In clinical work, for simple ventricular septal defect, because of the good treatment effect, long-term prognosis is not significantly different from normal people, especially with the current reimbursement ratio of new agricultural and medical insurance increased significantly, so for simple ventricular septal defect, there is no problem of treatment or not, but only the choice of treatment timing and the choice of what kind of treatment method.
The biggest confusion for parents is how to choose a treatment method for their children: should they choose minimally invasive interventional blocking or surgical repair for their children.
In order to answer parents’ questions, I would like to talk to you today about the choice of treatment for simple ventricular septal defect. I believe this is a problem that many parents of children with ventricular septal defect are eager to know and understand.
A. Misunderstanding
Minimally invasive treatment is the trend of the medical industry, and all surgeries and operations are developing in the direction of minimally invasive and painless. However, due to the rise and popularity of the concept of minimally invasive, many parents now ask doctors to do minimally invasive interventions or minimally invasive surgery for their children regardless of the size and location of the defect and whether it is combined with other problems. Because the cardiothoracic surgery department of Nanjing Children’s Hospital can do both surgery and minimally invasive blockage, the choice of the two surgical methods is analyzed in detail here. Indications for minimally invasive occlusion
Since the FDA has only approved the blocking device for myocardial ventricular septal defect blocking, there is a lack of consensus as to which children can be blocked.
① simple perimembranous ventricular septal defect, the diameter of the defect should generally be less than 5-6 mm, and the distance from the aortic valve should be greater than 2 mm. ② myocardial ventricular septal defect is an indication for intervention, but the defect is generally within 10 mm; ③ residual leak after surgery.
Currently, eccentric blockers can also be used to seal defects closer to the valve, and of course multiple blockers have been used to seal multiple defects, which is still controversial.
Therefore, if your child has a large defect or is located close to the aortic valve, blocking is not recommended.
Indications for surgical procedures
All types of ventricular septal defects can be treated surgically.
Advantages and disadvantages of occlusion
The biggest advantage of interventional occlusion is that it is minimally invasive and has no surgical scars. Of course, with the advancement of technology, occlusion can now be achieved under ultrasound guidance without the use of x-ray guidance.
The biggest problem of blocking is the material, because the blocker is made of woven nickel-titanium alloy wire, the long-term effect of nickel-titanium alloy on the body and heart is an unknown factor, and the blocker is visualized under x-ray, which will have some minor troubles in life in the future. Of course, minimally invasive blocking may also result in dislocation of the blocker requiring emergency surgery, cardiac arrhythmia, heart block, etc.
V. Advantages and disadvantages of surgical procedures
The point of surgical procedures is that they have been proven to be safe and effective over a long period of time, and have no impact on the long-term quality of life of the child.
The disadvantage is that surgical scars, of course, as long as surgery, there will be trauma, but also some parents are more concerned about anesthesia, extracorporeal circulation and surgical safety issues: including postoperative residual leakage, heart block, arrhythmia, etc.
VI. Summary and development trend
Therefore, if the size and location of your child’s defect are suitable for blocking, you can choose surgery or minimally invasive blocking according to the advantages and disadvantages as above. If the defect is large or located close to the aortic valve or combined with other malformations such as atrial septal defect, direct surgery is recommended.
Minimally invasive occlusion for simple ventricular septal defect is a very good method and a trend for future development, but the current problem is the material of the occluder. If the development is successful, it will be a revolutionary change in the field of congenital heart disease treatment, and by then, many congenital heart diseases can be treated by minimally invasive blocking.