Efficacy and safety of TEE guided right axillary small incision ventricular septal defect closure in children with perimembranous ventricular septal defect
Objective To investigate the efficacy and safety of transesophageal echocardiography(TEE)guided right axillary small incision ventricular septal defect closure in the treatment of perimembranous ventricular septal defect(PmVSD).Methods A total of 98 PmVSD children who underwent surgical treatment in Henan Children's Hospital from May 2020 to May 2021 were selected and were divided into two groups according to the operation type:a closure group(50 cases)and a repair group(48 cases).In the closure group,there were 28 boys and 22 girls,aged(3.25±0.40)years.In the repair group,there were 26 boys and 22 girls,aged(3.68±0.31)years.The closure group underwent TEE guided right axillary small incision ventricular septal defect closure,while the repair group underwent right axillary direct incision surgical repair under cardiopulmonary bypass.Both groups were followed up for 2 years.The operation conditions and the differences of myocardial injury and cardiac function were compared between the two groups.t test,x2 test,and Fisher exact probability method were used.Results The success rates of operation in the closure group and the repair group were 98.00％(49/50)and 100.00％(48/48),respectively,and there was no statistically significant difference between the two groups(P＞0.05).The operation time,ICU stay,and hospital stay in the closure group were shorter than those in the repair group[(74.25±11.58)min vs.(133.69±28.78)min,(4.60±1.00)h vs.(6.82±1.23)h,(4.05±0.69)d vs.(7.03± 1.25)d](all P＜0.05),and the drainage volume within 24 h after operation was lower than that of the repair group[0 vs.(67.50±15.69)ml](P＜0.05).The levels of cardiac troponin Ⅰ(cTnⅠ)and creatine kinase isoenzyme(CK-MB)in the closure group were lower than those in the repair group 24 h after operation(both P＜0.05).There were no statistically significant differences in the cardiac function indexes between the two groups before and 2 years after operation(all P＞0.05).There were no statistically significant differences in the incidence of residual shunt or new tricuspid regurgitation between the two groups within 2 years after operation(all P＞0.05).However,the incidences of new abnormal electrocardiogram in the closure group 3,6,12,and 24 months after operation were lower than those in the repair group[10.00％(5/50)vs.27.08％(13/48),6.00(3/50)vs.20.83％(10/48),4.00％(2/50)vs.16.67％(8/48),2.00％(1/50)vs.12.50％(6/48)](all P＜0.05).Conclusion TEE-guided right axillary small incision ventricular septal defect closure and surgical repair both have good long-term follow-up results for PmVSD,but TEE guided right axillary small incision ventricular septal defect closure has the advantages of faster postoperative recovery,less myocardial damage,and more minimally invasive incision.
Perimembranous ventricular septal defectTransesophageal echocardiographyRight axillary small incision ventricular septal defect closureCurative effectCardiac function
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