Case report: Recovery of long-term delayed complete atrioventricular block after minimally invasive transthoracic closure of ventricular septal defect.

Introduction: Long-term delayed complete atrioventricular block (CAVB) is a serious complication of ventricular septal defect (VSD) closure treatment. Thus, cardiac surgeons have made significant efforts to explore its causes and reduce its incidence. In recent years, minimally invasive transthoracic closure (MITC) of VSD has been used widely and successfully in China as it is easy to repeat, ensures individualized closure, and can be debugged repeatedly. Theoretically, the possibility of the recurrence of CAVB is lower than that with transcatheter closure. Although the incidence of CAVB after MITC of VSD is inevitable, long-term delayed CAVB has rarely been reported. Case description: Herein, we report a case of delayed CAVB that occurred 2 years and 5 months after performing MITC of a perimembranous VSD. The cardiac rhythm recovered after the occluder was removed surgically. Conclusion: The findings of our case report emphasize that since delayed CAVB may occur in the long term after MITC of VSD, the safety of MITC of VSD should be reassessed, the indications for MITC should be strictly followed, and long-term follow-up, including lifelong follow-up, is recommended for patients postoperatively. In addition, the occluder should be removed surgically in patients with CAVB as it may restore normal heart rhythm.

Risk factors for atrioventricular block after occlusion for perimembranous ventricular septal defect.

BACKGROUND: The risk factors for complete atrioventricular block (CAVB) after device closure of perimembranous ventricular septal defect (pmVSD) remain unclear. OBJECTIVE: The purpose of this study was to analyze the incidence and risk factors for CAVB after device closure for pmVSD. METHODS: We reviewed 1884 patients with pmVSD who had undergone successful device occlusion between June 2005 and January 2020. Permanent CAVB was defined as CAVB requiring implantation of a permanent pacemaker (PPM) or extraction of the occluder. RESULTS: In total, 14 patients (0.7%) developed permanent CAVB. Of these patients, 10 (0.5%) required PPM implantation. Four permanent CAVB occurred within 7 days after the procedure (acute), 2 between 7 and 30 days (subacute), 3 between 30 days and 1 year (late), and 5 more than 1 year (very late). None of the subacute, late, and very late CAVB recovered normal conduction with medication and eventually required device removal or PPM implantation. Four patients with acute CAVB and 1 with subacute CAVB underwent device removal, and 4 (80%) recovered normal conduction. Multivariate regression revealed that the ratio of device to defect size was the only independent risk factor for permanent CAVB (odds ratio 3.027; 95% confidence interval 1.476-6.209; P = .003). CONCLUSION: The incidences of permanent CAVB after occlusion for pmVSD and PPM implantation were 0.7% and 0.5%, respectively. The ratio of device to defect size was the only independent risk factor for permanent CAVB. Device removal is an effective therapeutic modality for recovering normal conduction in acute and subacute CAVB patients.

Outcomes of Three Different Minimal Invasive Approaches for Secundum Atrial Septal Defect Closure: A Single Institute Experience.

OBJECTIVE: The aims of this retrospective study were to investigate and evaluate the safety and efficacy of three approaches for closure of secundum atrial septal defect (ASD). METHODS: In this study, we reviewed clinical data for transcatheter occlusion (TCO, n=63), transthoracic occlusion (TTO, n=55), and right anterolateral minithoracotomy (RALT, n=60) techniques used for ASD closure. We compared the safety and efficacy of the three approaches. RESULTS: ASD size in the TTO group was similar to that in the RALT group (P=0.645) and significantly larger than that in the TCO group (P<0.001). The RALT group had more non-central types of ASD than the TTO and TCO groups (P=0.019 and P<0.001). The operative time in the TTO group was shorter than that in the TCO and RALT groups (P<0.001 and P<0.001). The ventilation time and intensive care unit duration were shorter in the TTO group than in the RALT group (P<0.001 and P<0.001). Hospital duration in the TCO group was shorter than that in the TTO and RALT groups (P<0.001 and P<0.001). There were no residual shunt and mortality in any group in hospital or during follow-up. There was no significant difference in the incidence of total complications among the three groups (P=0.738). CONCLUSION: TCO, TTO, and RALT can be performed with favorable cosmetic and clinical results for closing ASD. Appropriate patient selection is an important factor for successful closure. These techniques are promising alternatives to standard median sternotomy and merit additional study.

Clinical efficacy of transthoracic occlusion via a right subaxillary incision and conventional surgery in the treatment of ventricular septal defect: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To analyze the clinical efficacy of transthoracic occlusion via a right subaxillary incision and conventional surgery in the treatment of ventricular septal defect (VSD). Methods    The clinical data of patients with congenital VSD undergoing right subaxillary incision surgery in our hospital from January 2017 to January 2020 were retrospectively analyzed. According to the surgical methods, the patients were divided into two groups: a conventional surgery group (conventional group) and a transthoracic occlusion group (occlusion group). There were 221 patients in the conventional group, including 97 males and 124 females, with an average age of 2.6±2.2 years and an average weight of 13.4±6.2 kg; there were 185 patients in the occlusion group, including 90 males and 95 females, with an average age of 3.2±2.6 years and an average weight of 14.7±6.6 kg. The clinical effectiveness was compared. Results    The success rate of surgery was 100% in both groups. The intraoperative blood loss was less in the occlusion group (P<0.05). The incision length, operation time, postoperative mechanical ventilation time, retention time in the intensive care unit, the time to resume normal diet and normal activities after operation were all shorter than those in the conventional group (P all <0.05). The total cost during hospitalization of the conventional group was less than that of the occlusion group (P<0.001). There was no statistical difference in the incidence rate of perioperative complications between the two groups (P>0.05). During the follow-up (15.8±8.8 months), the incidence of complications in the conventional group was higher than that in  the occlusion group with a statistical difference (P<0.001). Conclusion    Compared with conventional surgery, transthoracic occlusion for VSD via right subaxillary incision has the advantages of smaller incision, shorter operation time, less blood loss, shorter postoperative recovery time and less long-term complications. However, the total hospitalization cost is relatively high, mainly because of the high consumables cost, and the long-term effects still need further comparative observation.

Contrastive study on the efficacy and safety between transcatheter patent ductus arteriosus closure and mini-incision transthoracic occlusion in children / 中华实用儿科临床杂志

Objective To evaluate efficacy and safety of transcatheter patent ductus arteriosus(PDA) closure compared with mini-incision transthoracic occlusion in children.Methods The safety and complications of 175 patients who underwent transcatheter closure(transcatheter group) hospitalized in Department of Pediatrics,Linyi People's Hospital were analyzed,the ages ranging from 3 months to 14 years,and the material used was Chinese homemade occluder except for the spring coil.Compared with the 157 patients who underwent mini-incision transthoracic occlusion (mini-incision group) hospitalized in Department of Heart Surgery,Linyi People's Hospital from Jan.2009 to Nov.2013,the ages ranging from 5 months to 14 years,the material used was same as the transcatheter group.Acquired data was processed through statistics.Results One hundred and seventy-one of the 175 patients achieved success in the transcatheter group,technically success rate was 97.71％,there were 8 patients with complications,but no death,the occurrence rate of complications was 4.57％ ;however,137 of 157 patients achieved success in the mini-incision group,technically success rate was 87.26％,there were 21 patients with complications and 1 death,the occurrence rate of complications was 13.38％.Success rate of the transcatheter group was much higher than the mini-incision group(x2 =8.05,P ＜ 0.01),while complications of the transcatheter group was significantly less than the mini-incision group(x2 =13.48,P ＜ 0.01),and also the transcatheter group had less hemorrhage during operation,shorter operation time,shorter hospital stay and less hospital expenses compared with the mini-incision group [(0.021 ± 0.007) L vs (0.088 ± 0.027) L,(36.81± 7.19) minvs (88.65 ±27.92) min,(4.16±0.45) dvs (10.68 ±2.38) d,(27 943.6± 2754.1) RMBvs(35037.4±8659.2) RMB;t=29.23,22.19,33.44,18.47,allP＜0.01].Conclusions Transcatheter PDA closure in children is better than mini-incision transthoracic occlusion because of its higher efficacy and lower risk,so it is the first choice of treatment to the children with PDA.