Intraoperative Device Closure Research Articles

Clinical evaluation of percutaneous and intra-operative device closure of atrial septal defects under transesophageal echocardiographic guidance: one center experience and mid-term follow-up

ObjectiveThe percutaneous closure of a single secundum atrial septal defect (ASD) under transesophageal echocardiography guidance as an accepted alternative to the transcatheter closure with fluoroscopy has been proven. However, the technique has not been routinely used. This study was to present and share our experience in comparing the clinical outcomes of the percutaneous and intra-operative device closure (IODC) of atrial septal defects without fluoroscopy.MethodsFrom January 2013 to December 2016, 103 patients with maximum diameters of ASD of less than 30 mm were allocated to groups taking either the percutaneous closure of atrial septal defects approach (PASD group, n = 53) or the intra-operative device closure approach (IODC Group, n = 50). They were operated on using the minimally invasive Amplatzer duct occluder under the guidance of transesophageal echocardiography without cardiopulmonary bypass. Echocardiography was performed to obtain an en face view of the ASD and important surrounding structures before the operation. Patient characteristics, perioperative data, and follow-up data were retrospectively documented and analyzed.ResultsPatient characteristics were comparable between the two groups. These were no differences in the maximum diameters of defects and the size of the occluders in each group (16.4 ± 5.3 mm vs16.4 ± 5.2 mm, P = 0.98; 22.4 ± 5.8 mm vs 21.3 ± 6.6 mm, P = 0.38). Intracardiac manipulation time was 20.72 ± 7.70 min in the PASD group and 6.01 ± 1.03 min in the IODC group (P < 0.001). The procedure time was 28.70 ± 10.41 min in the PASD group and 39.13 ± 6.03 min in the IODC group (P < 0.001). The successful closure defect was 100% in both groups when the maximum diameter of defect less than 25 mm. Four patients the PASD groups with maximum diameters between 25 mm and 30 mm were transferred to the IOCD group after unsuccessful device implantations. The total occlusion rate was 82% immediately after deployment, 98% at 3 months, and 100% at 6 months. No cardiac-related complications occurred during the follow-up period of between 3 to 65 months (mean 21.4 ± 9.8 months).ConclusionsPercutaneous device closures of Secundum atrial septal defects showed safety and high efficiency in patients under guidance by transesophageal echocardiography when compared with intra-operative device closures and are especially suited for women and children.

Transcatheter and intraoperative device closure of atrial septal defect in infants under three years of age

BackgroundTranscatheter and intraoperative device closures have been widely used in the treatment of secundum atrial septal defect (ASD). However, for young infants with ASD, device closure remains controversial, and such treatment features limited data. We compared the clinical data and follow-up results of percutaneous and intraoperative device closure for ASD to evaluate the feasibility, safety, and efficacy of both treatments in infants under 3 years of age.MethodsFrom September 2010 to September 2018, 186 children under 3 years of age with significant secundum ASD were included in this study. A total of 88 and 98 patients were divided into groups A (transcatheter device closure) and B (intraoperative device closure), respectively. The clinical data and follow-up results of the two groups were analyzed retrospectively.ResultThe mean age and weight of patients in group A were significantly higher than those in group B. The proportion of complex ASDs (multiples or rims deficiency) and the device/weight ratio in group B were significantly higher than those in group A. Successful closure was obtained in 86 (97.7%) and 96 (98.0%) infants in groups A and B, respectively, with two failed cases in each group (2.3% vs 2%). The rate of periprocedural complications reached 13.6 and 26.5% for groups A and B (P = 0.058), respectively. The durations of the procedure and postoperative hospital stay in group A were significantly shorter than those in group B (P < 0.05). Excellent follow-up results were observed in both groups. At present, no death nor major complications have occurred. Symptoms either resolved completely or improved significantly for all symptomatic infants. No residual shunts at the 6th month of follow-up evaluation were observed. Patients with failure to thrive gained weight appropriately for age, and the structure and hemodynamic parameters significantly improved during follow-up.ConclusionTranscatheter and intraoperative device closure are feasible, effective, and safe methods for the treatment of ASDs in infants under 3 years of age. Considering improved cosmetic effect and the short duration of the procedure and postoperative hospital stay, transcatheter is preferred for patients with appropriate conditions. Intraoperative device closure can be performed as an alternative to percutaneous closure, particularly for infants with large, complex ASDs, young age, or low-body weight.

A Sufentanil-Based Rapid Cardiac Anesthesia Regimen in Children Undergoing Percutaneous Minimally-Invasive Intraoperative Device Closure of Ventricular Septal Defect.

ObjectiveTo assess the effectiveness and safety of fast-track cardiac anesthesia using the short-acting opioid sufentanil in children undergoing intraoperative device closure of ventricular septal defect (VSD).MethodsThis retrospective clinical study included 65 children who underwent intraoperative device closure of VSD between January 2017 and June 2017. Patients were diagnosed with isolated perimembranous VSD by transthoracic echocardiography. Then, they were divided into two groups, group F (n=30), whose patients were given sufentanil-based fast-track cardiac anesthesia, and group C (n=35), whose patients were given conventional cardiac anesthesia. Perioperative clinical data were analyzed.ResultsNo significant differences were found between the preoperative clinical parameters and intraoperative hemodynamic indices between the two groups. In group C, compared with group F, the postoperative duration of mechanical ventilation, the length of stay in the intensive care unit, the length of hospital stay, and the hospital costs were significantly increased.ConclusionIn this retrospective study at a single center, sufentanil-based fast-track cardiac anesthesia was shown to be a safe and effective technique for minimally-invasive intraoperative device closure of VSD in children, which was performed with reduced in-hospital costs.

Health-related quality of life in children and adolescents undergoing intraoperative device closure of isolated perimembranous ventricular septal defects in southeastern China

ObjectivesTo investigate the health-related quality of life (HRQOL) in children and adolescents who underwent intraoperative device closure of perimembranous ventricular septal defects (pmVSDs).MethodsFrom October 2017 to January 2018, a total of 126 children and adolescents with isolated pmVSDs who underwent intraoperative device closure were enrolled in this study. We used the Pediatric Quality of Life Inventory Measurement Models 4.0 generic core scales to measure HRQOL 24 h before the operation and three months and one year after surgery.ResultsA total of 126 patients were successfully occluded. No severe complications occurred during the operative time, and 1 case of Mobitz type I atrioventricular block (AVB) and 1 case of complete cAVB occurred during the postoperative period. Compared with the data before the operation, the total score and five domain scores, including physical, psychosocial, emotional, social and psychological functioning, were significantly higher at three months after the operation. In addition, the total score, physical functioning score, and the psychosocial functioning score at the 1-year follow-up were even higher than those at 3 months after the operation.ConclusionsThe present study suggests that intraoperative device closure of pmVSD could improve health-related quality of life in children/adolescents and that the improvement may progress as the time after the operation increases. Further studies should concentrate on comparisons with other medical methods, larger samples, and longer follow-up periods.

Transcatheter and intraoperative device closure and surgical repair for atrial septal defect

BackgroundTranscatheter and intraoperative device closure for atrial septal defect (ASD) are widely applied to reduce the incision size and the potential for injury during cardiopulmonary bypass (CPB) in conventional surgical repair. No studies had been conducted to compare the safety and efficiency of these three treatments.MethodsFrom January 2018 to April 2018, 87 patients with an isolated ASD who had undergone transcatheter device closure (n = 45), intraoperative device closure (n = 22) and surgical repair (n = 20) were retrospectively reviewed and further analyzed to compare these three treatments.ResultsThe successful closure rate was similar in the three groups. There was a significant difference in aortic cross-clamping time, CPB duration and operative time between the surgical group and the device groups. The length of intensive care unit stay, postoperative mechanical ventilation time and length of hospital stay were shorter in the two device groups than in the surgical group. The incision was the most extended in the surgical group. Regarding major adverse events, no significant differences were found among the three groups.ConclusionsTranscatheter and intraoperative device closure and surgical repair for ASD are all safe and effective. Considering their respective disadvantages and advantages, the transcatheter approach may be the first choice for an isolated secundum ASD, the intraoperative approach may be the second choice, and surgical repair may be the last resort.

Comparison of Remifentanil-Based Fast-Track and Fentanyl-Based Routine Cardiac Anesthesia for Intraoperative Device Closure of Atrial Septal Defect (ASD) in Pediatric Patients.

BackgroundThe aim of this study was to evaluate the effectiveness and safety of remifentanil-based fast-track anesthesia for intraoperative device closure of atrial septal defects (ASDs).Material/MethodsThe clinical data of 152 pediatric patients who received intraoperative device closure of ASD in our hospital from January 2015 to December 2017 were retrospectively analyzed. Patients were divided into 2 groups: group F (remifentanil-based fast-track anesthesia group, n=72) and group C (fentanyl-based routine anesthesia group, n=80). The relevant data from 2 groups were collected and analyzed.ResultsNo significant differences were found in the preoperative data or intraoperative hemodynamic index between these 2 groups. Group C was significantly inferior to group F regarding the duration of mechanical ventilation, length of intensive care unit (ICU) stay, length of hospital stay, and hospitalization expenses (P<0.05). In terms of postoperative complications, no death, third-degree atrioventricular block, occluder detachment, or residual leakage was reported in either group. The incidence of lung infections and bronchospasm was significantly higher in group C than in group F. There were no anesthetic-related complications.ConclusionsThe application of remifentanil-based fast-track anesthesia for intraoperative device closure of ASD is as effective and safe as fentanyl-based routine anesthesia. Moreover, remifentanil-based fast-track anesthesia has the advantages of shorter duration of mechanical ventilation, shorter length of hospital and ICU stay, fewer postoperative complications, and lower hospitalization expenses, and is therefore worthy of promotion in clinical practice.

Strategy of treating secundum atrial septal defect not referred to percutaneous closure.

To evaluate safety and effectiveness of intraoperative device closure for secundum atrial septal defect (ASD) not referred to percutaneous closure. From April 2010 to December 2018, 231 secundum ASD children (≤14years) directly recommended to surgical repair were enrolled in this study. These patients were divided into two groups according to the parents' choice based on surgeons' recommendation. Follow-up evaluations were adopted at 2weeks, 3months, 6months, and 12months after the procedure and yearly thereafter. In Group A, 127 patients underwent an initial attempt at device closure. In Group B, 104 patients underwent a repair procedure under cardiopulmonary bypass. All patients survived. Group A had lower values of operation time, mechanical ventilation time, cardiac intensive care unit duration and amount of blood transfusion. Nevertheless, postoperative hospitalization time between two groups showed no statistical difference. In group A, 109 (85.83%) patients were successfully occluded, whereas 18 (14.17%) patients were converted to open-heart surgery. No severe complications occurred in the follow-up period. Intraoperative device closure is safe, effective procedure for selected cases with secundum ASDs which were not referred to percutaneous closure because of more suitable occluder selection, no "unbutton effect" and stitching enhancement.

Intraoperative Device Closure of a Perimembranous Ventricular Septal Defect Using the Right Thoracic Ventricle Approach

This study compared the safety and effectiveness of intraoperative device closure of a perimembranous ventricular septal defect (pmVSD) using theright thoracic minimal incision to right ventricle and lower midline sternotomy to right ventricle approaches. We retrospectively analyzed the clinical data of 46 patients who underwent intraoperative device closure of a pmVSD through the right thoracic minimal incision to right ventricle route (group 1) and 52 patients who underwent intraoperative device closure of a pmVSD through a minimal incision in the lower sternum (group 2) at our hospital from March 2016 to March 2017. In group 1, a right thoracic minimal incision to the fourth intercostal space was used to establish a delivery system through the right ventricle to complete pmVSD closure. In group 1, intraoperative device closure of the pmVSD was successful in 44 patients and was converted to open surgery in 2 patients (a delivery system could not be established in the one, and a significant residual shunt was present in the other). In group 2, the corresponding numbers of patients were 50and 2, respectively. Neither group exhibited serious adverse effects, including dislocation of the occluder, third-degree atrioventricular block, or new onset of aortic valve regurgitation during the perioperative period or during a median follow-up period of 1 to 2 years. Intraoperative device closure of a pmVSD through the right thoracic minimal incision to right ventricle approach is safe and effective. This procedure can avoid some of the shortcomings caused by sternotomy, uses an incision with an improved cosmetic appearance, and is worth recommendation.

Intraoperative Device Closure of Isolated Ventricular Septal Defects: Experience on 1,090 Cases

This study summarizes the clinical experience and 8-year follow-up results of the intraoperative device closure of ventricular septal defects (VSD). From January 2009 to June 2017, 1,090 patients with isolated VSD were enrolled at our institute to participate in the study. The procedure involved a small lower sternal incision that was performed after full evaluation of VSD by transesophageal/transthoracic echocardiographic (TEE/TTE) guidance and the deployment of a domestically made occluder to close the VSD periventricularly and off cardiopulmonary bypass. Follow-up was in the first 3 months and then every 1 to 2 years with TTE, electrocardiography, and upon symptoms. In all, 1,033 patients were occluded successfully under this approach, and the remaining patients were converted to surgical repair. The size of the occluder deployed ranged from 6 to 14 mm and included 825 symmetric devices and 208 asymmetric devices. A total of 25 patients developed severe arrhythmias, including 11 cases of complete atrioventricular block and 14 cases of Mobitz type II atrioventricular block, during and after the procedure. Minimally invasive transthoracic device closure of VSD with an asymmetric or symmetric domestically made device on a beating heart is a safe and feasible alternative to conventional surgical repair. More experience in multicenter and long-term follow-up is necessary to assess the actual feasibility and safety of this procedure.

Comparative study of the transcatheter and transthoracic device closure treatments for atrial septal defect: A Chinese single-institution experience.

The purpose of this study was to compare patient populations, safety, feasibility, complications, and total costs of the transcatheter and transthoracic device closure treatments for secundum atrial septal defect.From January 2014 to December 2014, we enrolled 155 patients with secundum atrial septal defects in our hospital. The patients were divided into 2 groups: the 70 patients in group A underwent transcatheter device closure, and the 85 patients in group B underwent transthoracic intraoperative device closure with a right lateral mini-thoracotomy.In group A, the total occlusion rate was 94.3% immediately after the operation, 100% at 3 months, and 100% at 12 months of follow-up; the group A results were not statistically different from the group B results (94.1%, 98.8%, 98.8%, respectively). There was a statistically significant difference in the minor complication rate (P < 0.05), and there were no reported deaths. There was a greater indicated scope using the transthoracic closure device to treat atrial septal defects. In our comparative study, the patients in group B had longer intensive care unit stays and hospital stays than group A (P < 0.05).Both of the device closure treatment options for secundum atrial septal defect are safe and feasible. The transcatheter device closure approach has the advantages of more cosmetic results, less trauma, and a shorter hospital stay than the transthoracic approach. On the contrary, the transthoracic closure device is an economical alternative choice, particularly for patients who are not eligible for the transcatheter closure device.

Intra-operative device closure of perimembranous ventricular septal defect without cardiopulmonary bypass under guidance of trans-epicardial echocardiography: a single center experience.

BackgroundIntraoperative device closure of perimembranous ventricular septal defect(VSD) through a lower mini-sternotomy is safe, less invasive, and has excellent surgical and cosmetic outcomes. Our study is to evaluate the feasibility of closing VSD under guidance of trans-epicardial echocardiography.MethodsWe reviewed the clinical course of 41 patients referred to our institution for minimally invasive closure of perimembranous VSD. The trans-epicardial echocardiography(TEE) was used to monitor the whole procedure to guide the positioning of device and evaluate the operative effect instantly after operation.ResultThe procedure was successfully done in 38 patients(92.6 %) with mean age of 1.2 ± 1.5 years(range 0.5-6.1 years),mean weight of 10.78 ± 6.87 kg(range 5.2 ~ 26 kg) and VSD size of 5.1 ± 1.13 mm(range 5 ~ 10 mm). Three cases failed, including two cases whose guide-wires could not pass through VSDs and one case whose occluder could not repair VSD well. Three patients had tiny residual shunts because of the shifting of occluders. There were no major complications such as arrhythmia, valve regurgitation and the failure of occluder during follow-up(Mean 2.3 ± 1.2 years). TEE provided superior imaging of shapes and surrounding structures of the VSDs, and guide-wires passing through VSDs.ConclusionsIntraoperative device closure of perimembranous VSD through a lower mini-sternotomy without cardiopulmonary bypass appears to be a safe and effective procedure. The use of trans-epicardial echocardiography provides useful information for intraoperative device closure of VSD.

GW24-e3091 The perioperative role of the echocardiography in left ventricular-right atrium shunt (Gerbode defect)

ObjectivesLeft ventricular-right atrium (LV-RA) shunt (Gerbode defect), is a rare type of ventricular septal defect. The purpose of this study was to discuss the role of the echocardiography in LV-RA...

Intraoperative Device Closure of Subaortic Ventricular Septal Defects

To evaluate the safety and the indication for percardiac device closure of subaortic ventricular septal defects (VSDs) under guidance of transesophageal echocardiography. A total of 62 patients with VSDs immediately below the aortic valve underwent percardiac device closure without cardiopulmonary bypass. There were no deaths. Of 62 patients, 52 (83.9%) underwent successful closure and 10 (16.1%) were converted to open-heart surgery due to tricuspid regurgitation, aortic regurgitation, and a residual shunt. Multiple logistic regression analysis showed the type and diameter of VSD were associated with the failure of device closure. There were no severe adverse events. Follow-up ranged from 13 to 31 months (mean, 22.3 ± 5.2 months). Early and late complications occurred in 10 patients (19.2%) and two patients (3.8%), respectively. Excellent short-term results can be achieved in selected patients with percardiac device closure of subaortic ventricular septal defects.

Techniques and results in the management of multiple muscular trabecular ventricular septal defects

The management of patients with multiple muscular trabecular ventricular septal defects (VSDs) remains controversial. In the past two decades, innovative techniques including a right ventricular apical infundibulotomy and transcatheter, intraoperative and perventricular device closure have been exploited, and essential right atrial approach and limited apical left ventriculotomy have also been refined. However, specific management guidelines for this difficult disease have not been established. In this article, the benefits and drawbacks of each technique are reviewed and discussed. Primary repair for infants with multiple muscular trabecular VSDs was associated with good late outcomes. The right atrial approach was satisfactory for all muscular VSDs, excluding apical defects that were well seen through a limited apical ventriculotomy. Surgical closure of apical defects could be achieved safely and completely in early infancy through a limited apical left ventriculotomy or a right ventricular apical infundibulotomy. Further follow-up and prudent evaluations of ventriculotomy-associated morbidities are needed. Pulmonary artery banding should be limited to a small infant with complex associated defects. Percutaneous device closure, the most desirable option, is impractical due to limitations between the delivery system and access route. Intraoperative device closure appears less successful than device closure in the catheterization laboratory. Perventricular device closure has a significant advantage of being a non-bypass procedure approach. A less invasive strategy for "true" Swiss cheese septum is needed. All may have an important role, and results obtained by using these techniques are encouraging. These hybrid approaches will promise future success on management guidelines of multiple muscular trabecular VSDs.

Atrioventricular Block Subsequent to Intraoperative Device Closure Atrial Septal Defect with Transthoracic Minimal Invasion; A Rare and Serious Complication

ObjectivesAtrioventricular block (AVB) is a infrequent and serious complication after percutaneous ASD closure. In this study, we report on the incidence of AVB associated with intraoperative device closure of the ASD with transthoracic minimal invasion, and the outcomes of this complication in our center.MethodsBetween May 2006 and January 2011, a total of 213 secundum-type ASD patients were accepted in our hospital for intraoperative and transthoracic device closure with a domestic occluder. All patients were assessed by real-time transthoracic echocardiography (TTE) and electrocardiograph (ECG).ResultsAll patients were occluded successfully under this approach. Immediate postprocedure third-degree AVB was observed in two patients. Since heart rates were in the range of about 50 to 55 beats per minute, no intervention was needed except for close observation for one patient. Another patient who recovered sinus rhythm intermittently during the operation was fitted with a temporary pacemaker. Approximately one week following glucocorticoid treatment, the AVB resolved spontaneously in these two patients. Mobitz type II AVB occurred in three patients during the procedure. Two patients developed post-operative cardiac arrest and were rescued successfully with cardiopulmonary resuscitation. One other patient changed to Mobitz type I AVB after three days. During the follow-up period, which ranged from six months to five years, no further occurrence of AVB was found.ConclusionsIntraoperative and transthoracic device closure of secundum ASDs with domestic occluder resulted in excellent closure rate. AVB is an infrequent but serious complication during and after device closure of a secundum ASD. AVB is a complication that warrants greater attention and long-term follow-up.

Closure of Perimembranous Ventricular Septal Defects with Intraoperative Device Technique: Another Safe Alternative to Surgical Repair

This study aims at assessing the safety and feasibility of intraoperative device closure of the perimembranous ventricular septal defect (VSD). Total 89 patients in group I with intraoperative device closure and 58 in group II with surgical repair were enrolled in our hospital to participate in the study from January 2009 to December 2010. In group I, the approach involved a minimal inferior median incision that was performed after full evaluation of the perimembranous VSD by real-time transesophageal echocardiographic guidance, and the insertion of an asymmetric or a symmetric domestically made device was used to occlude the perimembranous VSD. In group I, 83 patients were occluded successfully under this approach. The size of the occluder implanted ranged from 6 to 14 mm. Complete atrioventricular block occurred in one case and Mobitz type II atrioventricular block occurred in one case during the procedure. One patient presented complete atrioventricular block one week after the operation. Two patients converted to surgical repair because of severe intraoperative aortic valve regurgitation. One patient with significant residual shunt transformed to surgical treatment. In our comparative studies, patients in group II experienced significantly longer operative time, ICU stay, and hospital stay (p < 0.001). The cost of group I was less than that of group II (p < 0.001). Minimally invasive transthoracic device closure of the perimembranous VSD with an asymmetric or a symmetric domestically made device without cardiopulmonary bypass is safe and feasible. It should be considered an acceptable alternative to surgery in selected subgroups. However, it is necessary to evaluate the long-term results.

Long‐Term Outcomes of Device Closure of Very Large Secundum Atrial Septal Defects: A Comparison of Transcatheter vs Intraoperative Approaches

Transcatheter device closure (TCDC) and intraoperative device closure (IODC) have emerged as minimally invasive methods in the treatment of secundum atrial septal defects (ASDs), but the long-term safety and efficacy remains uncertain for the large ASDs. TCDC may be as safe and efficacious as IODC for closure of large ASDs in terms of long-term clinical outcomes. Ninety-two patients who had ASDs with a defect diameter of ≥30 mm were included in this study. The patients received either TCDC (n = 42) or IODC (n = 50). An Amplatzer septal occluder was used in both groups. The dumbbell-like device deploying technique was introduced in the TCDC group. Physical exams, electrocardiography, and echocardiography were performed preprocedurally and postprocedurally at the index follow-up visits. The procedural immediate success rate was 97.6% for TCDC and 98.0% for IODC (P = 0.328). The rate of periprocedural complications was 9.5% for TCDC and 28.0% for IODC (P = 0.026). The mean hospital stay was 7.5 ± 2.7 days for TCDC and 11.9 ± 3.8 days for IODC (P < 0.001). For the mean follow-up of 5.4 ± 0.5 years, there were no cardiac deaths and late complications in either group. No significant residual shunts were documented, and symptoms were significantly improved in both groups. Right and left ventricular diameter, pulmonary artery diameter, and pulmonary systolic pressure were all significantly decreased in both groups (P < 0.05). The present study confirmed the long-term safety and efficacy for closing a large ASD either by TCDC or IODC. Either of them could become an effective alternative to the surgery for large ASD closure. The authors have no funding, financial relationships, or conflicts of interest to disclose.

Intraoperative device closure of perimembranous ventricular septal defects: another safe and feasible alternative to surgical repair in infants

Conventional surgical closure has been considered the gold standard for the treatment of perimembranous ventricular septal defects (PVSDs) in infants for many years, but it requires a cardiopulmonary bypass and midline sternotomy which can lead to both physical and psychological trauma in the future. An intraoperative device closure can be performed with the advantages of reduced invasion, faster recovery and so on. We evaluate the safety and feasibility of intraoperative device closure of PVSDs in infants in comparison with surgical closure. One hundred eighty-six infants with a PVSD were enrolled in our study. Among them, 97 patients were treated by surgical closure and 89 were treated by intraoperative device closure. The success rates, complications, length of hospital stay and costs were measured. The success rate was similar (P = 0.228) in the two groups: 87/89 patients (97.8%) in the device group versus 97/97 patients (100%) in the surgical group. Complication needs management was required in one patient of the device group (1.1%) and in two patients of the surgical group (2.0%) (P = 1.000). Minor complications were observed in 7/87 patients (8.0%) of the device group versus 15/99 patients (15.2%) of the surgical group (P < 0.001). Both groups were similarly effective in reducing the left ventricular end-diastolic dimension, pulmonary arterial pressure and cardiothoracic rate. The procedure time, inpatient stay and intensive care unit stay are shorter in the device group; the total cost was similar for both groups. Intraoperative device closure of PVSDs under real-time transoesophageal echocardiography guidance is safe and feasible without CPB. Under the right conditions, intraoperative device closure can be a good alternative to surgical closure for the treatment of PVSDs in infants.

Atrioventricular block of intraoperative device closure perimembranous ventricular septal defects; a serious complication

BackgroundAtrioventricular block (AVB) is a well-reported complication after closure of perimembranous ventricular septal defects (VSDs). To report the occurrence of AVB either during or following closure of perimembranous VSDs using a novel "hybrid" method involving a minimal inferior median incision and of intraoperative device closure of the perimembranous VSDs.MethodsBetween January 2009 and January 2011, patients diagnosed with perimembranous VSDs eligible for intraoperative device closure with a domestic occluder were identified. All patients were assessed by real-time transesophageal echocardiography (TEE) and electrocardiography.ResultsOf the 97 included patients, 94 were successfully occluded using this approach. Complete AVB occurred in only one case and one case of Mobitz type II AVB was diagnosed intraoperatively. In both patients, the procedure was aborted and the AVBs quickly resolved. Glucocorticosteroids were administered to another two patients who developed Mobitz type II AVB intraoperatively. Those two patients converted to Mobitz type I AVB 3 days and 5 days postsurgically. During the follow-up period (range, 6-24 months), one patient developed complete AVB 1 week following device insertion. Surgical device removal was followed by a rapid and complete recovery of atrioventricular conduction.ConclusionsIntraoperative device closure of perimembranous VSDs with a domestic occluder resulted in excellent closure rates; however, AVB is a serious complication that can occur either during or any time after device closure of perimembranous VSDs. The technique described herein may reduce the incidence of perioperative AVB complications. Surgeons are encouraged to closely monitor all patients postsurgically to ensure AVB does not occur in their patients. Additional long-term data to better identify the prevalence and risk factors for AVB in treated patients are needed.

Intraoperative device closure of multidefect under transoesophageal echocardiographic guidance in an infant

A 6-month-old female of 6 kg presenting with tachypnea, tachycardia, refractory heart failure, and pneumonia was referred to our centre for treatment. Complete echocardiography confirmed a perimembranous ventricular septal defect (VSD) associated with a secundum atrial septal defect (ASD) and a patent ductus arteriosus (PDA), sized of ∼5.4, 9.0, and 4.6 mm in …