Percutaneous Perventricular Device Closure of Ventricular Septal Defect: From Incision to Pinhole.

Abstract

As an alternative to open surgical repair, perventricular device closure provides minimally invasive treatment for doubly committed subarterial ventricular septal defects. However, unlike percutaneous transcatheter access, mini-thoracotomy is still needed. This report describes the percutaneous perventricular device closure technique and its short-term results for this type of heart defect. Sixteen patients who had isolated doubly committed subarterial ventricular septal defects underwent percutaneous perventricular device closure. By puncture of the chest wall and subsequently the infundibulum of the right ventricle under continuous guidance of transesophageal echocardiography, the guidewire and the delivery sheath were advanced into the heart to complete the perventricular closure. Closure outcomes and possible complications were measured in the hospital and during 1-year follow-up. Closure was successful in 15 patients (93.8%). No deaths, residual shunting, new valve regurgitation, or arrhythmias occurred either perioperatively or during the entire follow-up period. One patient had pericardial effusion and tamponade, and the procedure was converted to mini-thoracotomy perventricular closure. The mean hospital stay was 3.5 ± 2.0 days (range, 3.0 to 6.0 days), and only 1 patient required a blood transfusion (6.3%). Percutaneous perventricular device closure of isolated doubly committed subarterial ventricular septal defects appeared to be safe and efficacious, with acceptable short-term outcomes. Larger studies and long-term follow-up are needed for further evaluation.