Perimembranous ventricular septal defect closure via ultra-minimal trans
intercostal incision in children
Abstract
Aims:This study aimed to investigate the safety, feasibility and
availability of perimembranous ventricular septal defect (PmVSD) closure
via a left parasternal ultra-minimal trans intercostal incision in
children. Methods and results:From January 2015 to January 2019, 131
children with restrictive PmVSDs were enrolled in this study and
successfully done in 126 patients (96.18%). PmVSDs were occluded via an
ultra-minimal trans intercostal incision (≤1 cm), and the entire
occlusive process was guided and monitored by TEE. A pericardium hanging
technique was employed without sternal incision. PmVSDs were closed
through a short delivery sheath assembled using a concentric occluder
device. All patients were followed up for a perid ranging from18 months
to 24 months. Thirteen patients with PmVSD had aneurysm of membranous
septum (AMS). Multistream (more than or equal to 2) PmVSDs with AMS were
found in eleven cases. After the operation, mild residual shunt beside
the amplatzer occluder in one patient was found and had self-healing
result during the 5-month follow-up period. Five patients transferred to
ventricular septal defect repair operation under direct visualization
with a cardiopulmonary bypass. One reason was ventricular fibrillation
when guide wire passed the PmVSD, another was device dislocation, and
others were the guide wire cannot pass through the PmVSD.
Conclusions:PmVSDs closure using a concentric occluder via a left
parasternal ultra-minimal trans intercostal incision under TEE guidance
is feasible, safe, and effective in children. This approach can be
considered as an alternative treatment to open-heart surgery for
restrictive PmVSDs.