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J Thorac Cardiovasc Surg 2005;130:892
© 2005 The American Association for Thoracic Surgery

Brief Communication

A truly hybrid approach to perventricular closure of multiple muscular ventricular septal defects

^a Section of Pediatric Cardiology, The University of Chicago Hospitals, Chicago, Ill.
^b Congenital and Pediatric Cardiac Surgery, Section of Cardiothoracic Surgery, The University of Chicago Hospitals, Chicago, Ill.

Received for publication February 1, 2005; accepted for publication February 16, 2005.

^_* Address for reprints: Emile A. Bacha, MD, Congenital and Pediatric Cardiac Surgery, The University of Chicago Children's Hospital, 5841 S Maryland Ave, MC 5040, Chicago, IL 60637 (Email: ebacha@surgery.bsd.uchicago.edu).

The first 20% of the full text of this article appears below.

Surgical closure of muscular ventricular septal defects (VSDs) remains a challenging problem. Percutaneous device closure in infants remains challenging. ¹ Perventricular device closure on the beating heart has been described previously. ² Some VSDs cannot be crossed through the right ventricular (RV) free wall puncture. We report the case of an infant with two significant VSDs who underwent successful perventricular device closure with a truly hybrid technique.

Clinical Summary

A 4-month-old, 5.7-kg infant was referred to our center for perventricular closure of 2 VSDs. The procedure was performed in the catheterization suite as part of a live course to demonstrate the technique of hybrid intervention. Transesophageal echocardiography (TEE) revealed the presence of two nonrestrictive VSDs (9-mm apical and 7-mm anterior defects; Figure E1). The right femoral artery was accessed percutaneously, and left ventricular (LV) angiography demonstrated the defects (Figure 1). A 3-cm incision was made over the typhoid process, and the RV free wall was exposed. With a previously described technique, ² the apical VSD was easily crossed with a wire. Because of crowding of the RV apex with muscle bundles, we could not expand the RV disk of the 10-mm Amplatzer MVSD . . . [Full Text of this Article]

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