Perventricular device closure of a doubly committed juxtaarterial ventricular septal defect through a left parasternal approach: midterm follow-up results

Abstract

BackgroundIt is infeasible to occlude a doubly committed juxtaarterial ventricular septal defect (DCVSD) percutaneously. The previous perventricular device closure technique was performed through an inferior median sternotomy approach. The purpose of this study is to evaluate the feasibility, safety and efficacy of perventricular device closure of DCVSDs through a left parasternal approach.MethodsSixty-two patients, with the DCVSD of less than 6 mm in diameter, were enrolled in this study. The pericardial space was approached through a left parasternal mini-incision without entering into the pleural space. Two parallel pursestring sutures were placed on the right ventricular outflow tract for puncture. Under transesophageal echocardiographic guidance, a new delivery sheath loaded with the device was inserted into the right ventricle and advanced through the defect into the left ventricle. The device, connected with a device stay suture, was deployed subsequently.ResultsSuccessful device closure of the defects was achieved in 58/62 patients (94 %). The DCVSD failed to close in 4 (6 %) patients due to device-related aortic regurgitation and device migration. The mean DCVSD diameter was 3.4 ± 1.0 mm (range, 2.0 to 6.0 mm). The implanted device size was 5.2 ± 1.3 mm (range, 4 to 8 mm). Forty-four out of 58 patients (76 %) was implanted with an eccentric occluder. The mean intracardiac manipulation time was 14 ± 13 min (range, 2 to 60 min). The procedure time was 66 ± 15 min (range, 42 to 98 min). During the follow-up period of 180 to 1860 (median 880) days, new mild pulmonary regurgitation occurred in 2 patients. No other device-related complications were found. The complete closure rate was 95 % at discharge, 98 % at 1-, 6- and 12-month, 96 % at 2-year, and 100 % at 3-year follow-up.ConclusionsPerventricular device closure of a DCVSD through a left parasternal approach is feasible, safe, and efficacious in selected patients. This minimally invasive technique permits easy defect crossing and accurate device positioning.

A study on eccentric occluder via ultra minimal incision of doubly committed subarterial ventricular septal defects

“…Ventricular septal defect (VSD) is the most common congenital heart diseases. As one kind of VSDs doubly committed subarterial ventricular septal defect (DCS‐VSD) is very high incidence in Asians, reaching 25% 1 . For a long time, DCS‐VSD can only be treated by cardiopulmonary bypass surgery.…”

“…TEE‐guided transthoracic occlusion, without cardiopulmonary bypass cardiopulmonary bypass, and no radiation, is an excellent surgical stratege. At present, the surgical approaches for DCS‐VSD occlusion surgery mainly include sternum incision, intercostal incision on the left side and underarm incision 1,3,6,7 . This study reports a comparison of the two surgical approaches, which are sternum incision and intercostal incision, combined with the literature, to analyze their respective advantages and disadvantages, and discuss which method is a better surgical approach.…”

Perventricular double-device closure of wide-spaced multi-hole perimembranous ventricular septal defect

“…Since then, this technique has been increasingly developed and is becoming an effective alternative to surgery [ 3 , 6 , 8 , 9 ]. Although peratrial or perventricular device closure of PmVSDs through a right or left parasternal approach has been reported [ 6 , 10 ], the lower median sternotomy approach is still the preference due to its simplicity, reliability, and the perpendicular short entry route to the septum.…”

“… Impingement on the adjacent valves The ventricular septal occluder may affect the function of the aortic valve. During the procedure, if a new aortic regurgitation was found, the device would be retrieved and replaced with a small or eccentric occluder [ 10 , 12 – 14 ]. In this study, no device-induced aortic regurgitation was found because the double devices were placed in the pouch of the PmVSD aneurysm far from the aortic valve.…”

Value of transesophageal echocardiography in device closure of perimembranous ventricular septal defects in children via ultraminimal intercostal incision

“…The transesophageal echocardiography (TEE) has developed rapidly [1][2][3][4][5][6][7][8] due to clearer image [9,10] . TEE-guided transthoracic minimally invasive perimembranous ventricular septal defect (PmVSD) closure has wide indications and many advantages [10][11][12][13] in children. On the basis of the simple and feasible surgical method, it is a trend that the surgical incision is continuously minimized.…”