Observation of the effectiveness of transthoracic closure therapy for ventricular septal defects with a distance from the superior margin of the defect to the aortic valve ≤2 mm
LIU Gui-dong
ZHANG Feng
HUANG Xiao-bi
ZHU Wen-qing
Abstract：Objective To observe the effectiveness of ultrasound-guided thoracoscopic minimally invasive occlusion therapy for the treatment of perimembranous ventricular septal defects with the upper margin of the defect ≤2 mm from the aortic valve in children.Methods A retrospective analysis was conducted on 110 children with perimembranous ventricular septal defects with the upper margin of the defect ≤2 mm from the aortic valve admitted to Anhui Provincial Children's Hospital from March 2017 to August 2023.The patients were divided into a surgical group(n=61)and an occlusion group(n=49)based on the surgical approach.The surgical group underwent traditional repair surgery under extracorporeal circulation,while the occlusion group received ultrasound-guided thoracoscopic minimally invasive occlusion therapy.The operation time,ventilator assistance time,intensive care unit stay time,total intraoperative blood loss,postoperative hospital stay,perioperative complications,and echocardiographic parameters at 6 months postoperatively were recorded for both groups.Results The operation time,mechanical ventilation time and the postoperative hospital stay in the occlusion group were significantly shorter than the surgery group[61.8(49.8,77.4)min vs.140.0(130.0,160.0)min、100.0(67.5,120.0)min vs.210.0(175.0,240.0)min、4.0(3.0,5.0)d vs.6.0(6.0,6.0)d,all P＜0.05].The median total blood loss was less in the occlusion group than in the surgery group[0.0(0.0,62.5)ml vs.115.0(90.0,140.0)ml,P＜0.05].The incidence of postoperative complications has no significant difference between the two groups(P＞0.05).There was no significant difference in the incidence of arrhythmia between the two groups(P＞0.05).The incidence of new valvular regurgitation in the occlusion group was higher than that in the surgery group(8.2％vs.0％,P＜0.05).Conclusion Ultrasound-guided transthoracic occlusion for children with perimembranous ventricular septal defects with the upper edge of the defect ≤2 mm from the aortic valve.For cases without combined aortic valve regurgitation,the therapeutic effect is satisfactory.It is a safe and feasible surgical method.
Keywords：Ventricular septal defectAortic valve prolapseThoracoscopic minimally invasive occlusionEchocardiographyCardiopulmonary bypass
Publication Date：2024-10-10
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 929-933 )