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This report describes the echocardiographic features of an indirect Gerbode defect in a young cat. Echocardiography revealed high-velocity, turbulent systolic flow directed from left ventricle to right ventricle through a ventricular septal defect. The flow immediately entered the right atrium through a tricuspid septal leaflet. The indirect-type Gerbode defect was confirmed through necropsy. When a high-velocity turbulent flow in the RA without pulmonary hypertension is observed on echocardiography, Gerbode defect should be considered.
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Animals , Cats , Echocardiography , Heart Atria , Heart Septal Defects, Ventricular , Heart Ventricles , Hypertension, PulmonaryABSTRACT
Objective This study was aimed to discuss the safety, feasibility and availability of perimembranous ventricular septal defects(PmVSD) closure via super minimal intercostal incision under transesophageal echocardiography(TEE) guidance in children.Methods There were 81 cases of PmVSD via super minimally invasive transintercostal device closure operation(length of incision ≤ 1cm) from August 2014 to August 2016.TEE was used to guide and monitor the entire procedure.Assessed the effectiveness of device closure by postoperative regular follow-up.Results 80 patients were successfully operated by super minimally invasive transintercostal device closure in all 81 cases.Operation success rate reached 98.77%.The average diameter of ventricular septal defects was(3.72±0.96)mm.The average diameter of amplatzer occluder was(4.88±0.95)mm.Postoperative follow-up time was from 6 months to 24 months.One of 16 cases that with aneurysm of membranous septum had more than two shunts, remained a mild residual shunt beside of the amplatzer occluder but self cured during follow-up.Mild pericardial effusion was found in one patients after the operation and disappeared during follow-up.There were no cases of perioperative death, device deformation or displacement, residual shunt, complete atrioventricular block and valve involvement in the patients whom were successfully operated.One patient transferred to ventricular septal defect repair operation under direct visualization with a cardiopulmonary bypass, because ventricular fibrillation happened when guide wire passed the ventricular septal.Conclusion Super minimally invasive transintercostal device closure of PmVSD in children guided by TEE was safety and availability, that could avoid x-ray radiation and sternotomy, and operate simply, with small incision and low complication.
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Objective To investigate the characteristics of the newly discovered tricuspid injury during the fol-low -up of the patients with interventional transcatheter closure for perimembranous ventricular septal defect (VSD). Methods A retrospective analysis of clinical data was performed in the successful completion of membranous VSD in-tervention from March 2003 to April 2015,and 11 cases of serious tricuspid injury in children were found during the fol-low -up.Results Among 11 children,10 cases underwent surgery again,and in 7 cases of them with pseudoaneurysm of perimembranous septum,the occluders were deviated toward the right ventricul which caused valvular inadequacy for plate winding closures,extrusion and wear of tricuspid chordae and /or leaflet by right ventricul(RV)disc.Among them,1 case was caused by leaflet fusion tear and tricuspid valve insufficiency;3 cases without pseudoaneurysm were caused by a spindle like RV disc recovery structure protruding into the right ventricle,and then the disc squeezed the tricuspid tendinous cord or leaflet and the right ventricular disc nut wrapped tendon of tricuspid valve finally leading to tricuspid valve insufficiency.There was a small amount of tricuspid regurgitation after surgery;the cardiac size and car-diac function returned to normal.One case did not receive surgery,and at present the right atrium and right ventricle were significantly enlarged,and the activity was limited.Conclusions Tricuspid injury discovered newly after perimem-branous VSD interventional therapy is more common in pseudoaneurysm with large tumor occluding the right ventricular disc resulting in poor formation,and it is important to consider these factors in choosing the size of the occluder and the operation.Long term follow -up mechanism should be established for the treatment of VSD after interventional therapy.
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Objective To evaluate the short-term effectiveness of Amplatzer device closure for congenital heart diseases.Methods Under X-ray fluoroscopy or/and transthoracic echocardiography(TTE),percutaneous puncture of the femoral artery or vein was conducted and the Amplatzer occluder was passed through the catheter.Effectiveness evaluation by transthoracic echocardiography,electrocardiography(ECG),and X-ray examination was applied at 24 hours,1 month,6 months,and every 1 year after the procedure.Results In 1 case of perimembranous ventricular septal defect(VSD),the detachment of the Amplatzer occluder to the arch of aorta was due to an inadequate small size.This patient was immediately operated with successful removal of the device through the femoral artery and later underwent a re-deployment of a larger-sized Amplatzer occluder closure successfully.The remaining 29 patients with atrial septal defect(ASD),patent ductus arteriosus(PDA),or perimembranous ventricular septal defect underwent a successful deployment of the Amplatzer occluder on one session without complications.The operation time was 20~90 min (38?16 min),the X-ray exposure time was 5~45 min(18?10 min),and the length of hospital stay was 3~7 days(4?2 days).Conclusions Amplatzer occluder transcatheter closure of congenital heart diseases has advantages of simplicity of deployment,good safety,and high success rate.This procedure is suitable for patients with secundum ASD,membranous VSD,and PDA.
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Objective To identify the risk factors resulting in arrhythmias after transcather closure of perimembranous ventricular septal defects in patients under 18 years old so as to decrease the incidence of arrhythmias after the interventional catheterization.Methods The types and risk factors of arrhythmias were analysed in 89 cases who underwent transcather closure of perimembranous ventricular septal defect from Jun. 2002 to Jun. 2004. Results Total procedures were attempted in 89 cases successfully. 11cases were developed various kinds of block conduct. The up margin of defects to the aortic valve
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Objective To evaluate the possibility, methods and efficiency of simultaneous transcatheter therapy for perimembranous ventricular septal defect(PMVSD) combined with atrial septal defect(ASD).Methods Four patients with PMVSD combined with ASD, including 3 males and 1 female, age ranging from 12 to 26 years; underwent simultaneous attempted transcatheter therapy. The diameters of PMVSD were 3-6 mm and the distances from the defect rim to aortic valve were 2-6 mm by the echocardiography before the precedure. The stretched diameter of ASD was 6-10 mm. PMVSD were occluded using homemade two-disc PMVSD occluder first and the ASD were occluded later on. Results All patients were treated successfully at one time. The diameter of PMVSD were 3.5-10.0 mm, the diameters of occluder was 4-12 mm. The stretched diameter of ASD was 6-10 mm and the occluder diameter was 6-12 mm. No residual shunt was found by the transthoracic echocardiography and left ventriculography after the occluders deployed. No complication occurred. Conclusion Simultaneous transcatheter therapy for PMVSD combined with ASD is feasible, safe and effective.