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Transcarotid Approach to Ventricular Septal Defect Closure in Small Infants

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Abstract

Perimembranous ventricular septal defect closure in small infants has traditionally been a surgically treated defect, although alternative hybrid strategies are emerging. We aim to describe a novel approach to retrograde device closure of clinically relevant perimembranous ventricular septal defects in small infants via carotid cutdown. A retrospective review of all patients managed with attempted carotid cutdown for device closure of a perimembranous ventricular septal defect was recorded at a single tertiary cardiac centre. We summarized data on successful device deployment, conversion to open repair, complications, and length of stay. Eighteen infants with median (IQR) age of 7 months (5–9 months) and weight of 7.1 kg (6.5–7.8 kg) with clinically relevant PMVSD underwent attempted retrograde closure via carotid cutdown. Median (IQR) defect size was 8 mm (7–9 mm). Successful device deployment without significant aortic or tricuspid valve interference occurred in 15 (83%) patients. Three patients were converted to open repair, one following damage to the tricuspid valve apparatus. Median (IQR) hospital stay was 1 day (1–3 days). There were no complications related to carotid cutdown. Retrograde device closure of hemodynamically significant PMVSD is feasible and effective in small infants. Decision to convert to surgical repair should be made early if suboptimal device placement occurs. Carotid evaluation should be performed to rule out any access-related complications.

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Authors and Affiliations

  1. Department of Paediatric Cardiology and Cardiac Surgery, Children’s Health Ireland At Crumlin, Dublin, Ireland

    Colm R. Breatnach, Damien Kenny, Niall Linnane, Mohamed Al Nasef, Li Yen Ng, Jonathan McGuinness, Brian McCrossan, Lars Nölke, Paul Oslizlok, Mark Redmond & Kevin Walsh

  2. Department of Paediatric Cardiology, The Royal Belfast Hospital for Sick Children, 180 Falls Road, Belfast, Northern Ireland

    Brian McCrossan

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  1. Colm R. Breatnach
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  2. Damien Kenny
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  3. Niall Linnane
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  4. Mohamed Al Nasef
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  5. Li Yen Ng
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  6. Jonathan McGuinness
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  7. Brian McCrossan
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Correspondence to Colm R. Breatnach.

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Breatnach, C.R., Kenny, D., Linnane, N. et al. Transcarotid Approach to Ventricular Septal Defect Closure in Small Infants. Pediatr Cardiol 42, 1539–1545 (2021). https://doi.org/10.1007/s00246-021-02638-6

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  • DOI: https://doi.org/10.1007/s00246-021-02638-6

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