Original article
Adult cardiac
Transthoracic Device Closure of Juxtaarterial Ventricular Septal Defects: Midterm Follow-Up Results

https://doi.org/10.1016/j.athoracsur.2017.01.042Get rights and content

Background

In recent years, minimally invasive transthoracic device closure has been introduced as an alternative treatment option for selected patients with juxtaarterial ventricular septal defects. This study evaluated the midterm safety and efficacy of using device closure in selected patients.

Methods

Between January 2008 and December 2014, 25 patients with juxtaarterial ventricular septal defects who met the inclusion criteria were enrolled in this study. Periventricular closure was attempted using minimally invasive transthoracic device closure without cardiopulmonary bypass under general anesthesia and transesophageal echocardiography guidance. Patients were strictly monitored according to a standard protocol by one specially appointed doctor.

Results

Minimally invasive transthoracic device closure was successfully performed in 23 patients (92%) with a median age of 18 months. Device closure failed in 2 patients (1 with aortic regurgitation and 1 with right ventricular outflow tract stenosis), and they were converted to an open operation. No severe complications (device shift, significant arrhythmia, ventricular outflow tract obstruction, or obvious valve regurgitation) were observed. There was no closure-associated valve regurgitation. No patient had worrisome progression of aortic regurgitation or pulmonary regurgitation.

Conclusions

In select patients, minimally invasive transthoracic device closure of juxtaarterial ventricular septal defects appears to be safe and effective, with good midterm outcomes.

Section snippets

Patients and Methods

Informed consent was obtained from the parents. The study was approved by the Institutional Review Ethics Board of Women and Children’s Hospital, Qingdao University.

Between January 2008 and October 2014, 25 patients with juxtaarterial VSDs underwent minimally invasive transthoracic device closure without cardiopulmonary bypass at the Heart Center of Women and Children’s Hospital of Qingdao. The inclusion criterion was confirmed diagnosis of a juxtaarterial VSD by echocardiography. The exclusion

Results

Patients were a median age of 18 months (range, 3 months to 15 years) at the time of the operation; 13 (52%) were male and 12 (48%) were female. Complete demographic data are reported in Table 1. The procedure was successfully performed in 23 patients (92%). There were no deaths or major morbidity such as obvious residual shunt (>3 mm measured by TEE), more than mild degree AR, device embolism, or fatal arrhythmia during the hospital or follow-up phase. Transventricular VSD closure failed in 2

Comment

Juxtaarterial VSD is a type of VSD that is more common in Eastern races; the defective superior borders are the aortic ring and pulmonary ring. As a result of the special anatomic site, juxtaarterial VSD is an absolute contraindication for transcatheter interventional occlusion, and classic treatment involves repair of the VSD under CPB [4]. Because of a low tendency for spontaneous closure and likelihood of progressive AP as well as insufficiency, such patients should undergo surgical repair

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