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Perventricular device closure of ventricular septal defects: six months results in 30 young children
1Department of Thoracic and Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Insights
Perventricular device closure offers a safe and effective option for young children with isolated ventricular septal defects, avoiding cardiopulmonary bypass. This minimally invasive approach shows promising short-term results with high success rates and acceptable outcomes.
Area of Science:
- Pediatric Cardiology
- Minimally Invasive Cardiac Surgery
- Interventional Cardiology
Background:
- Traditional surgical and transcatheter methods for ventricular septal defects (VSDs) have limitations in pediatric patients.
- This study focuses on perventricular device closure for nonmuscular VSDs in young children.
- The technique aims to overcome limitations of existing VSD closure methods.
Purpose of the Study:
- To evaluate the short-term safety and efficacy of perventricular device closure for isolated nonmuscular VSDs.
- To assess the outcomes of a minimally invasive approach without cardiopulmonary bypass in pediatric patients.
- To determine the feasibility of this technique in young children.
Main Methods:
- Thirty pediatric patients with nonmuscular VSDs underwent perventricular device closure.
- A minimally invasive subxiphoid incision was used, avoiding cardiopulmonary bypass.
- Transesophageal echocardiography guided ventricular puncture and device deployment.
Main Results:
- Successful closure was achieved in 90% (27/30) of patients.
- No mortality or atrioventricular block occurred during the follow-up period.
- Minor complications included transient incomplete right bundle branch block and mild tricuspid regurgitation in some patients.
Conclusions:
- Perventricular device closure is a safe and effective option for selected young children with isolated VSDs.
- The technique demonstrates acceptable short-term outcomes without the need for cardiopulmonary bypass.
- This minimally invasive approach offers a viable alternative for pediatric VSD management.
Background:
Both surgical repair and transcatheter closure of isolated ventricular septal defects are known to have limitations in children. This report describes the short-term results of perventricular device closure of nonmuscular ventricular septal defects without cardiopulmonary bypass in young children.
Methods:
Thirty patients who had nonmuscular ventricular septal defects underwent perventricular closure by minimally invasive technique without cardiopulmonary bypass. A subxiphoid minimally invasive incision was performed. Under the continuous guidance of transesophageal echocardiography, the free wall of the right ventricle was punctured and a guidewire was introduced into the left ventricle through the defect. A delivery sheath was advanced over the wire and through the defect into the left ventricle. The device was released.
Results:
Closure was successful in 27 patients (90%). There was no mortality or atrioventricular block perioperatively or during the entire follow-up period. Three patients developed incomplete right bundle branch blocks and seven patients developed new trace or mild tricuspid regurgitation after the closure. The mean hospital stay was 3.6 +/- 0.7 days (range, 3 to 5 days) and no patient needed any blood or blood products. Follow-up at 6 months showed that two of the three patients had persistent incomplete right bundle branch block and three of the seven patients had persistent closure-related trace or mild tricuspid regurgitation.
Conclusions:
Perventricular device closure of isolated ventricular septal defects without cardiopulmonary bypass appeared to be safe and efficacious in selected young children. The outcomes of short-term follow-up are acceptable.
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