Transesophageal echocardiography-guided hybrid therapy for ventricular septal defects in children

Abstract

To evaluate transesophageal echocardiography (TEE)-guided periventricular device closure for treatment of ventricular septal defects (VSD) in children. The Amplatzer device was applied, the size of which was 1 or 2 mm larger than the VSD size assessed by TEE. Via a small lower sternotomy, the device was introduced through right ventricular surface to close the VSD under continuous TEE guidance without cardiopulmonary bypass. The procedures were successful in 6 cases, including 4 cases with muscular VSD and 2 cases with perimembranous VSD. The diameter of VSD was 3 mm to 10 mm and one case had pulmonary hypertension. One case of multi-muscular VSD with transposition of the great arteries failed to the treatment because the mitral open was interfered by the device. One case had bundle branch block in ICU stay and returned to normal without special therapy. The average operation time was 30 min and blood loss was 5 approximately 20 ml, no patients required blood transfusion; the average length of ICU stay was 24 h. Patients were discharged 1 to 2 d postoperatively. At a median follow-up for 12 months, all patients were asymptomatic and had no residual ventricular shunts. With the guide of TEE, intra-operative hybrid therapy is a safe and effective method for closure of muscular and perimembranous VSD without cardiopulmonary bypass in children.