Closure Of Muscular Ventricular Septal Defects Research Articles

Percutaneous Transcatheter Closure of Congenital Ventricular Septal Defects.

Ventricular septal defects (VSDs) are the most common kind of congenital heart disease and, if indicated, surgical closure has been accepted as a gold-standard treatment. However, as less-invasive methods are preferred, percutaneous device closure has been developed. After the first VSD closure was performed percutaneously by Lock in 1988, both techniques and devices have developed consistently. A perventricular approach for closure of muscular VSD in small patients and the closure of perimembranous VSD using off-label devices are key remarkable developments. Even though the Amplatzer membranous VSD occluder (Abbott) could not be approved for use due to the high complete atrioventricular conduction block rate, other new devices have shown good results for closure of perimembranous VSDs. However, the transcatheter technique is slightly complicated to perform, and concerns about conduction problems after VSD closure with devices remain. There have been a few reports demonstrating successful closure of subarterial-type VSDs with Amplatzer devices, but long-term issues involving aortic valve damage have not been explored yet. In conclusion, transcatheter VSD closure should be accepted as being as effective and safe as surgery but should only be performed by experienced persons and in specialized institutes because the procedure is complex and requires different techniques. To avoid serious complications, identifying appropriate patient candidates for device closure before the procedure is very important.

Percutaneous Muscular Ventricular Septal Defect Closure with 2D Transthoracic Echocardiography: Can We Sufficiently Visualize It?

Ventricular septal defect (VSD) is one of the most common congenital heart diseases worldwide today. Although the majority close spontaneously, transcatheter VSD closure is a common option for symptomatic patients with suitable anatomy in adult age. Although transesophageal echocardiography (TEE) and intracardiac echocardiography are the most common imaging modalities for the procedure, in patients with poor TEE images, Transthoracic echocardiography (TTE) can be used as a reliable alternative. Here we present an adult patient with pulmonary hypertension associated with a muscular VSD which was closed percutaneously using 2-dimensional TTE because of poor TEE images.

Hybrid perventricular muscular ventricular septal defect closure using the new multi-functional occluder

The hybrid perventricular approach for the closure of trabecular ventricular septal defects is an attractive treatment modality for small children. Worldwide experience has shown that procedure success is influenced by the defect anatomical accessibility, operators' expertise, and device technical features. In May 2018, a new promising device, the KONAR-Multi-functional™ ventricular septal defect occluder (Lifetech, Shenzhen, China), obtained CE-marking for septal defect transcatheter closure after the first-in-man implantation in 2013. Herein, this is the first report of successful perventricular closure of ventricular septal defect using this new device in a child with significant co-morbidities.

Rescue Cardiac Surgeries After Pediatric Catheter-Based Interventions: A Ten-Year Retrospective Study

Catheter-based interventions for treating congenital cardiac defects have gained wide acceptance as they reduce the risks associated with surgery. However, these procedures are associated with some complications, such as the embolization of devices or stents and the injury of surrounding structures, which might need a rescue surgical intervention. Data from 25 patients who needed rescue surgery following interventional catheterization between January 2008 and January 2018 were retrospectively collected and statistically analyzed to review the decision and timing of surgery as well as the surgical techniques and results. There were 24 cases of rescue surgery after device embolization, including 9 cases of atrial septal defect closure, 8 cases of patent ductus arteriosus closure, 4 cases of pulmonary artery balloon dilatation with stenting, 3 cases of muscular ventricular septal defect closure, and 1 case of right ventricular outflow tract injury during balloon valvuloplasty. Median age was 4 years (range, 2 months to 12 years). All rescue surgeries were done via median sternotomy. The mean time interval between the decision to remove the device surgically and the actual surgical procedure was 75 ± 14 minutes. There were no reported cases of postoperative complications or mortality among the patients who underwent surgery. Our single-center experience confirms that early rescue cardiac surgery to correct adverse events after pediatric transcatheter interventions is safe and effective. Surgical strategies should be tailored according to the situation in each case.

A case of hypertrophic cardiomyopathy combined with muscular ventricular septal defect and abnormal origin of right coronary artery

BackgroundHypertrophic cardiomyopathy (HCM) is a myocardial disease. However, the coexistence of HCM with muscular ventricular septal defect (VSD), especially those with both incomplete spontaneous closure and coronary abnormal origin, is relatively rare.Case presentationWe report herein a unique case of HCM accompanied with incomplete spontaneous closure of muscular VSD and abnormal origin of right coronary artery (RCA) in a 26-year-old man, which was diagnosed by combination of transthoracic 2-dimensional (2D), color Doppler, Contrast-enhanced echocardiography and computed tomography angiography (CTA).ConclusionsTo our knowledge, this is the first report that HCM along with the incomplete spontaneous closure of muscular VSD and anomalous RCA arising from left coronary sinus was revealed through combination of transthoracic 2D, color Doppler, Contrast-enhanced echocardiography and CTA. These observations indicated that other associated anomalies in patients with HCM could be easily missed if examined by the single echocardiography. Therefore, HCM-associated congenital abnormalities should be screened by combination of transthoracic 2D, color Doppler, contrast-enhanced echocardiography, and CTA.

Transesophageal echocardiography-assisted transcatheter device closure of apical muscular ventricular septal defect.

Transesophageal echocardiography-assisted transcatheter device closure of apical muscular ventricular septal defect.

Hybrid muscular ventricular septal defect closure in a 4.5 kg infant followed by sildenafil treatment and transcatheter atrial septal defect occlusion.

Hybrid muscular ventricular septal defect closure in a 4.5 kg infant followed by sildenafil treatment and transcatheter atrial septal defect occlusion.

Evaluation of middle-term effect of percutaneous intervention therapy for muscular ventricular septal defect in children

Objective To evaluate the safety and efficacy of percutaneous closure for muscular ventricular septal defect(MVSD). Methods Fifty-one patients diagnosed as MVSD from October 2011 to July 2016 at Guangdong General Hospital were enrolled including 32 males and 19 females, ranging from 1 to 16 (5.12±3.52) years in age, weight (20.19±10.55) kg.The diameter of the MVSD was (4.82±2.51) mm which was measured by transthoracic echocardiography(TTE), and multiple defects were found in 10 patients.The choice of plugging device and transport system depended on the size, position and status of MVSD.TTE and left ventricular (LV) angiography were performed before and after release of the device to evaluate the therapeutic effects.Electrocardiogram and TTE were performed during follow-up period at 24 h, 1 month, 3 months, 6 months and 12 months after operation and yearly thereafter. Results Eight cases showed no hemodynamic significance through standard catheter examination then the interventional therapy was stopped.Cardiac arrest was found in 1 case when the long sheath was transported along the track, and the procedure was terminated immediately, and the selective surgical operation was performed after successful rescue.The devices were successfully placed in the rest of 42 patients (97.6%) with operation time (90.68±36.42) min and fluoroscopy time (18.67±10.89) min.The average of follow-up time was (13.82±13.84) months ranging from 1 to 48 months.It was found that mild residual shunts showed in 4 cases during operation, mild tricuspid regurgitation showed in 2 cases and trivial aortic regurgitation showed in 1 case at 6 months after operation, but there was no need to intervene anymore. Conclusions Percutaneous closure of MVSD in children is safe and effective with high successful rate and low incidence of complication.The middle-term follow-up findings were satisfactory. Key words: Congenital heart disease; Muscular ventricular septal defect; Transcatheter closure; Follow-up studies

Spontaneous closure of muscular ventricular septal defects

Introduction/Objective. Ventricular septal defect (VSD) is the most frequently diagnosed congenital heart anomaly. The prognosis is usually good as it has spontaneous closure evolution, especially small muscular VSDs. The aim of this study was to determine the natural history of isolated muscular VSDs including the frequency of spontaneous closure in relation to location in the muscular septum and the age at the time of closure. Methods. The study included 96 children (52 girls and 44 boys) with isolated muscular VSD diagnosed during the first month of life. We analyzed the tendency of spontaneous closure of these defects for the duration of childhood during a follow-up period of 16 years. Two-dimensional color Doppler echocardiography was performed to detect muscular VSD as a primary cardiac lesion. There was significant prevalence of small apical versus trabecular defects and their outcomes were evaluated. Results. Our study evaluated 91 children, 49 (53.8%) girls and 42 (46.2%) boys who did not undergo surgery. Apically located VSD was diagnosed in 68 (74.7%), while trabecular defects were found in 23 (25.3%) children. Spontaneous closure occurred in 56 out of 91 cases (61.5%). The time of spontaneous closure was most commonly recorded during the first six months after birth (46.4%). The overall rate of spontaneous closure was 81.3% by the end of the first year. Apically located ventricular defects underwent spontaneous closure in the majority of patients, in comparison to trabecular ventricular defects (?2 = 12.581; p < 0.001). Kaplan?Meier analysis demonstrated a significant difference in the average time required for spontaneous closure between the analyzed patient groups (log-rank = 9.64, p = 0.002). Conclusion. The frequency of spontaneous closure of muscular VSDs, especially apically located, is very high in the first six months, especially within the first year of life. It is advisable to detect them early on using color flow imaging and to follow up patients up to spontaneous closure.

Iatrogenic embolization and transcatheter retrieval of a ventricular septal defect occluder in a dog

A 7-month-old Irish Setter underwent transcatheter therapy of a muscular ventricular septal defect (VSD) and pulmonary valve stenosis. Standard devices for muscular VSD closure could not span the interventricular septum due to right ventricular hypertrophy, and an Amplatzer post-infarction muscular VSD occluder with a wider waist was successfully implanted. Following VSD closure, inflation of the balloon dilation catheter during balloon pulmonary valvuloplasty resulted in iatrogenic embolization of the VSD occluder to the left ventricular outflow tract. Retrieval and reimplantation of the device was achieved using a snare catheter. This report describes a potential complication and management during intracardiac device implantation in a dog. Additionally, the case illustrates that the Amplatzer post-infarction muscular VSD occluder holds potential value in animals with a hypertrophied interventricular septum that cannot be spanned using a conventional device.

Current topics in surgery for multiple ventricular septal defects.

In this review article, we describe several topics, including the sandwich technique, the transatrial re-endocardialization technique, the limited apical left ventriculotomy approach and device closure. The sandwich technique was introduced for the closure of muscular ventricular septal defects (VSD) by sandwiching the septum between two felt patches placed in the left and right ventricle. This technique requires neither the transection of muscular trabeculae nor ventriculotomy. Although the sandwich technique has resulted in the improvement of surgical outcomes, cases of postoperative cardiac dysfunction have been reported. Multiple smaller VSDs have been closed with transatrial re-endocardialization. Septal dysfunction may be avoided through this technique, in which the septal trabeculae are approximated in two layers of superficial, endocardial running sutures. Recently, a number of reports have recommended a limited apical left ventriculotomy approach. With this technique, a much shorter incision of around 1cm at the apex of the left ventricle may be sufficient for achieving the complete closure of apical muscular VSDs. The transcatheter or perventricular device closure of muscular VSDs has increasingly been performed with good results. Although favorable early and mid-term results of device closure have been reported, this method is not always safer or less invasive than surgical closure. Long-term evaluations should be performed to determine whether the right and left ventricular functions are affected by treatment with relatively large devices in the heart.

Longer-term outcome of perventricular device closure of muscular ventricular septal defects in children.

To describe the longer-term clinical experience and follow-up with perventricular device closure of ventricular septal defects (VSD) in children. Between January 2005 and December 2013, muscular ventricular septal defect closure with the Amplatzer Muscular VSD Occluder was undertaken using a hybrid perventricular approach. Data including demographic, echocardiographic parameter, and clinical outcome were reviewed retrospectively. Median age at the time of procedure was 8.9 months (range 1.9-31.0 months) and median weight was 6.6 kg (range 4.5-12.9 kg). All had a moderate to large muscular VSD, three had more than one VSD, four had previous coarctation repair, and five had previous pulmonary artery (PA) banding. A single Amplatzer muscular occluder (range 8-18 mm) was deployed in each patient without cardiopulmonary bypass under echocardiographic guidance. Two of ten patients subsequently required a short period of cardiopulmonary bypass for reconstruction of PA after de-banding and closure of atrial septal defect in one. Occluder removal was necessary in one patient due to entrapment of the tricuspid valve and progressive tricuspid regurgitation. This patient underwent surgical repair with a good result and no device-related valve damage. In the remaining nine patients, no severe complications such as device embolization, arrhythmia, or significant valve regurgitation were noted in the post-operative period or follow-up. At a median time of 6.5 years (range 0.9-8.4 years) post device implantation, complete closure was achieved in five patients and four had small residual leaks, which were not hemodynamically significant. Perventricular muscular VSD closure is effective in small children with suitable muscular defects and may avoid the morbidity associated with cardiopulmonary bypass and conventional surgical repair. There have been no late complications with this approach.

Percutaneous Pulmonary Valve Replacement During Pregnancy

The number of women of childbearing age who have congenital heart disease is increasing.1 A similar proportion of these women can be expected to attempt pregnancy as women in general.2 Although most of these women can be expected to tolerate pregnancy well, particularly if the pregnancy is carefully planned following appropriate clinical evaluation, not all pregnancies are planned, and some will occur in women with unsuitable hemodynamics. We report the case of a 21-year-old woman born with pulmonary atresia and a ventricular septal defect (VSD), ultimately palliated by a fenestrated closure of VSD and a valved homograft conduit placement between the right ventricle and the main pulmonary artery at the age of 3 years, who presented at 16 weeks gestation with a severely degenerate conduit. A 21-year-old woman had been born with pulmonary atresia and a VSD. She was initially palliated with bilateral Blalock-Taussig shunts (classical left and modified right) in the neonatal period because her pulmonary artery confluence was hypoplastic. At 3 years of age, she underwent reparative surgery consisting of closure of the VSD with a fenestrated patch and the placement of a 19-mm homograft valved conduit between the right ventricular outflow tract (RVOT) and the pulmonary artery bifurcation, thereby stimulating growth of the hypoplastic pulmonary artery confluence. The bilateral Blalock-Taussig shunts were ligated. At the age of 18 years, both of her pulmonary arteries were stented because of distorted and stenotic branch pulmonary arteries. The fenestration of the VSD patch was closed interventionally by the use of a muscular VSD closure device. At 20 years of age, there was clinical and echocardiographic evidence of degeneration of the homograft conduit, and she was advised against pregnancy pending further evaluation. Approximately 6 months later, she presented at 16 weeks gestation of an unplanned pregnancy. At this stage, …

Transapical closure of mitral paravalvular leak over a surgically constructed mitral annulus

Paravalvular leakage (PVL) after mitral valve replacement surgery is a rare but serious complication occurring in approximately 5% of cases. Although many patients remain asymptomatic, those that develop heart failure, arrhythmias, endocarditis or severe hemolysis conventionally undergo surgical repair or replacement despite the higher morbidity and mortality with reoperation. Transcatheter techniques introduced in 1992 have proven to be a safe alternative to surgery, especially in high-risk patients with only a 1–2% risk of emergent surgery or death, with technical success rates ranging from 63 to 100% and clinical success rates ranging from 54 to 100% [1,2]. We report the first transapical PVL closure of a surgically constructed mitral annulus in a high-risk patient with an Amplatzer muscular ventricular septal defect (mVSD) closure device (AGA Medical Corporation; Plymouth, MN). A 56-year-oldmanhad an elective aorto-coronary bypass (LIMA-LAD, SVG-PDA, sequential SVG-OM1 and OM2) and mitral annuloplasty ring for severe mitral regurgitation in September 2006. In October 2006, he developed severe mitral PVL due to dehiscence of the annuloplasty ring with resultant hemolytic anemia. During surgery, the dehiscence of the annuloplasty ring was deemed to be unrepairable and a CarboMedics 33 mm mechanical valve with pledgetted sutures was placed in the mitral annulus. In November 2006, the patientwas readmitted for severe mitral PVL. During surgery, the valve was excised and due to insufficient tissue to hold the valve in the mitral annulus, a new annulus was surgically constructed and a CarboMedics 31 mm mechanical valve was implanted. In May 2007, he presented again with mitral PVL and hemolysis for which the patient underwent right thoracotomy, fibrillatory arrest and suture repair of two areas of mitral PVLs with pledgetted sutures. InNovember 2012, the patientwas admitted forheart failure and a three-dimensional TEE showed a severe mitral PVL due to large dehiscence from 9 to 12 o'clock in the left atrial view and no other leaks (Fig. 1). Since the mitral prosthesis was functioning well and the patient refused redo-surgery (logistic EuroSCORE—18.27%), we opted for the percutaneous PVL closure. The trans-septal approach was deemed to be

Transvascular closure of single and multiple muscular ventricular septal defects in neonates and infants < 20 kg

While surgical closure of ventricular septal defects (VSD) is still the gold standard, we review our experience with the interventional closure of single and multiple muscular VSD in newborns and infants under 20 kg. Between 2004 and 2012 transcatheter closure of ten Swiss cheese VSD, six single muscular and one apical VSD was attempted in 17 patients between 10 days and 7.3 years of age and with a bodyweight ranging from 2.2 to 19 kg. Seven patients had had a significant shunt after cardiac surgery, five patients a shunt induced congestive heart failure and in five patients postponement of surgery was intended. A total of 20 devices was successfully implanted in 15 of 17 (88%) patients, reducing the interventricular shunt and improving the haemodynamic situation in 14 patients. An acute AV-block led to immediate removal of the device in a patient of 2.2 kg. One Amplatzer muscular VSD occluder could not be delivered due to the sharp bending of the delivery sheath in 2004. Three patients died during follow-up not related to the intervention. Re-intervention was necessary in one patient with Swiss cheese VSD. Interventional closure of muscular VSD is possible in newborns and infants and presents an eligible treatment option. New occlusion systems with miniaturized introducer sheaths of 4-6 French have extended the spectrum of treatable lesions. An individual and interdisciplinary risk-benefit stratification is required to choose from surgical, interventional, or combined strategies.

Hybrid Technique for Muscular Ventricular Septal Defect Closure

Since 2008 we have performed 10 hybrid procedures for perventricular muscular ventricular septal defects (mVSD) closure. The mean age was 8.5 months (range 2.7 to 17.8), the mean diameter of mVSD was 6.3 mm (range 4 to 10 mm). The postoperative course was uncomplicated and complete closure of the mVSD was accomplished in all patients. There was neither in-hospital nor late mortality, and the longest follow-up now exceeds three years (range 2 months to 3.1 years).

ASSA13-15-6 Transcatheter Closure of Patent Ductus Arteriosus with Severe Pulmonary Hypertension Using Domestic Occluder in Adults

<h3>Background</h3> To evaluate the clinical efficacy of transcatheter closure of patent ductus arteriosus (PDA) with severe pulmonary hypertention using domestic occluder in adults. <h3>Methods</h3> From July 2000 to July 2011.82 adult patients (13 male, 69 females) were treated by transcatheter closure with domestic occluder. Patients mean age was 36.6years (ranging 18 to 60 years) and the mean PDA diameter at its narrowsest segment was (9.6 ± 2.6) (ranging 6.0 to 16.0) mm. 6 patients of them were treated with sildenafil and/or bosentan before PDA closure. All patients accepted contrast examination of aorta arch-descendens before transcatheter treatment. Patients were classified according to Krichenko grouping method, type A consisted of 35 patients, type B consisted of 4, type C 40 cases, and type E 3 cases. Duct occluder was used in 58, atrial septal defect closure device in 3 and muscular ventricular septal defect closure device in 5. The achievement of permanent transcatheter closure was decided according to the change of the pulmonary arterial pressure, aortic pressure and oxygen saturation. <h3>Results</h3> The devices were successfully placed in all patients except three patients owing to the resistance of pulmonary hypertention. The systolic pulmonary pressure decreased from (97.3 ± 20.4) (range 70 to 140) mmHg to (51.2 ± 19.4) (33 to 109)mmHg, and the mean pulmonary pressure decreased from (71.2 ± 13.5) (51 to 105) mmHg to (36.4 ± 15.1)(22 to 71)mmHg. Complete angiographic closure was seen 10 minutes after the device deployment in 52 out of 82 patients (63.4%), while trivial to small leak was present in 30 (36.6%). During the occlusion, the average X-ray exposure duration was 16.9 +/- 10.3 minutes, occlusion time was 83.5 +/- 39.2 minutes. 15 of them with systolic pulmonary artery pressure &gt; 70 mmHg after PDA closure were treated with sildenafil or/and bosentan. Complete echocardiographic closure was demonstrated in 77 out of 79 patients (97.5%) at 1 month, and 100% at 6-month follow-up in all patients. Among successful patients, the dimensions of the left atrium, left ventricle and pulmonary artery attenuated considerably in follow-up except for two patients. There were no PDA recanalization and migration of devices after the complete occlusion during following up. <h3>Conclusions</h3> Transcatheter closure of patent ductus arteriosus with severe pulmonary hypertention using domestic occluder is a safe and effective interventional method in adults.

Long-term Complications Following Surgical Patch Closure of Multiple Muscular Ventricular Septal Defects

Multiple muscular ventricular septal defects (VSDs) in children can be difficult to treat and a range of techniques has been advocated. These include pulmonary artery banding, interventional catheter closure, and a variety of surgical approaches. When there are apical muscular defects and associated coarse trabeculations in the right ventricle (RV) producing a "Swiss cheese" pattern, a large patch extending on to the RV free wall and excluding part of the apex has been used. We assessed four adult patients who had surgery 22 to 45 years ago to treat muscular VSD by patches which excluded the RV apex. Ages ranged from 22 to 50 years. Re-presentations were for polycythemia, cyanosis, syncope, and atrial flutter. Echocardiography showed bidirectional flow from left ventricle to apex of RV, no pulmonary hypertension, small-sized RV with diastolic dysfunction, enlarged right atria, reopening of patent foramen ovale (PFO) in three, and positive bubble studies with right to left shunting in two. Catheterization confirmed elevated right atrial and RV end diastolic pressures. Two patients had evidence of hepatic cirrhosis. One woman had device closure of PFO, but has right heart failure. One man had redo surgical closure of VSD and PFO. Another patient is being considered for a Glenn shunt to take some load off RV. Surgical closure of muscular VSD by large patch with RV apical exclusion gives good early results. However, long term in adult life, the reduced size of RV, and diastolic dysfunction cause problems. These include reopening of PFO with cyanosis, right heart failure, cirrhosis, and arrhythmias.

EComment. Percutaneous closure of post-myocardial infarction septal defect

We read with great interest the paper by Papalexopoulou et al. regarding the best timing of surgery in patients with post-infarct ventricular septal rupture [1]. After carefully reviewing the literature, the authors conclude that the best strategy is to delay the surgery by 3-4 weeks if the haemodynamic status of the patient allows. However, current guidelines advocate immediate surgical closure of the ventricular septal defect (VSD) irrespective of the patient's haemodynamic status to circumvent further haemodynamic decline [2]. First described by Lock et al. in 1988, the transcatheter closure of VSD has gained a widespread use, and devices originally intended to close the patent foramen ovale or atrial septal defects, have been modified for closure of muscular VSD. This less-invasive interventional approach allows, in the majority of cases, rapid haemodynamic stabilization by reducing the left-to-right shunt [3]. Anatomical considerations, best depicted by echocardiography, represent a major limitation of this procedure. Large VSDs exceeding 35 mm, apical VSDs without suitable rim or basal VSDs in the vicinity of mitral apparatus or the aortic valve represent a contraindication to the percutaneous closure with Amplatzer devices [4]. Another important drawback is the limited number of centres with sufficient expertise in performing these challenging procedures, because percutaneous closure of an acute postinfarct VSD remains one of the most demanding procedures in interventional cardiology. Costache et al. used an Amplatzer occluder as a bridge-to-surgical procedure in a 79-year old woman in cardiogenic shock secondary to a post-infarct VSD [5]. The combined approach enabled them to perform surgery on a more stable patient. Recently, Thiele et al. [4] evaluated, in a prospective study, the outcomes of primary interventional closure of postinfarction VSD in an acute setting as an alternative to surgical closure. The overall 30-day mortality of this less-invasive approach was 35%. Not surprisingly, the mortality rate was higher in patients with cardiogenic shock. Major complications occurred in 41% and these included free ventricular wall rupture, device embolization or dislocation and residual left-to-right shunting. Despite advances in medical and surgical care intervention, mortality of postinfarction VSD remains high, especially in patients with haemodynamic compromise. Future multicentre studies are warranted to identify patients best suited for surgical or interventional closure, in the era of evolving alternative technologies. Conflict of interest: none declared

The hybrid perventricular closure of apical muscular ventricular septal defect with Amplatzer duct occluder

PurposeApical muscular ventricular septal defects (MVSDs), especially in small infants, can be difficult to manage using surgical and percutaneous closure. An intraoperative perventricular procedure is a good option for closing apical MVSDs in small children with or without associated cardiac anomalies. We evaluated the results of hybrid perventricular closure of apical MVSDs performed using an Amplatzer duct occluder (ADO).MethodsWe retrospectively reviewed the medical records of 5 patients who underwent hybrid perventricular closure of MVSDs with ADOs, from March 2006 to May 2011. The median patient age at the time of the procedure was 12 months (range, 25 days to 25 months), and the median body weight was 9.1 kg (range, 4.3 to 15 kg). Two patients had multiple ventricular septal defects (VSDs; additional perimembranous VSD in 1 patient and multiple MVSDs in the other) and 3 patients had associated cardiac anomalies; complete transposition of the great arteries in 1 patient and an atrial septal defect in 2 patients. All the procedures were performed on beating hearts, exception in 1 case. The ADO selected for the aortic side was at least 1 to 2 mm larger than the largest VSD in the left ventricle side.ResultsThe procedure was successful in all patients and each device was well positioned. During the median follow-up of 2.4 years, a small residual VSD was noted in 2 patients who had multiple VSDs and no leakage was seen in the other 3 patients.ConclusionPerventricular closure of MVSD with an ADO is a good option for patients with apical MVSD. However, careful manipulation is important, especially in the case of small infants.