Perventricular device closure of muscular ventricular septal defects on beating hearts: initial experience in eight children.

Abstract

The conventional surgical repair and transcatheter closure of muscular ventricular septal defects are known to have undesirable limitations. This communication describes the short-term results of perventricular device closure of muscular ventricular septal defects with the heart beating in 8 children with 15 muscular ventricular septal defects, with or without other congenital malformations. A subxiphoid minimally invasive incision was used in 3 children with isolated muscular ventricular septal defects whereas standard full median sternotomies were used in the other 5 children who required subsequent correction of coexisting malformations. 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. A total of 14 muscular ventricular septal defects were successfully closed perventricularly without cardiopulmonary bypass. There was no mortality perioperatively or during the entire follow-up period. At 6-month follow-up, there was no detectable residual shunt, arrhythmia, or new mitral or tricuspid insufficiency. Other than 5 children with the coexisting malformations, none of the other children required any blood or blood products. The average hospital stay was 7.9 +/- 2.2 days (range, 5-11 days). Perventricular device closure of muscular ventricular septal defects with or without coexisting congenital malformations appeared to be safe and efficacious. The outcomes of short-term follow-up are acceptable.