021 Jul 1.
This study aimed to investigate the safety, feasibility and, availability of perimembranous ventricular septal defect (PmVSD) closure via a left parasternal ultra-minimal trans intercostal incision in children.
From January 2015 to January 2019, 131 children with restrictive PmVSDs were enrolled in this study and successfully done in 126 patients (96.18%). PmVSDs were occluded via an ultra-minimal trans intercostal incision (≤1 cm), and the entire occlusive process was guided and monitored by TEE. A pericardium hanging technique was employed without sternal incision. PmVSDs were closed through a short delivery sheath assembled using a concentric occluder device. All patients were followed up for a period ranging from18 months to 24 months. Thirteen patients with PmVSD had aneurysm of membranous septum (AMS). Multistream (≥2) PmVSDs with AMS were found in 11 cases. After the operation, mild residual shunt beside the amplatzer occluder in one patient was found and had self-healing result during the 5-month follow-up period. Five patients transferred to ventricular septal defect repair operation under direct visualization with a cardiopulmonary bypass. One reason was ventricular fibrillation when guidewire passed the PmVSD, another was device dislocation, and others were the guidewire cannot pass through the PmVSD.
PmVSDs closure using a concentric occluder via a left parasternal ultra-minimal trans intercostal incision under TEE guidance is feasible, safe, and effective in children. This approach can be considered as an alternative treatment to open-heart surgery for restrictive PmVSDs.
本研究旨在探讨经左胸骨旁超微创肋间切口行膜周部室间隔缺损（PmVSD）封堵术的安全性、可行性和实用性。
2015 年 1 月至 2019 年 1 月，共有 131 例限制型 PmVSD 患儿纳入本研究，其中 126 例（96.18%）患儿成功完成手术。采用超微创肋间切口（≤1cm），在经胸超声心动图（TEE）引导和监测下进行 PmVSD 封堵。采用心包悬挂技术，无需胸骨切开。通过使用同心封堵器装置组装的短输送鞘进行 PmVSD 封堵。所有患者均随访 18 个月至 24 个月。13 例 PmVSD 患儿合并膜部室间隔瘤（AMS）。11 例存在多流（≥2 流）伴 AMS 的 PmVSD。术后发现 1 例患者在 Amplatzer 封堵器旁有轻度残余分流，随访 5 个月后自行愈合。5 例患者在体外循环直视下行室间隔缺损修补术。其中 1 例因导丝通过 PmVSD 时发生室颤，1 例因器械脱位，其余 3 例因导丝无法通过 PmVSD。
经左胸骨旁超微创肋间切口在 TEE 引导下使用同心封堵器行 PmVSD 封堵术，在儿童中是可行、安全和有效的。对于限制型 PmVSD，这种方法可以考虑作为心脏直视手术的替代治疗方法。
