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Updated: Feb 18, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Doubly committed ventricular septal defect closure using eccentric occluder via ultraminimal incision
Jin Yu1, Lianglong Ma2, Jingjing Ye1
1Department of Ultrasound Diagnosis, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Insights
This study demonstrates that transoesophageal echocardiography-guided closure of doubly committed ventricular septal defects (DCVSDs) in children using an eccentric occluder via an ultraminimal intercostal incision is safe and effective, with a 100% success rate.
Area of Science:
- Pediatric Cardiology
- Minimally Invasive Cardiac Surgery
- Echocardiography
Background:
- Doubly committed ventricular septal defects (DCVSDs) are a subset of congenital heart defects.
- Traditional surgical repair often involves sternotomy, leading to longer recovery times.
- Minimally invasive techniques are increasingly explored for pediatric cardiac interventions.
Purpose of the Study:
- To evaluate the safety, feasibility, and availability of DCVSD closure using an ultraminimal intercostal incision.
- To assess the efficacy of transoesophageal echocardiography (TEE) guidance in this procedure.
- To determine the outcomes of this novel approach in pediatric patients.
Main Methods:
- 35 children with DCVSDs (≤5 mm) underwent closure using a left parasternal ultraminimal intercostal incision (≤1 cm).
- A pericardium hanging technique and a short delivery sheath with an eccentric occluder were employed.
- Transoesophageal echocardiography guided the entire procedure, with follow-up assessments.
Main Results:
- 100% success rate in complete DCVSD closure among all 35 patients.
- Average operation duration was 45.42 minutes, with an average hospital stay of 8 days.
- No complications were observed during or after the procedure, and pre-existing mild aortic regurgitation resolved in one patient.
Conclusions:
- Ultraminimal intercostal incision DCVSD closure guided by TEE is a safe, feasible, and effective option for children.
- This minimally invasive approach offers excellent outcomes and is recommended for clinical use.
- The eccentric occluder device facilitates successful closure through a small incision.
Objectives:
This study aimed to investigate the safety, feasibility and availability of doubly committed ventricular septal defect (DCVSD) closure via an ultraminimal intercostal incision under the guidance of transoesophageal echocardiography in children.
Methods:
From August 2014 to August 2016, 35 children with DCVSDs (≤5 mm in diameter) were enrolled in this study. A left parasternal ultraminimal intercostal incision (≤1 cm) and a pericardium hanging technique were employed without sternal incision. DCVSDs were closed through a short delivery sheath assembled with an eccentric occluder device. Transoesophageal echocardiography was used to guide and monitor the entire procedure. All patients were followed up.
Results:
All 35 children had complete closures with an operation success rate of 100%. The average size of DCVSDs was 3.50 ± 0.79 (range 2.2-5.0) mm, and the average device size was 5 ± 2 (range 4-9) mm. The average operation duration was 45.42 ± 11.77 (range 25-70) min, and the average hospital stay was 8 ± 2 (range 7-16) days. The median follow-up period was 17 months (range 6 months-2.5 years). Pre-existing aortic regurgitation disappeared after surgery in 1 patient and remained the same in 4 patients. No other complications were found during the operation or during follow-up.
Conclusions:
Under transoesophageal echocardiography guidance, DCVSD closure using an eccentric occluder via an ultraminimal intercostal incision is feasible, safe and effective in children. The use of this approach is recommended.
