Document Detail

Robotically assisted perventricular closure of perimembranous ventricular septal defects: preliminary results in Yucatan pigs.
MedLine Citation:
PMID:  16434274     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Robotic systems allow surgeons to perform minimally invasive cardiac surgery in adults. Experience in the pediatric population, however, is limited. Perventricular closure of muscular ventricular septal defects has been reported in humans but requires a median sternotomy. The objective of this study was to assess the feasibility of robotically assisted closure of perimembranous ventricular septal defects by using the perventricular approach. METHODS: The procedure was attempted in 7 pigs with naturally occurring perimembranous ventricular septal defects. Echocardiography was performed to confirm the presence and assess the size of the defect. A 3-armed da Vinci system consisting of two 8-mm instrument ports and a 12-mm endoscopy port was used. A pericardiotomy was performed, and the right ventricular free wall was visualized. A spinal needle was advanced into the right ventricular cavity. By using echocardiographic guidance, a glide wire was advanced through the angiocatheter and manipulated through the defect into the left ventricle or the ascending aorta. A delivery sheath was advanced over the wire. An appropriately sized Amplatzer device was deployed through the sheath. RESULTS: The procedure was successful in 5 pigs. One device was removed because it was smaller than the defect and an appropriately sized device was not available. The placement failed in the second pig in the series. Four pigs were followed up for 1 to 4 months. Angiograms performed before the pigs were killed documented complete occlusion in 3 and mild-to-moderate shunt in 1. CONCLUSIONS: Robotically assisted perventricular closure with the Amplatzer Membranous VSD Occluder is feasible. This approach avoids the associated morbidities of cardiopulmonary bypass and median sternotomy. Further investigation and refinements are needed, however, before application of this approach in humans.
Zahid Amin; Russell Woo; David A Danford; Stacey E Froemming; Vadiyala M Reddy; John Lof; David Overman
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-01-18
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  131     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-25     Completed Date:  2006-03-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  427-32     Citation Subset:  AIM; IM    
Joint Division of Pediatric Cardiology, University of Nebraska/Creighton University, Children's Hospital of Omaha, Omaha, Neb 68114 , USA.
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MeSH Terms
Cardiac Surgical Procedures*
Echocardiography, Transesophageal
Heart Septal Defects, Ventricular / surgery*,  ultrasonography
Prostheses and Implants
Surgical Procedures, Minimally Invasive

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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