Minimally invasive transthoracic closure of ventricular septal defects without cardiopulmonary bypass under guidance of transepicardial echocardiography

Abstract

Objective To introduce a new technique: minimally invasive transthoracic closure of ventricular septal defects (VSD) without cardiopulmonary bypass (CPB) under guidance of transepicardial echocardiography (TECE). Methods A total of 41 patients with VSD, 5 months to 6 years, averaging (15.1±18.5)months, underwent transthoracic device closure. The weight of these patients ranged from 5 to 26.0 kg with an average weight of (10.78 ± 6.87) kg. The diameter of their VSD ranged from 3 to 8.5 mm with an average of (5.2 ± 1.13) mm. After small median sternotomy incision, an appropriately sized VSD occluder was inserted into the left ventricle via VSD, then the occluder was released and the VSD was closed. TECE was used to monitor the whole procedure to guide the device positioning and evaluate the cursive effect instantly after operation. Results The procedure was successful in 38 patients. Three cases failed, including two cases whose guiding wire could not pass through VSD and one case whose occluder could not fix well. Three patients had tiny residual shunt after operation, two vanished during the follow-up period, and one case still had small amount residual shunt because of the occluders shifting. In 6 to 36 months follow-up, neither complete atrioventricular heart block nor aortic insufficiency was found in any patient. Conclusions The transthoracic closure of ventricular septal defects without cardiopulmonary bypass under guidance of transepicardial echocardiography is easy, safe, and efficient. Key words: Heart septal defects, ventricular/SU; Heart catheterization; Echocardiography/MT; Surgical procedures, minimally invasive/MT; Cardiac surgical procedures