Clarifying the doubly committed and juxta-arterial ventricular septal defect

Clarifying the doubly committed and juxta-arterial ventricular septal defect Ventricular septal defect, Doubly committed ventricular septal defect, Perventricular device closure, Device closure of ventricular septal defect Yu et al. [1] are congratulated on their achievement of successfully closing allegedly doubly committed ventricular septal defects in their series of 35 children recently reported in the journal. However, can we be sure that the defects in question were truly doubly committed and juxta-arterial? The criterion stated by the authors for diagnosis in this fashion was that the defect should be ‘located at the 12.00 to 1.30 o’clock position in the parasternal short axis view’. The criterion for diagnosis of the doubly committed and juxta-arterial defect, however, is dependent on its borders rather than its location. However, the doubly committed variant is one of the defects that can open to the outflow tract of the right ventricle and hence be detected ‘in the 12.00 to 1.30 o’clock position’. In our recent experience in Cincinnati, of the defects detected on the basis of ‘conal hypoplasia’ and opening to the right ventricle in this position when assessed echocardiographically, only a proportion was found to be doubly committed based on their borders, specifically with fibrous continuity between the leaflets of the aortic and pulmonary valves forming their cranial margin. It is not possible to distinguish this feature of fibrous continuity between the leaflets of the aortic and pulmonary valves in Fig. 3 as provided by Yu et al. [1]. The defects illustrated could just as well have been muscular outlet defects or perimembranous defects with outlet extension. Because another criterion for exclusion was size <5 mm, it seems that the defects could have possessed completely muscular borders, and more so since the authors describe the pulmonary ‘annulus’ as being ‘slightly higher than the aortic annulus’ in their patients. Had the defects truly been doubly committed, then the so-called ‘annuluses’ would have been at the same level. We do not mean to question the efficacy of the method proposed by the Chinese authors. If it is to be more widely used, nonetheless, then surely it is crucial to provide more precise details of the criteria used so as to diagnose the defects as being doubly committed and juxta-arterial? REFERENCE [1] Yu J , Ma L , Ye J , Zhang Z , Li J , Yu J et al. Doubly committed ventricular septal defect closure using eccentric occlude via ultraminimal incision . Eur J Cardiothorac Surg 2017 ; 52 : 805 – 9 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cardio-Thoracic Surgery Oxford University Press

Clarifying the doubly committed and juxta-arterial ventricular septal defect

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Publisher
Oxford University Press
Copyright
© The Author(s) 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
ISSN
1010-7940
eISSN
1873-734X
D.O.I.
10.1093/ejcts/ezx473
Publisher site
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Abstract

Ventricular septal defect, Doubly committed ventricular septal defect, Perventricular device closure, Device closure of ventricular septal defect Yu et al. [1] are congratulated on their achievement of successfully closing allegedly doubly committed ventricular septal defects in their series of 35 children recently reported in the journal. However, can we be sure that the defects in question were truly doubly committed and juxta-arterial? The criterion stated by the authors for diagnosis in this fashion was that the defect should be ‘located at the 12.00 to 1.30 o’clock position in the parasternal short axis view’. The criterion for diagnosis of the doubly committed and juxta-arterial defect, however, is dependent on its borders rather than its location. However, the doubly committed variant is one of the defects that can open to the outflow tract of the right ventricle and hence be detected ‘in the 12.00 to 1.30 o’clock position’. In our recent experience in Cincinnati, of the defects detected on the basis of ‘conal hypoplasia’ and opening to the right ventricle in this position when assessed echocardiographically, only a proportion was found to be doubly committed based on their borders, specifically with fibrous continuity between the leaflets of the aortic and pulmonary valves forming their cranial margin. It is not possible to distinguish this feature of fibrous continuity between the leaflets of the aortic and pulmonary valves in Fig. 3 as provided by Yu et al. [1]. The defects illustrated could just as well have been muscular outlet defects or perimembranous defects with outlet extension. Because another criterion for exclusion was size <5 mm, it seems that the defects could have possessed completely muscular borders, and more so since the authors describe the pulmonary ‘annulus’ as being ‘slightly higher than the aortic annulus’ in their patients. Had the defects truly been doubly committed, then the so-called ‘annuluses’ would have been at the same level. We do not mean to question the efficacy of the method proposed by the Chinese authors. If it is to be more widely used, nonetheless, then surely it is crucial to provide more precise details of the criteria used so as to diagnose the defects as being doubly committed and juxta-arterial? REFERENCE [1] Yu J , Ma L , Ye J , Zhang Z , Li J , Yu J et al. Doubly committed ventricular septal defect closure using eccentric occlude via ultraminimal incision . Eur J Cardiothorac Surg 2017 ; 52 : 805 – 9 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

European Journal of Cardio-Thoracic SurgeryOxford University Press

Published: Dec 26, 2017

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