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Original Articles: Pediatric Cardiac

Perventricular Device Closure of Ventricular Septal Defects: Six Months Results in 30 Young Children

^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

Accepted for publication March 25, 2008.

^_* Address correspondence to Dr An, Department of Thoracic and Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China (Email: anqi8890{at}163.com).

Background: Both surgical repair and transcatheter closure of isolated ventricular septal defects are known to have limitations in children. This report describes the short-term results of perventricular device closure of nonmuscular ventricular septal defects without cardiopulmonary bypass in young children.

Methods: Thirty patients who had nonmuscular ventricular septal defects underwent perventricular closure by minimally invasive technique without cardiopulmonary bypass. A subxiphoid minimally invasive incision was performed. 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: Closure was successful in 27 patients (90%). There was no mortality or atrioventricular block perioperatively or during the entire follow-up period. Three patients developed incomplete right bundle branch blocks and seven patients developed new trace or mild tricuspid regurgitation after the closure. The mean hospital stay was 3.6 ± 0.7 days (range, 3 to 5 days) and no patient needed any blood or blood products. Follow-up at 6 months showed that two of the three patients had persistent incomplete right bundle branch block and three of the seven patients had persistent closure-related trace or mild tricuspid regurgitation.

Conclusions: Perventricular device closure of isolated ventricular septal defects without cardiopulmonary bypass appeared to be safe and efficacious in selected young children. The outcomes of short-term follow-up are acceptable.

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Invited Commentary

Emile A. Bacha
Ann. Thorac. Surg. 2008 86: 146. [Extract] [Full Text] [PDF]

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				E. A. Bacha Invited commentary. Ann. Thorac. Surg., July 1, 2008; 86(1): 146 - 146. [Full Text] [PDF]