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Titolo:
Outcomes of intraoperative device closure of muscular ventricular septal defects
Autore:
Okubo, M; Benson, LN; Nykanen, D; Azakie, A; Van Arsdell, G; Coles, J; Williams, WG;
Indirizzi:
Univ Toronto, Sch Med, Hosp Sick Children, Dept Pediat & Surg, Toronto, ON, Canada Univ Toronto Toronto ON Canada , Dept Pediat & Surg, Toronto, ON, Canada Univ Toronto, Sch Med, Hosp Sick Children, Div Cardiol & Cardiovasc Surg, Toronto, ON, Canada Univ Toronto Toronto ON Canada ol & Cardiovasc Surg, Toronto, ON, Canada
Titolo Testata:
ANNALS OF THORACIC SURGERY
fascicolo: 2, volume: 72, anno: 2001,
pagine: 416 - 423
SICI:
0003-4975(200108)72:2<416:OOIDCO>2.0.ZU;2-1
Fonte:
ISI
Lingua:
ENG
Soggetto:
TRANSCATHETER CLOSURE; SURGICAL CLOSURE; DOUBLE UMBRELLA; CANINE MODEL; VSD OCCLUDER; MANAGEMENT; REPAIR;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
32
Recensione:
Indirizzi per estratti:
Indirizzo: Benson, LN Hosp Sick Children, Div Cardiol, 555 Univ Ave, Toronto, ON M5G 1X8, Canada Hosp Sick Children 555 Univ Ave Toronto ON Canada M5G 1X8 anada
Citazione:
M. Okubo et al., "Outcomes of intraoperative device closure of muscular ventricular septal defects", ANN THORAC, 72(2), 2001, pp. 416-423

Abstract

Background. The surgical management of muscular ventricular septal defects(mVSD) in the small infant is a challenge particularly when multiple and associated with complex cardiac lesions. Devices for percutaneous implantation have the advantage of ease of placement and for the double umbrella designs a wide area of coverage. We reviewed our experience and clinical outcomes of intraoperative mVSD device closure for such defects in small infants. Methods. Since October 1989, intraoperative VSD device closure was a component of the surgical strategy in 14 consecutive patient implants (median age, 5.5 months; range, 3 to 11 kg), whose defects were thought difficult to approach using conventional techniques. Nine patients had associated complex cardiac lesions, 10 multiple mVSDs, and 4 patients had a previous pulmonary artery banding. Results. There were 2 early deaths, 1 in a severely ill child who preoperatively had pulmonary hypertension and left ventricular failure and another in a patient with a hypoplastic left heart. Mean pulmonary to systemic flowratio before device insertion was 3.5:1. Complete closure was achieved in 5 patients and clinically insignificant residual shunts persisted in 7. In 2 infants with significant residual lesions concomitant pulmonary artery banding was required. Postoperative mean pulmonary to systemic flow ratio was1.7:1. In follow-up of the 12 surviving infants (mean, 41 months), 8 had complete closure and 3 persistent residual shunts. One patient with no residual shunting required heart transplantation for progressive ventricular failure 9 years after operation. All devices were well positioned on postoperative echocardiograms. There was 1 late death due to aspiration in a patientwith a tiny residual shunt. Conclusions. Infants requiring operative intervention with mVSDs are difficult to manage and have an increased mortality and morbidity. Intraoperative VSD device placement for closure of mVSDs is feasible, can avoid ventriculotomy, division of intracardiac muscle bands, and is ideally suited for the neonate or infant. (C) 2001 by The Society of Thoracic Surgeons.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 02/04/20 alle ore 13:01:26