Skip to main content
SpringerLink
Log in

Value of echocardiography for mini-invasive per-atrial closure of perimembranous ventricular septal defect

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

The purpose of this study was to assess the value of echocardiography for intraoperative guidance during closure of perimembranous ventricular septal defects (pmVSD) and to assess outcomes of these patients. We identified and assessed 78 patients who underwent 2- and 3-dimensional echocardiography-guided mini-invasive per-atrial closure of pmVSD in the cardiac surgery department of our institution, from February 2016 to August 2018, and 76 patients who underwent transcatheter closure of VSD guided by fluoroscopy at the pediatric department (percutaneous control group). All the patients underwent echocardiography. Their clinical data were retrospectively reviewed and analyzed. All patients were followed up using transthoracic echocardiography (TTE) for a maximum of 24 months after the closure. All patients underwent successful device implantation. Echocardiography showed that the major immediate complications included residual shunt, pericardial effusion, and tricuspid regurgitation in the per-atrial group. During the mid-term follow-up period, TTE revealed that the most common complication was tricuspid regurgitation (non-preexisting). There were no cases of VSD recurrence, device displacement, valvular injury, malignant arrhythmias, hemolysis, or death. Moreover, according to the TTE data, the intracardiac structure of the patients were improved. Compared to the control group, the intracardiac manipulation time was shorter and the number of patients with residual shunts, redeployment of devices, or immediate new tricuspid regurgitations was fewer when using 2- and 3-dimensional echocardiography. However, the procedure time in the per-atrial group was slightly longer than that in the control group. Two- and 3-dimensional echocardiography are feasible monitoring tools during mini-invasive per-atrial VSD closure. The short- and mid-term follow-up showed satisfactory results compared to fluoroscopy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

All data generated or analyzed during this study are included in this article.

Abbreviations

PmVSD:

Perimembranous ventricular septal defect

2D:

2-Dimensional

3D:

3-Dimensional

CDFI:

Color Doppler flow imaging

TTE:

Transthoracic echocardiography

TEE:

Transesophageal echocardiography

LA:

Left atrium

LV:

Left ventricle

PA:

Pulmonary artery

RA:

Right atrium

RV:

Right ventricle

VS:

Ventricular septum

MR:

Mitral regurgitation

TR:

Tricuspid regurgitation

AR:

Aortic regurgitation

LVEF:

Left ventricular ejection fraction

ICMT:

Intracardiac manipulation time

References

  1. Carlgren LE (1959) The incidence of congenital heart disease in children born in Gothenberg 1941–1950. Br Heart J 21:40–50

    Article  CAS  Google Scholar 

  2. Anderson RH, Becker AE, Tynan M (1986) Description of ventricular septal defects or how long is a piece of string? Int J Cardiol 13(3):267–278

    Article  CAS  Google Scholar 

  3. Serraf A, Lacour-Gayet F, Bruniaux J et al (1992) Surgical management of isolated multiple ventricular septal defects. Logical approach in 130 cases. J Thorac Cardiovasc Surg 103:437–442 discussion 443

    Article  CAS  Google Scholar 

  4. Brizard CP, Olsson C, Wilkinson JL (2004) New approach to multiple ventricular septal defect closure with intraoperative echocardiography and double patches sandwiching the septum. J Thorac Cardiovasc Surg 128:684–692

    Article  Google Scholar 

  5. Kitagawa T, Durham LA 3rd, Mosca RS et al (1998) Techniques and results in the management of multiple ventricular septal defects. J Thorac Cardiovasc Surg 115:848–856

    Article  CAS  Google Scholar 

  6. Rao PS, Harris AD (2018) Recent advances in managing septal defects: ventricular septal defects and atrioventricular septal defects. F1000 Res 26:7

    Google Scholar 

  7. Holzer RJ, Sallehuddin A, Hijazi ZM (2016) Surgical strategies and novel alternatives for the closure of ventricular septal defects. Expert Rev Cardiovasc Ther 14(7):831–841

    Article  CAS  Google Scholar 

  8. Butera G, Piazza L, Saracino A et al (2013) Transcatheter closure of membranous ventricular septal defects—old problems and new solutions. Interv Cardiol Clin 2(1):85–91

    PubMed  Google Scholar 

  9. Cotrim C, Cordeiro P, Zamorano J et al (2005) Adolescent and adult congenital heart disease assessed by real-time three-dimensional echocardiography: an initial experience. Rev Port Cardiol 24(4):547–553

    PubMed  Google Scholar 

  10. Perk G, Lang RM, Garcia-Fernandez MA et al (2009) Use of real time three-dimensional transesophageal echocardiography in intracardiac catheter based interventions. J Am Soc Echocardiogr 22(8):865–882

    Article  Google Scholar 

  11. Lang RM, Mor-Avi V, Sugeng L et al (2006) Three-dimensional echocardiography: the benefits of the additional dimension. J Am Coll Cardiol 48(10):2053–2069

    Article  Google Scholar 

  12. Anwar AM, Geleijnse ML, Soliman OI et al (2007) Assessment of normal tricuspid valve anatomy in adults by real-time three-dimensional echocardiography. Int J Cardiovasc Imaging 23(6):717–724

    Article  Google Scholar 

  13. Sugeng L, Shernan SK, Salgo IS et al (2008) Live 3-dimensional transesophageal echocardiography: Initial experience using the fully-sampled matrix array probe. J Am Coll Cardiol 52(6):446–449

    Article  Google Scholar 

  14. Thakkar B, Patel N, Shah S et al (2012) Perventricular device closure of isolated muscular ventricular septal defect in infants: a single centre experience. Indian Heart J 64(6):559–567

    Article  Google Scholar 

  15. Xing Q, Pan S, An Q et al (2010) Minimally invasive perventricular device closure of perimembranous ventricular septal defect without cardiopulmonary bypass: multicenter experience and mid-term follow-up. J Thorac Cardiovasc Surg 139(6):1409–1415

    Article  Google Scholar 

  16. Hongxin L, Zhang N, Wenbin G et al (2014) Peratrial device closure of perimembranous ventricular septal defects through a right parasternal approach. Ann Thorac Surg 98(2):668–674

    Article  Google Scholar 

  17. Egbe AC, Poterucha JT, Rihal CS et al (2015) Transcatheter closure of postmyocardial infarction, iatrogenic, and postoperative ventricular septal defects: the Mayo Clinic experience. Catheter Cardiovasc Interv 86(7):1264–1270

    Article  Google Scholar 

  18. Kim SS, Hijazi ZM, Lang RM et al (2009) The use of intracardiac echocardiography and other intracardiac imaging tools to guide noncoronary cardiac interventions. J Am Coll Cardiol 53(23):2117–2128

    Article  Google Scholar 

  19. Balluz R, Liu L, Zhou X et al (2013) Real time three-dimensional echocardiography for quantification of ventricular volumes, mass, and function in children with congenital and acquired heart diseases. Echocardiography 30(4):472–482

    Article  Google Scholar 

  20. Yip WCL, Zimmerman F, Hijazi ZM (2005) Heart block and empirical therapy after transcatheter closure of perimembranous ventricular septal defect. Catheter Cardiovasc Interv 66(3):436–441

    Article  Google Scholar 

  21. Zuo J, Xie J, Yi W et al (2010) Results of transcatheter closure of perimembranous ventricular septal defect. Am J Cardiol 106(7):1034–1037

    Article  Google Scholar 

  22. Song S, Fan T, Li B et al (2017) Minimally invasive peratrial device closure of perimembranous ventricular septal defect through a right infraaxillary route: clinical experience and preliminary results. Ann Thorac Surg 103(1):199–205

    Article  Google Scholar 

  23. Cao H, Chen Q, Zhang GC et al (2016) Transthoracic subarterial ventricular septal defect occlusion using a minimally invasive incision. J Card Surg 31(6):398–402

    Article  Google Scholar 

  24. Hu X, Peng B, Zhang Y et al (2019) Short-term and mid-term results of minimally invasive occlusion of ventricular septal defects via a subaxillary approach in a single center. Pediatr Cardiol 40(1):198–203

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Echocardiography, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, China

    Zhenwei Guo, Shuo Zhang, Mei Zhu, Wenbin Guo, Juan Feng & Hao Liang

  2. School of Mathematical Science, Peking University, Beijing, 100871, China

    Decai Liang

  3. CardiMed Medical Technology, Shanghai, 200000, China

    Xin Jiang

  4. Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Shandong Provincial Hospital No. 324 Jingwu Road, Jinan, 250021, Shandong, China

    Ximing Wang

Authors
  1. Zhenwei Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shuo Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mei Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xin Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wenbin Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Juan Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Decai Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hao Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ximing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ximing Wang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The present study was a retrospective study approved by the ethics committee and adhered to the Declaration of Helsinki.

Informed consent

All authors read and approved the final manuscript. Additionally, written informed consent was obtained from the patients or the patient’s relatives.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guo, Z., Zhang, S., Zhu, M. et al. Value of echocardiography for mini-invasive per-atrial closure of perimembranous ventricular septal defect. Int J Cardiovasc Imaging 37, 117–124 (2021). https://doi.org/10.1007/s10554-020-01967-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-020-01967-6

Keywords

Search

Navigation