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Right arrow Congenital - acyanotic

J Thorac Cardiovasc Surg 2009;137:929-933
© 2009 The American Association for Thoracic Surgery

Congenital Heart Disease

Perventricular device closure of muscular ventricular septal defects on beating hearts: Initial experience in eight children

Changping Gan, MSa, Ke Lin, MDa, Qi An, MDa,*, Hong Tang, MDb, Haibo Song, MDc, Raphael C. Lui, MD, FRCSC, FACSa, Kaiyu Tao, MSa, Zhongyun Zhuang, MDa, Yingkang Shi, MDa

a Department of Thoracic and Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
b Department of Echocardiography, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
c Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China

Received for publication May 22, 2008; revisions received August 18, 2008; accepted for publication September 1, 2008.

* Address for reprints: Qi An, MD, Department of Thoracic and Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China, 610041. (Email: anqi8890{at}163.com).

Objective: The conventional surgical repair and transcatheter closure of muscular ventricular septal defects are known to have undesirable limitations. This communication describes the short-term results of perventricular device closure of muscular ventricular septal defects with the heart beating in 8 children with 15 muscular ventricular septal defects, with or without other congenital malformations.

Methods: A subxiphoid minimally invasive incision was used in 3 children with isolated muscular ventricular septal defects whereas standard full median sternotomies were used in the other 5 children who required subsequent correction of coexisting malformations. Under the continuous guidance of transesophageal echocardiography, the free wall of the right ventricle was punctured, and a guidewire was introduced into the left ventricle through the defect. A delivery sheath was advanced over the wire and through the defect into the left ventricle. The device was released.

Results: A total of 14 muscular ventricular septal defects were successfully closed perventricularly without cardiopulmonary bypass. There was no mortality perioperatively or during the entire follow-up period. At 6-month follow-up, there was no detectable residual shunt, arrhythmia, or new mitral or tricuspid insufficiency. Other than 5 children with the coexisting malformations, none of the other children required any blood or blood products. The average hospital stay was 7.9 ± 2.2 days (range, 5–11 days).

Conclusion: Perventricular device closure of muscular ventricular septal defects with or without coexisting congenital malformations appeared to be safe and efficacious. The outcomes of short-term follow-up are acceptable.

Abbreviations and Acronyms ASD = atrial septal defect; CHD = congenital heart disease; CPB = cardiopulmonary bypass; LV = left ventricular; MVSD = muscular ventricular septal defect; PDA = patent ductus arteriosus; PVDC = perventricular device closure; PVSD = perimembranous ventricular septal defect; RV = right ventricular; TEE = transesophageal echocardiogram






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