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J Thorac Cardiovasc Surg 2009;137:556-559
© 2009 The American Association for Thoracic Surgery

Congenital Heart Disease

Minimally invasive perventricular device closure of an isolated perimembranous ventricular septal defect with a newly designed delivery system: Preliminary experience

Xing Quansheng, MDa, Pan Silin, MSa,*, Zhuang Zhongyun, BSb, Rong Youbao, BSa, Li Shengde, MSa, Cao Qian, MSa, Duan Shuhua, BSa, Hou Kefeng, BSa, Ji Zhixian, MSa, Wu Qin, MSa

a Pediatric Cardiovascular Centre, Qingdao Children's Hospital, Qingdao, China
b Shanghai Co Ltd of Xingzhuangjiyi Alloy Material, Shanghai, China

Received for publication December 10, 2007; revisions received February 24, 2008; accepted for publication May 9, 2008.

* Address for reprints: Pan Silin, MS, Pediatric Cardiovascular Center, Qingdao Children's Hospital, Qingdao, Shandong 266011, China. (Email: silinpan{at}126.com).

Objective: We sought to summarize the preliminary clinical experience of minimally invasive transthoracic device closure of perimembranous ventricular septal defects with a new delivery system without cardiopulmonary bypass.

Methods: Twenty-one patients aged 11 months to 12 years (median age, 3.6 years) with isolated perimembranous ventricular septal defects underwent minimally invasive device closure with an inferior sternotomy of 3 to 5 cm under transesophageal echocardiographic guidance. A single per–right ventricular U-like suture was established, and a new delivery system was introduced, aided by a 16-gauge trocar, including a guidewire, proper sheath, and loading sheath. The proper size of devices was determined by means of transesophageal echocardiographic analysis, and then the device was released under real-time transesophageal echocardiographic monitoring if no significant aortic regurgitation, abnormal atrioventricular valvular motion, or residual interventricular shunt appeared.

Results: All of the defects were successfully closed. No residual shunt, noticeable aortic or tricuspid regurgitation, or significant arrhythmias appeared during more than 5 months of follow-up.

Conclusion: Minimally invasive transthoracic device closure of perimembranous ventricular septal defects with a new delivery system without cardiopulmonary bypass is feasible and safe under transesophageal echocardiographic guidance. However, it is necessary to evaluate the intermediate and long-term results.

Abbreviations and Acronyms CPB = cardiopulmonary bypass; PMVSD = perimembranous ventricular septal defect; TEE = transesophageal echocardiography; TTE = transthoracic echocardiography; VSD = ventricular septal defect






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