Original article
Congenital heart surgery
Intraoperative Device Closure of a Perimembranous Ventricular Septal Defect Using the Right Thoracic Ventricle Approach

https://doi.org/10.1016/j.athoracsur.2018.08.038Get rights and content

Background

This study compared the safety and effectiveness of intraoperative device closure of a perimembranous ventricular septal defect (pmVSD) using the right thoracic minimal incision to right ventricle and lower midline sternotomy to right ventricle approaches.

Methods

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.

Results

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 50 and 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.

Conclusions

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.

Section snippets

Material and Methods

This study was approved by the Ethics Committee of our university and strictly adhered to the tenets of the Declaration of Helsinki. All patients’ guardians signed informed consent forms before the operation.

Results

Intraoperative device closure through the right thoracic minimal incision to right ventricle approach was successful in 44 patients. For the remaining 2 patients, the procedure was converted to open surgery because a delivery system could not be established in the one patient and a significant residual shunt was noted in the other patient. Transthoracic echocardiography/transesophageal echocardiography showed that the median ventricular defect diameter was 5.1 mm (interquartile range, 1.23 mm).

Comment

Recently, intraoperative device closure of VSDs has been widely used in clinical practice and has achieved satisfactory short-term and midterm clinical efficacy rates 6, 7, 8, 9, 10, 11, 12. The minimal incision in the lower sternum method is the earliest used, best developed, and most widely used approach. It is advantageous for its simple operation, broad indications, ease of choice regarding the most appropriate puncture point of the right ventricular surface, ease of avoiding injury to the

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    Ventricular septal defects

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    Drs Qiang Chen and Qiu contributed equally to this work and are co-first authors.

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