The application of left anterior minimally invasive thoracotomy to surgical repair of subarterial ventricular septal defect in children_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANG Zhaolei ¹ ,  MEI Ju ¹ , TANG Min ¹ , MA Nan ¹ , LIU Hao ¹ , SHEN Sai'e ² , DING Fangbao ¹ , BAO Chunrong ¹

1. Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, P.R.China;
2. Department of Anesthesiology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, P.R.China;

Corresponding author：

MEI Ju, Email: ju_mei63@126.com

Keywords：

Minimally invasive surgery; subarterial ventricular septal defect; surgical repair; children

DOI：

10.7507/1007-4848.201908074

Video：

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Objective To summarize the application and clinical effect of left anterior minimally invasive thoracotomy to surgical repair of subarterial ventricular septal defect (VSD) in children.Methods From October 2015 to April 2019, 21 children with subarterial VSD underwent surgical repair via left anterior minimally invasive thoracotomy. There were 13 males and 8 females, aged 5-13 (9.1±2.2) years, and weighing 22-55 (35.6±9.5) kg. The diameter of subarterial VSD was 4-15 (9.1±3.3) mm. Eight patients had right coronary valve prolapse, and 4 aortic valve regurgitation (3 mild and 1 mild-to-moderate). The minimally invasive surgery was performed via left parasternal thoracotomy through the second or third intercostal space. The peripheral perfusion was performed with femoral arterial and venous cannulation. After aortic cross-clamp (ACC), subarterial VSD was performed with direct suture of patch closure through an incision on the root of pulmonary artery.Results All patients successfully underwent surgical repair (patch closure, n=15; direct suture, n=6) of subarterial VSD through left anterior minimally invasive thoracotomy. The cardiopulmonary bypass time was 45-68 (57.1±6.3) min. The ACC time was 23-40 (32.6±4.7) min. The postoperative ventilation time was 5-9 (6.3±1.3) h, postoperative in-hospital time was 5-8 (5.7±1.0) d and drainage volume was 33-105 (57.5±17.7) mL in postoperative 24 h. No death, residual VSD shunt, atrioventricular block, wound infection or thoracic deformity occurred during the perioperation or follow-up. Only one patient still had trivial aortic valve regurgitation.Conclusion Left anterior minimally invasive thoracotomy could be safely and effectively applied to surgical repair of subarterial VSD in children, with satisfactory early- and mid-term outcomes.

Citation： JIANG Zhaolei, MEI Ju, TANG Min, MA Nan, LIU Hao, SHEN Sai'e, DING Fangbao, BAO Chunrong. The application of left anterior minimally invasive thoracotomy to surgical repair of subarterial ventricular septal defect in children. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(2): 152-155. doi: 10.7507/1007-4848.201908074 Copy

1.	Dieberg G, Smart NA, King N. Minimally invasive cardiac surgery: A systematic review and meta-analysis. Int J Cardiol, 2016, 223: 554-560.
2.	Liao Y, Long X, Zhu S, et al. Minimally access via left anterior mini-thoracotomy for repair of adult subarterial ventricular septal defects. J Cardiothorac Surg, 2017, 12(1): 48.
3.	张伟华, 罗鸿, 张新, 等. 右侧腋下直切口在小儿干下型室间隔缺损修补术中的应用. 中国胸心血管外科临床杂志, 2014, 21(4): 473-477.
4.	Hong ZN, Chen Q, Lin ZW, et al. Surgical repair via submammary thoracotomy, right axillary thoracotomy and median sternotomy for ventricular septal defects. J Cardiothorac Surg, 2018, 13(1): 47.
5.	Chiu SN, Wang JK, Lin MT, et al. Aortic valve prolapse associated with outlet-type ventricular septal defect. Ann Thorac Surg, 2005, 79(4): 1366-1371.
6.	Cheung Y, Chiu C, Yung T, et al. Impact of preoperative aortic cusp prolapse on long-term outcome after surgical closure of subarterial ventricular septal defect. Ann Thorac Surg, 2002, 73(2): 622-627.
7.	Tariq W, Farhan ARM, Raza BA. Doubly committed subarterial ventricular septal defect repair: An experience of 51 cases. Pak J Med Sci, 2017, 33(5): 1112-1116.
8.	Eroglu AG, Atik SU, Sengenc E, et al. Evaluation of ventricular septal defect with special reference to the spontaneous closure rate, subaortic ridge, and aortic valve prolapse Ⅱ. Pediatr Cardiol, 2017, 38(5): 915-921.
9.	Chen ZY, Ma YJ, Pan WZ, et al. Transfemoral device occlusion and minimally invasive surgical repair for doubly committed subarterial ventricular septal defects. Pediatr Cardiol, 2015, 36(8): 1624-1629.
10.	俞劲, 张泽伟, 叶菁菁, 等. 食管超声引导下经左侧胸骨旁肋间小切口封堵小儿干下型室间隔缺损. 中华小儿外科杂志, 2018, 39(8): 589-593.
11.	Lin K, Zhu D, Tao K, et al. Hybrid perventricular device closure of doubly committed subarterial ventricular septal defects: Mid-term results. Catheter Cardiovasc Interv, 2013, 82(3): E225-E232.
12.	Pan S, Xing Q, Cao Q, et al. Perventricular device closure of doubly committed subarterial ventral septal defect through left anterior minithoracotomy on beating hearts. Ann Thorac Surg, 2012, 94(6): 2070-2075.
13.	刘健, 唐先成, 黄击修, 等. 食管超声引导下先天性房/室间隔缺损封堵 188 例的效果及影响因素分析. 中国胸心血管外科临床杂志, 2018, 25(12): 51-54.
14.	伍成德, 刘鹏, 林巍, 等. 经胸微创封堵与体外循环治疗不同直径干下型 VSD 疗效分析. 海南医学, 2017, 28(18): 2974-2978.
15.	王欣, 赵天力, 吴勤, 等. 经胸微创封堵术与体外循环下手术治疗室间隔缺损效果的比较. 中华心血管病杂志, 2012, 40(10): 830-833.
16.	Jung SH, Je HG, Choo SJ, et al. Right or left anterolateral minithoracotomy for repair of congenital ventricular septal defects in adult patients. Interact Cardiovasc Thorac Surg, 2010, 10(1): 22-26.
17.	Meriem MK, Lucile H, Damien B. Anatomy of the ventricular septal defect in congenital heart defects: a random association? Orphanet J Rare Dis, 2018, 13(1): 118.
18.	Dave HH, Comber M, Solinger T, et al. Mid-term results of right axillary incision for the repair of a wide range of congenital cardiac defects. Eur J Cardiothorac Surg, 2009, 35(5): 864-870.
19.	Ghosh S, Sridhar A, Solomon N, et al. Transcatheter closure of ventricular septal defect in aortic valve prolapse and aortic regurgitation. Indian Heart J, 2018, 70(4): 528-532.
20.	Eroğlu AG, Oztunç F, Saltik L, et al. Aortic valve prolapse and aortic regurgitation in patients with ventricular septal defect. Pediatr Cardiol, 2003, 24(1): 36-39.
21.	Tweddell JS, Pelech AN, Frommelt PC. Ventricular septal defect and aortic valve regurgitation: pathophysiology and indications for surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2006, 9(1): 147-152.
22.	Brizard C. Surgical repair of infundibular ventricular septal defect and aortic regurgitation. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2006, 9(1): 153-160.
23.	Frigiola A, Abella RF, Giamberti A. Doubly committed subarterial ventricular septal defect with severe aortic regurgitation: the "two-patch" technique. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2006, 9(1): 161-164.
24.	凌翔, 陈胜喜, 罗万俊, 等. 主动脉瓣成形术治疗室间隔缺损并中重度主动脉瓣关闭不全. 中华实用儿科临床杂志, 2007, 22(21): 1670-1671.

1. Dieberg G, Smart NA, King N. Minimally invasive cardiac surgery: A systematic review and meta-analysis. Int J Cardiol, 2016, 223: 554-560.
2. Liao Y, Long X, Zhu S, et al. Minimally access via left anterior mini-thoracotomy for repair of adult subarterial ventricular septal defects. J Cardiothorac Surg, 2017, 12(1): 48.
3. 张伟华, 罗鸿, 张新, 等. 右侧腋下直切口在小儿干下型室间隔缺损修补术中的应用. 中国胸心血管外科临床杂志, 2014, 21(4): 473-477.
4. Hong ZN, Chen Q, Lin ZW, et al. Surgical repair via submammary thoracotomy, right axillary thoracotomy and median sternotomy for ventricular septal defects. J Cardiothorac Surg, 2018, 13(1): 47.
5. Chiu SN, Wang JK, Lin MT, et al. Aortic valve prolapse associated with outlet-type ventricular septal defect. Ann Thorac Surg, 2005, 79(4): 1366-1371.
6. Cheung Y, Chiu C, Yung T, et al. Impact of preoperative aortic cusp prolapse on long-term outcome after surgical closure of subarterial ventricular septal defect. Ann Thorac Surg, 2002, 73(2): 622-627.
7. Tariq W, Farhan ARM, Raza BA. Doubly committed subarterial ventricular septal defect repair: An experience of 51 cases. Pak J Med Sci, 2017, 33(5): 1112-1116.
8. Eroglu AG, Atik SU, Sengenc E, et al. Evaluation of ventricular septal defect with special reference to the spontaneous closure rate, subaortic ridge, and aortic valve prolapse Ⅱ. Pediatr Cardiol, 2017, 38(5): 915-921.
9. Chen ZY, Ma YJ, Pan WZ, et al. Transfemoral device occlusion and minimally invasive surgical repair for doubly committed subarterial ventricular septal defects. Pediatr Cardiol, 2015, 36(8): 1624-1629.
10. 俞劲, 张泽伟, 叶菁菁, 等. 食管超声引导下经左侧胸骨旁肋间小切口封堵小儿干下型室间隔缺损. 中华小儿外科杂志, 2018, 39(8): 589-593.
11. Lin K, Zhu D, Tao K, et al. Hybrid perventricular device closure of doubly committed subarterial ventricular septal defects: Mid-term results. Catheter Cardiovasc Interv, 2013, 82(3): E225-E232.
12. Pan S, Xing Q, Cao Q, et al. Perventricular device closure of doubly committed subarterial ventral septal defect through left anterior minithoracotomy on beating hearts. Ann Thorac Surg, 2012, 94(6): 2070-2075.
13. 刘健, 唐先成, 黄击修, 等. 食管超声引导下先天性房/室间隔缺损封堵 188 例的效果及影响因素分析. 中国胸心血管外科临床杂志, 2018, 25(12): 51-54.
14. 伍成德, 刘鹏, 林巍, 等. 经胸微创封堵与体外循环治疗不同直径干下型 VSD 疗效分析. 海南医学, 2017, 28(18): 2974-2978.
15. 王欣, 赵天力, 吴勤, 等. 经胸微创封堵术与体外循环下手术治疗室间隔缺损效果的比较. 中华心血管病杂志, 2012, 40(10): 830-833.
16. Jung SH, Je HG, Choo SJ, et al. Right or left anterolateral minithoracotomy for repair of congenital ventricular septal defects in adult patients. Interact Cardiovasc Thorac Surg, 2010, 10(1): 22-26.
17. Meriem MK, Lucile H, Damien B. Anatomy of the ventricular septal defect in congenital heart defects: a random association? Orphanet J Rare Dis, 2018, 13(1): 118.
18. Dave HH, Comber M, Solinger T, et al. Mid-term results of right axillary incision for the repair of a wide range of congenital cardiac defects. Eur J Cardiothorac Surg, 2009, 35(5): 864-870.
19. Ghosh S, Sridhar A, Solomon N, et al. Transcatheter closure of ventricular septal defect in aortic valve prolapse and aortic regurgitation. Indian Heart J, 2018, 70(4): 528-532.
20. Eroğlu AG, Oztunç F, Saltik L, et al. Aortic valve prolapse and aortic regurgitation in patients with ventricular septal defect. Pediatr Cardiol, 2003, 24(1): 36-39.
21. Tweddell JS, Pelech AN, Frommelt PC. Ventricular septal defect and aortic valve regurgitation: pathophysiology and indications for surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2006, 9(1): 147-152.
22. Brizard C. Surgical repair of infundibular ventricular septal defect and aortic regurgitation. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2006, 9(1): 153-160.
23. Frigiola A, Abella RF, Giamberti A. Doubly committed subarterial ventricular septal defect with severe aortic regurgitation: the "two-patch" technique. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2006, 9(1): 161-164.
24. 凌翔, 陈胜喜, 罗万俊, 等. 主动脉瓣成形术治疗室间隔缺损并中重度主动脉瓣关闭不全. 中华实用儿科临床杂志, 2007, 22(21): 1670-1671.

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The application of left anterior minimally invasive thoracotomy to surgical repair of subarterial ventricular septal defect in children

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