Device closure of perimembranous ventricular septal defects with a minimally invasive technique in 12 patients.

Abstract

Both surgical management and percutaneous device closure of perimembranous ventricular septal defects without cardiopulmonary bypass have drawbacks and limitations. This report describes the experience with intraoperative device closure of perimembranous ventricular septal defects without cardiopulmonary bypass by a minimally invasive technique. Twelve patients who had perimembranous ventricular septal defects underwent perventricular closure by a minimally invasive incision without cardiopulmonary bypass. A subxiphoid minimally invasive incision was performed. The right ventricle free wall was punctured, and a guidewire was introduced into the right ventricular cavity. A delivery sheath was advanced over the wire and through the defect into the left ventricular cavity under the guidance of transesophageal echocardiography. The device was released under the guidance of transesophageal echocardiography without cardiopulmonary bypass. The procedure was successful in the 12 patients. Patients stayed in the intensive care unit 1 day and were in the hospital 4 days. At follow-up of 2 to 4 months, there was no operative mortality, atrioventricular block, new aortic incompetence, or residual shunt. The minimally invasive technique appeared to be safe and efficacious for closure of perimembranous ventricular septal defects in the operating room with acceptable short-term outcomes.