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Updated: May 14, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
One-Stop Device Closure for Ventricular Septal Defect with Atrial Septal Defect Guided by Transesophageal
Jinghao Song1, Yuekun Sun1, Huaixue Mi1
1Department of Cardiovascular Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Engineering Research Center for Heart Transplant and Material, 250014 Jinan, Shandong, China.
Insights
Transesophageal echocardiography-guided percardiac or percutaneous closure of ventricular septal defect (VSD) with atrial septal defect (ASD) is safe and effective. These one-stop treatments offer a valuable alternative for selected patients with complex congenital heart disease.
Area of Science:
- Cardiology
- Congenital Heart Disease Treatment
- Minimally Invasive Cardiac Surgery
Background:
- Ventricular septal defect (VSD) with atrial septal defect (ASD) represents a common and complex congenital heart anomaly.
- Evaluating novel therapeutic strategies is crucial for improving patient outcomes.
Purpose of the Study:
- To assess the clinical efficacy and safety of transesophageal echocardiography (TEE)-guided percardiac or combined percutaneous techniques for treating VSD with ASD.
- To evaluate these techniques across diverse patient anatomies.
Main Methods:
- A retrospective cohort study of 40 patients with VSD and ASD from June 2015 to July 2023.
- TEE-guided peratrial, perventricular, or combined percardiac/percutaneous approaches were utilized based on defect type.
- Comprehensive follow-up included ECG, echocardiography, and X-ray at specified intervals post-surgery.
Main Results:
- 100% surgical success rate with no reoperations required during follow-up.
- Minor residual shunts and valve regurgitations observed in some cases resolved within 6 months.
- No significant differences in adverse event rates were found among the three surgical approaches (p=0.957).
Conclusions:
- TEE-guided percardiac or combined percutaneous device closure is a safe, effective, and feasible approach for one-stop treatment of VSD with ASD.
- These minimally invasive techniques offer a valuable alternative therapy for carefully selected patients.
Background:
Ventricular septal defect (VSD) with atrial septal defect (ASD) is a common complex congenital heart disease. This study aimed to evaluate the clinical efficacy and safety of transesophageal echocardiography (TEE)-guided percardiac or combined percutaneous techniques for treating VSD with ASD in patients with varying anatomies.
Methods:
This retrospective cohort study reviewed 40 cases of VSD with ASD treated in our center from June 2015 to July 2023. Under TEE guidance, peratrial, perventricular, or combined percardiac/percutaneous approaches were used based on the VSD type and secundum-type ASD. Follow-up examinations, including electrocardiography, transthoracic echocardiography, and X-ray, were performed after surgery at 24 hours, 1, 3, 6, and 12 months, and yearly.
Results:
All patients underwent surgery successfully (100%), with 24, 5, and 11 patients undergoing simultaneous closure via the peratrial, perventricular, and combined percardiac/percutaneous approaches, respectively. Among them, there were six cases of a mild residual shunt, three instances of a mild tricuspid regurgitation, two cases of a mild aortic valve regurgitation, one case of a mild mitral regurgitation, and three cases of an incomplete right bundle branch block, all observed after VSD closure; all had resolved within 6 months of the operation. The chi-square test showed no significant differences in adverse event rates among the three surgical approaches (χ2 = 0.09, df = 2, p = 0.957). The Friedman test compared the preoperative and postoperative left ventricular end-diastolic diameter for the three approaches, providing p < 0.001, p = 0.589, and p = 0.445, respectively. None of the patients required reoperation during the follow-up period.
Conclusions:
Under TEE guidance, using diverse percardiac or combined percutaneous device closure techniques for the one-stop treatment of different types of VSDs combined with ASD is safe, effective, and feasible. These approaches can be performed as a valuable alternative therapy for selected patients.
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