The Clinical Application Of Hybrid Procedure In The Treatment Of Congenital Heart Diseases With Muscular Ventricular Septal Defects

Purpose:To summarize the clinical experience of the hybrid procedure for the treatment of congenital heart disease with muscular ventricular septal defects.Methods:From September 2009 to September 2016,25 cases of congenital heart disease with muscular ventricular septal defects underwent hybrid procedure in our hospital.Of them,there were 10 males and 15 females,They ranged from 1 month to 5 years(mean 11.2 months)in ages.The first group include 13 cases with multiple ventricular septal defects,of them,there are 5 cases with patent ductus arteriosus(PDA)and 3 cases with atrial septal defect(ASD);The second group include 2 cases with ASD only;The third group include 9 cases PDA only;And the other in 1 case with transposition of the great arteries and PDA,underwent muscular ventricular septal defect occluder by right ventricular surface through median sternotomy incision and under the TEE guidance,then the conventional method was used for repairing other defect in the cardiac arrest with CPB in necessity.Results:There is 1 case of transient malignant arrhythmia,and sinus rhythm was observed after a few minutes during the operation,and no arrhythmia occurred after operation and follow-up.To observe immediately muscular ventricular septal in postoperative under the TEE: There are 19 cases without shunt,2 cases with residual shunt([2-3]mm),4 cases with micro-residual shunt(<2mm).The 4 cases with micro-residual shunt were disappeared under echocardiography(ECG)before hospital discharge;The 2 cases with residual shunt were disappeared under ECG in the 3 months.One patient died afteroperation in the case with transposition of the great arteries and PDA.24 patients were successfully discharged,and they had no abnormal cardiac function.There was no any complication which affected the valve function,such as occlude shift,tricuspid,bicuspid and aortic valve regurgitation,in 19 cases follow-up(median 15 months)after operation.Conclusion:Application of hybrid technology for the treatment of congenital heart disease with muscular ventricular septal defects was micro-traumatic and safe,lower operative mortality and higher efficacy,which plays an important role in the world: 1.Avoiding the ventricular incision approach,and reducing the the serious impact on cardiac function due to incision;2.With the characteristic of hybrid procedure underwent repairing and occludering,which can avoid the severe trauma due to second time surgery,the vascular access restrictions of the vascular interventional therapy,the possible effects on vascular intima and hemodynamics in children,while breaking the limitations of the traditional surgery and interventional therapy;3.To a large extent,avoiding the use of cardiopulmonary bypass,aortic occlusion and the time of surgery,reducing the risk of surgery and the incidence of some complications,such as residual shunt.