Fetal pulmonary atresia with ventricular septal defect :echocardiographic findings ,associated anomalies and chromosomal characteristics / 中华超声影像学杂志

Objective To analyze the echocardiographic findings , associated anomalies and chromosomal characteristics in fetuses with pulmonary atresia with ventricular septal defect ( PA/VSD ) . Methods T he echocardiographic data and follow‐up materials were retrospectively reviewed in 30 256 fetuses from December 2012 to M arch 2018 in the consultation center of fetal heart disease in maternal‐fetal medicine in Anzhen hospital . Of all the fetuses ,59 cases ( 0 .19% ) had PA/VSD . T he echocardiographic findings ,associated anomalies and chromosomal characteristics were retrospectively analyzed in all the 59 fetuses with PA/VSD . Based on w hether the presence of the native pulmonary arteries and the major aortopulmonary collateral arteries ( M APCAs) or not ,the PA‐VSD was classified into type A ,type B ,and type C . Results A large ventricular defect was demonstrated in five‐chamber view with 61 .7% of the mean ratio of the aortic overriding . O ther fetal echocardiographic features of all the 59 fetuses with PA/VSD included :the right aortic arch ( n ＝19 ) ,reversal flow in the ductus arteriosus ( n ＝40 ) ,M APCAs ( n ＝24) . T he classification of the PA/VSD included :type A ( n ＝35) ,type B ( n ＝5) and type C ( n ＝19) . Associated anomalies :persistent left superior vena cava ( n ＝ 13 ) ,anomalous pulmonary vein connection ( n＝5 ) ,complete atrioventricular septal defect ( n ＝ 5 ) ; single umbilical artery ( n ＝ 3 ) ,right atrial isomerism ( n ＝3) . Of all the 30 cases performed chromosomal test ,3 cases had aneuploidy and 7 cases had microdeletion of chromosome . Conclusions The fetal echocardiographic findings of the PA/VSD are characteristic . For prenatal diagnosis of PA/VSD ,the type of PA/VSD should be defined and chromosomal test should be performed ,w hich can be helpful for prenatal consulting .

Relationship between the expression of serum BNP levels and cardiac function,heart failure in children with ventricular septal defect of congenital heart disease / 中国基层医药

Objective To explore the relationship between the expression of serum B －type natriuretic peptide(BNP) levels and cardiac function,heart failure(HF) in children with ventricular septal defect of congenital heart disease(CHD).Methods From October 2013 to July 2017,150 children with ventricular septal defect of CHD who were treated in Yuncheng Central Hospital were selected ,and they were divided into no HF group (n＝40),mild HF group(n＝46) and moderately severe HF group ( n＝64) according to the New York university pediatric heart failure index(NYU PHFI) evaluation standard.Meanwhile,148 healthy children were selected as control group.The serum BNP levels,left ventricular ejection fraction (LVEF),left ventricular ejection fraction shortening rate (LVFS), left ventricular end diastolic diameter index (LVEDDI) and cardiac output index (CI) were measured in all subjects. The levels of BNP,LVFS,LVEF,LVEDDI and CI in the study group were compared with those in the control group. The levels of BNP,LVEF,LVFS,LVEDDI and CI in children with CHD ventricular septal defect were compared.The relationship between the level of BNP and LVEF ,LVFS,LVEDDI and CI in patients with ventricular septal defect of CHD was analyzed.Results The serum level of BNP in the study group was (268.47 ±25.48) ng／L,the levels of LVEF,LVFS,LVEDDI and CI in the study group were (55.56 ±4.23)%,(27.96 ±2.74)%,(77.56 ±6.54)mm／m2, (3.35 ±0.41) L· min－1·( m2 )－1 ,respectively.The serum level of BNP in the control group was (33.41 ± 6.21)ng／L,and the levels of LVEF,LVFS,LVEDDI and CI in the control group were (65.43 ±5.12)%,(36.24 ± 3.23)%,(57.32 ±5.31) mm／m2 ,(4.27 ±0.46)L· min－1·(m2 )－1 ,respectively.The serum levels of BNP and LVEDDI in the study group were significantly higher than those in the control group (t＝109.077,29.306,all P＜0.05),while the levels of LVEF,LVFS and CI in the study group were significantly lower than those in the control group(t＝18.152,23.875,18.231,all P＜0.05).With the increased severity of HF ,the levels of BNP and LVEDDI were increased,while the levels of LVEF,LVFS and CI were gradually decreased ( F＝332.232,245.400,all P＜0.05).The level of serum BNP was negatively correlated with LVEF ,LVFS,CI(r＝－0.705,－0.692,－0.718,all P＜0.05),but it was positively correlated with LVEDDI and HF (r＝0.721,0.735,all P＜0.05).Conclusion The level of serum BNP in patients with ventricular septal defect of CHD is correlated with cardiac function indicators ,and serum BNP is positively correlated with HF in children with ventricular septal defect of CHD ,which plays an important role for the diagnosis,treatment and prognosis of HF.

Relationship between the expression of serum BNP levels and cardiac function, heart failure in children with ventricular septal defect of congenital heart disease / 中国基层医药

Objective@#To explore the relationship between the expression of serum B-type natriuretic peptide(BNP) levels and cardiac function, heart failure(HF) in children with ventricular septal defect of congenital heart disease(CHD).@*Methods@#From October 2013 to July 2017, 150 children with ventricular septal defect of CHD who were treated in Yuncheng Central Hospital were selected, and they were divided into no HF group(n=40), mild HF group(n=46) and moderately severe HF group(n=64) according to the New York university pediatric heart failure index(NYU PHFI) evaluation standard.Meanwhile, 148 healthy children were selected as control group.The serum BNP levels, left ventricular ejection fraction(LVEF), left ventricular ejection fraction shortening rate(LVFS), left ventricular end diastolic diameter index(LVEDDI) and cardiac output index(CI) were measured in all subjects.The levels of BNP, LVFS, LVEF, LVEDDI and CI in the study group were compared with those in the control group.The levels of BNP, LVEF, LVFS, LVEDDI and CI in children with CHD ventricular septal defect were compared.The relationship between the level of BNP and LVEF, LVFS, LVEDDI and CI in patients with ventricular septal defect of CHD was analyzed.@*Results@#The serum level of BNP in the study group was (268.47±25.48)ng/L, the levels of LVEF, LVFS, LVEDDI and CI in the study group were (55.56±4.23)%, (27.96±2.74)%, (77.56±6.54)mm/m2, (3.35±0.41)L·min-1·(m2)-1, respectively.The serum level of BNP in the control group was (33.41±6.21)ng/L, and the levels of LVEF, LVFS, LVEDDI and CI in the control group were (65.43±5.12)%, (36.24±3.23)%, (57.32±5.31)mm/m2, (4.27±0.46)L·min-1·(m2)-1, respectively.The serum levels of BNP and LVEDDI in the study group were significantly higher than those in the control group(t=109.077, 29.306, all P<0.05), while the levels of LVEF, LVFS and CI in the study group were significantly lower than those in the control group(t=18.152, 23.875, 18.231, all P<0.05). With the increased severity of HF, the levels of BNP and LVEDDI were increased, while the levels of LVEF, LVFS and CI were gradually decreased(F=332.232, 245.400, all P<0.05). The level of serum BNP was negatively correlated with LVEF, LVFS, CI(r=-0.705, -0.692, -0.718, all P<0.05), but it was positively correlated with LVEDDI and HF(r=0.721, 0.735, all P<0.05).@*Conclusion@#The level of serum BNP in patients with ventricular septal defect of CHD is correlated with cardiac function indicators, and serum BNP is positively correlated with HF in children with ventricular septal defect of CHD, which plays an important role for the diagnosis, treatment and prognosis of HF.

Antepartum and postpartum echocardiographic diagnosis of isolated ventricular septal defect / 中国医学影像技术

Objective To investigate the differences between prenatal and postnatal ultrasound findings in isolated ventricular septal defects.Methods Totally 244 cases of isolated ventricular septal defect were retrospectively analyzed and followed in one year after birth.All fetus were divided into the correct group and the error group according to the postnatal results.The size and type of ventricular septal defect and ventricular shunt were assessed and analyzed statistically.Results In all of the 244 cases,correct group included 181 cases and error group included 63 cases.There was no significant difference in the type of defects between two groups (P=0.061);there were significant differences in the size of postpartum defect and the velocity of ventricular shunt between the two groups (both P＜0.05),and no significant difference of the direction of shunt between two groups (P=0.408);there were significant differences in the size of defects between the prenatal and postnatal in correct groups (P＜0.05),but the direction of shunt had no significant difference (P=0.087).Conclusion There is certain detection rate in prenatal diagnosis of isolated ventricular septal defect;anatomical characteristics of defect may affect antenatal examination results.There was significant difference between prenatal and postnatal ultrasound in the same lesion.

A Case of Pulmonary Arterial Hypertension Associated with Congenital Extrahepatic Portocaval Shunt

Congenital extrahepatic portocaval shunt (CEPS) is a rare anomaly of the mesenteric vasculature in which the intestinal and splenic venous drainage bypasses the liver and drains directly into the inferior vena cava, the left hepatic vein or the left renal vein. This uncommon disease is frequently associated with other malformations and mainly affects females. Here we report a case of pulmonary arterial hypertension associated with CEPS (Abernethy type 1b shunt) in a 20-yr-old man who was incidentally diagnosed during evaluation of multiple nodules of the liver. The patient was treated by inhalation of iloprost (40 microg/day) with improved condition and walking test. Physicians should note that congenital portocaval shunt may cause pulmonary hypertension.

Hybrid Procedure for Pulmonary Atresia with Ventricular Septal Defect in a Low Birth Weight Neonate

Cardiac surgery in neonates with congenital heart disease has progressed dramatically in the past three decades. However, low-birth-weight neonates with congenital heart disease continue to challenge the intellectual and technical skills of healthcare professionals. We present a case of a low-birth-weight neonate with pulmonary atresia and a ventricular septal defect, in whom palliation was achieved with a right ventricular outflow tract stent using a hybrid procedure.

Transesophageal echocardiography guidance for occluding procedure with cardiopulmonary bypass for muscular ventricular septal defects in children / 中华超声影像学杂志

Objective To discuss the application value of transesophageal echocardiography (TEE) in occluding procedure with cardiopulmonary bypass (CPB) for children muscular ventricular septal defects (mVSD).Methods Forty-nine mVSD patients for occluding procedure with CPB were performed guided and monitored by TEE,9 cases were simple mVSD,40 were mVSD combined with other cardiac malformations.The location,size,number,scope and the surrounding anatomy of mVSD were carefully observed before going into cardiac arrest,preparing the operator to choose appropriate occluder devices.The procedure was evaluated after the recovery of heart beat using TEE.Results In all of the 49 patients underwent occluding procedure,44 cases were implanted into one occluder,5 implanted into two occluders.The results of TEE after operation showed that the positions of all occluders were not shifted,2 had trace residual shunt,there were no complications worsening,such as mitral and aortic regurgitation,etc.One patient abandoned treatment for serious infection,the other patients' occluders were all in normal position followed up at 6 months to 2 years after operation,there were no tiny residual shunt and valves regurgitation except 1 patient.Conclusions The technique that TEE guiding and monitoring in occluding procedure with cardiopulmonary bypass for children muscular ventricular septal defects can shorten the time of cardiopulmonary bypass,significantly reducing complications and risks of the surgery,improving the successful rate.

Application of transesophageal echocardiography in min-invasive hybrid procedure for intracristal ventricular septal defects in children / 中华超声影像学杂志

Objective To evaluate the clinical outcome of transesophageal echocardiography(TEE) in guiding and monitoring min-invasive transthoracic hybrid procedure for intracristal ventricular septal defects (VSD) using eccentric occluders.Methods 13 patients with intacristal VSD successfully underwent the min-invasive hybrid procedure using eccentric occluders were analyzed retrospectively.They were all carefully examined by transthoracic echocardiography (TTE) preoperatively and were diagnosed as intracristal VSD.There were no obvious aortic valve prolapse and no severe regurgitation.The entire process was guided and monitored by TEE.The condition of VSD occlusion was assessed by immediate postoperative TEE.Results All cases were occluded successfully.The results of postoperative TEE showed that the occluder was coincided closely with the edge of VSD,no aortic valve regurgitation worsen.2 had tiny residual left-to-right shunt (＜1.5 mm),which disappeared 1 and 3 months respectively after operation.No occluder dislocated followed-up at 6 months to 2 years postoperatively,and no major complications occurred.Conclusions The min-invasive hybrid procedure for intracristal VSD using eccentric occluders guided and monitored by TEE is easy to manipulate,which is safe,less invasive,and has excellent early-term results.

Comparison study among a new continuous stitching and two classical methods in repairing large perimembranous ventricular septal defect / 中国医师进修杂志

Objective To compare the effect of repairing large perimembranous ventricular septal defect (VSD) with a new continuous stitching and two classical methods. Methods From January 2005 to January 2008,321 cases with VSD were operated. All the cases were divided into 3 groups according to operational way, with discontinuous stitching in group A (70 cases), continuous stitching in group B(116 cases),new continuous stitching in group C (135 cases). All the patients were total corrected with hypothermic cardiopulmonary bypass. Results Group C had the shortest cardiopulmonary bypass and aortic cross-clamp times [(48 ± 36) min and (26 ± 18) min]among the three groups (P < 0.05). Group C had not residual shunt and incidence rate was lowest among the three groups (P < 0.05). Temporary second degree auriculo-ventricular bolck (AVB) was found in the early stage and no third degree AVB among the three groups. Tricuspid regurgitation was higher in group A,but there was no significant difference between group B and group C. Follow-up was completed in a duration of 1-3 years and all the cases had a good health after discharged. Conclusions The new continuous stitching method has short eardiopulmonary bypass and aortic cross-clamp times. It has fewer residual shunt than other two classical methods and has no evidence of higher AVB occurrence.

Surgery for a Muscular Type Ventricular Septal Defect via Right Apical Ventriculotomy: A case report / 대한흉부외과학회지

Apical muscular ventricular septal defects (VSDs) are relatively rare conditions among all the different types of VSDs. Apical VSDs are difficult to treat because of they are difficult to visualize through a trans-atrioventricular approach, and especially in infants. Treatment by left ventriculotomy is associated with long-term ventricular dysfunction. Catheter-based intervention still shows less than satisfactory results and this type of intervention may not be possible in small infants. This report describes the benefits of right apical ventriculotomy in terms of successful closure of the lesion without harming the ventricular function.

Initial exploration of occlusive devices of ventricular septal defect by stereo 3-dimensional echocardiography / 中华超声影像学杂志

Objective To accurately investigate the characteristic and effective of occlusive devices in ventricular septal of defect (VSD) by using stereo 3D echocardiography. Methods Six patients with VSD were included who were undergone the defect closing operation with Amplatzer occluder device. Stereo 3D echocardiography was performed to show 3DE imaging appearance after the operative procedure. Results Stereo 3D echocardiography were performed after the procedure of implanting occluder device. It was clear to show the location of the occluder and the space relationship of each parts. Conclusions The appearance,location and space relationship of occluder could be seen clearly by stereo 3D echocardiography after implanting occluder device. Compare with 2D, real-time 3D echocardiography, stereo 3D echocardiography could provide more veracious information about heart structures and the therapeutic devices for clinical use.

Aortic Translocation for Complete Transposition of the Great Arteries with a Ventricular Septal Defect and Pulmonic Stenosis / 대한흉부외과학회지

The Rastelli operation has been a standard procedure for repairing complete transposition of the great arteries combined with a ventricular septal defect and pulmonary stenosis. Yet this procedure has several shortcomings, including the risk of incurring left ventricular outflow tract obstruction on long-term follow-up. In this regard, aortic translocation has recently been regarded as a potent alternative to Rastelli's operation. We report here on a case of complete transposition of the great arteries that was combined with an inlet-extended perimembranous ventricular septal defect and pulmonary stenosis in a 2-year-old boy. All the problems were successfully repaired using the aortic translocation technique. Postoperative echocardiography showed a straight and wide left ventricular outflow tract.

Hybrid Procedure for Muscular Ventricular Septal Defects: 2 case reports / 대한흉부외과학회지

Although surgical closure is the standard approach for a muscular ventricular septal defect, the procedure may be complicated by poor visualization and the need for incision on the ventricle. Another approach is catheter-based intervention. However, it also has limitations. A hybrid procedure, the intraoperative combined use of an interventional device may reduce the procedure's invasiveness. We successfully managed two cases of muscular ventricular septal defect with a hybrid procedure. We report here on these 2 cases along with a review of the literature.

A Case Report of Restrictive Ventricular Septal Defect & Left Ventricular Out Flow Tract Stenosis Caused by Fibrotic Tissue in Tetralogy of Fallot / 대한흉부외과학회지

The VSD in TOF is usually large and unrestrictive with an equal to or greater than that of the aortic annulus. Typically shunting through the VSD is bidirectional or right-to-left component. Restrictive VSD in TOF caused by ingrowing fibrotic tissue is very rare. We report a case of restrictive VSD and LVOTO in TOF caused by ingrowing fibrotic tissue with the review of literature.

Robotic Assisted Surgery in Adult Patient with Congenital Ventricular Septal Defect / 대한흉부외과학회지

Robotic assisted surgery in adult patient with congenital ventricular septal defect Since December in 2005, we have done minimally invasive surgeries in selected cases of mitral valve diseases, tricuspid valve diseases, atrial septal defects and atrial fibrillations with the AESOP(TM) robotic arm. We have had a better surgical view and skill, according to accumulation of the experience of this procedure. Recently, we performed robotic assisted surgery in a 47-year-old female with congenital perimembranous ventricular septal defect.

Half-turned Truncal Switch Operation for Transposition of Great Arteries, Ventricular Septal Defect and Pulmonic Stenosis / 대한흉부외과학회지

The surgical management of patients with transposition of the great arteries, ventricular septal defect, and pulmonary stenosis remains a challenge. The Rastelli operation or Lecompte operation is the preferred surgical procedure, but its long-term results are not optimal because of a warped left ventricular outflow tract through a space-occupied intraventricular tunnel and a contrived right ventricular outflow tract. We performed a half-turned truncal switch operation as an alternative surgical procedure in a 3-year-old boy (weighing 9.6 kg) with this anomaly. Postoperative echocardiography showed laminar flow through straight and nonobstructive aortic and pulmonary ventricular outflow tracts.

Repair of Postinfarction Ventricular Septal Defect / 대한흉부외과학회지

BACKGROUND: Ventricular septal defect (VSD) is rare but feared complication after acute myocardial infarction. The patient could survive by surgery only, but the surgical mortality is still high. We investigate the surgical result and predictors for early surgical mortality. MATERIAL AND METHOD: Between August 1993 and February 2006, 8 patients (male, 2; female, 6) with postinfarct VSD underwent surgical repair. Seven patients had one-vessel disease of left anterior descending artery, and 6 of them had wide extension of infarction to posterior septal wall as well as anterior septal wall of both ventricles. One patient had concomitant coronary bypass grafting to a coronary lesion unrelated to the infarction. Two patients had concomitant tricuspid annuloplasty and 1 patient mitral valvuloplasty. RESULT: Surgical mortality was 37.5% (3 patients). They all had only one-vessel disease of left anterior descending artery, which made extended posterior septal wall infarction as well as anterior septal wall infarction of both ventricles. In preoperative M-mode echocardiographic study of left ventricle, they had lower ejection fraction than survivors (34.9+/-4.2 vs. 54.8+/-12.3; p=0.036). CONCLUSION: Most of patients with postinfarction VSD had one-vessel disease of left anterior descending artery. Early surgical mortality occurred in the patients with poor ejection fraction of left ventricle and the wide anterior septal wall infarction extending to the posterior septum.

Aoric Valve Lesion in Type I Ventricular Septal Defect / 대한흉부외과학회지

BACKGROUND: In this study, we investigated the risk factors for the development or progression of aortic regurgitation(AR) in patients with type I ventricular septal defect (VSD) to determine the optimal surgical timing and strategy. MATERIAL AND METHOD: Three-hundred and ten patients with type I VSD with or without AR were included. The mean of age was 73.7+/-114.7 (1~37) months. One hundred and eighty six patients (60%) had no AR, 83 (27%) had mild AR, 25 (8%) had moderate AR and 16 (5%) had severe AR. Aortic valve was repaired in 5 patients and replaced in 11 patients with closure of VSD in the first operation. Four patients required redo aortic valve repair and 11 patients required redo aortic valve replacement. Age at operation, association with aortic valve prolapse, Qp/Qs, systolic pulmonary arterial pressure, VSD size and systolic pulmonary artery to aortic pressure ratio(s[PAP/AP]) were included as risk factors analysis for the development of AR. The long-term result of aortic valve repair and aortic valve replacement were compared. RESULT: Older age at operation, association with aortic valve prolapse, high Qp/Qs, and s[PAP/AP] were identified as risk factors for the development of AR (p<0.05, Table 2). The older the patient at the time of operation, the higher the severity of preoperative AR and the incidence of postoperative AR (p<0.05, Table 1, Fig. 1). For the older patients at operation, aortic valve repair had higher occurrence of AR compared to those who had aortic valve replacement (p<0.05, Fig. 2). CONCLUSION: From the result of this study, we can concluded that early primary repair is recommended to decrease the progression of AR. Aortic valve repair is not always a satisfactory option to correct the aortic valve pathology, which may suggest that aortic valve replacement should be considered when indicated.

Repair of Postinfarction Ventricular Septal Defect on a Beating Heart: One case report / 대한흉부외과학회지

Postinfarction ventricular septal defect often induces cardiogenic shock and requires operative treatment early after myocardial infarction. Although the operative mortality of this disease has decreased during the past 3 decades, it is still relatively high. In this case, to prevent global myocardial ischemia, we used the technique of repair of postinfarction ventricular septal defect on a beating heart. This approach does not require aortic cross-clamping and provides superior myocardial protection.

Interrupted Aortic Arch with Apical Muscular Ventricular Septal Defect Associating Esophageal Atresia with Tracheoesophageal Fistula / 대한흉부외과학회지

Interrupted aortic arch with concomitant intracardiac defects is a rare congenital anomaly that has an unfavorable natural course. We report a successful staged operation of interrupted aortic arch with apical muscular ventricular septal defect associating esophageal atresia with tracheoesophageal fistula in a 3-day-old neonate weighing 2.6 kg. We repaired esophageal atresia through the right thoracotomy and subsequently performed extended end-to-end anastomosis of the aortic arch with pulmonary artery banding through the left thoracotomy at same operation. The apical muscular VSD was repaired 87 day after first operation. The patient required multiple additional interventions before closure of the apical muscular ventricular septal defect, such as pyloromyotomy for idiopathic hypertrophic pyloric stenosis, anterior aortopexy for airway obstruction, and balloon aortoplasty for residual coarctation. She is now doing well.