Peratrial Device Closure of Perimembranous Ventricular Septal Defects Through a Right Parasternal Approach

Abstract

Both percutaneous and perventricular device closures of perimembranous ventricular septal defects (PmVSDs) have drawbacks. This study evaluates the feasibility, safety, and efficacy of peratrial device closure of a PmVSD using a probe-assisted delivery system. Seventy-three patients (peratrial group) were enrolled in this study. A 1.5- to 2.0-cm parasternal incision was made in the fourth right interspaces. A Z-shaped malleable hollow probe was inserted into the right atrium. Under transesophageal echocardiographic guidance, it was advanced through the tricuspid valve into the right ventricle. The tip of the probe was adjusted to point to or cross the defect. A flexible guidewire was sent to the left ventricle through the probe to establish a delivery pathway. Then the device was delivered and deployed. Seventy matched control patients, who underwent perventricular device closure of PmVSDs, were identified and assigned to the perventricular group. Successful device placement was achieved in 70 of 73 (96%) patients in the peratrial group. The minimal PmVSD diameter ranged from 2.0 to 7.0 mm (median, 3.0 mm). Although the intracardiac manipulation time was longer in the peratrial group, the procedural time and postoperative hospital stays were shorter than in the perventricular group (all p<0.01). During the follow-up period of 6 to 24 months, no significant device-related complication was found in either group. The peratrial device closure of PmVSDs is feasible, safe, and efficacious. Compared with the perventricular technique, it has the advantages of less trauma, shorter hospital stays and procedure time, and better cosmetic results.