Percardiac device closure of perimembranous ventricular septal defects through a right or left parasternal approach

Abstract

Objective To evaluate the feasibility, safety and efficacy of percardiac device closure of a perimembranous ventricular septal defect(PmVSD) through a right or left parasternal approach. Methods Between May 2011 and June 2014, a total of 104 patients underwent peratrial device closure of PmVSD through a right parasternal approach(right parasternal group). A 1.5 to 2 cm parasternal incision was made in the fourth right intercostal space. A specially designed hollow probe was inserted into right atrium and passed through tricuspid valve into right ventricle. Under transesophageal echocardiographic guidance, the probe tip was adjusted to point to or cross defect. A flexible guidewire was inserted into left ventricle through the channel of probe and a delivery sheath was introduced through defect over wire. Then the device was deployed for closing defect. And another 22 patients underwent perventricular device closure of PmVSDs through a left parasternal approach(left parasternal group). A 2 cm parasternal incision was made in the third left intercostal space. A puncture site was chosen and pursestring sutures were placed at right ventricular free wall. After puncture, the device-loaded delivery sheath was inserted into right ventricle and crossed defect directly. The device was deployed subsequently. And 121 matched control patients(sternal groups 1 & 2) were identified on the basis of patient age, PmVSD and device size. Results The successful occlusion rates of right and left parasternal approaches were 100/104(96%) and 21/22(95%) respectively. The mean exit diameters of PmVSDs were 3.2±1.1(2.0-7.0) and 3.0±1.2(2.0-6.0) mm respectively. The mean intracardiac manipulation time was longer in right(14±12 min, P<0.05) or left(14±16 min) parasternal group than in sternal groups. But the procedure time was shorter in right(55±17 min, P<0.01) or left(66±27 min, P<0.05) parasternal group than in sternal groups. During a follow-up period of 90-1, 095 days, there were no significant device-related complications. Conclusions Peratrial device closure of VSDs is feasible, safe and efficacious. It offers the advantages of mini-invasiveness, better cosmetic results and a shorter procedure time. Key words: Heart septal defects, ventricular; Minimal surgical procedures; Cardiac surgical procedures