Related Experiment Video
Updated: Oct 30, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Perimembranous ventricular septal defect closure via ultra-minimal trans intercostal incision in children
Zhan Gao1,1, Jin Yu1,2, Zewei Zhang1,1
1Department of Cardiac Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Insights
This study shows that closing perimembranous ventricular septal defects (PmVSDs) in children using a minimally invasive approach is safe and effective. This trans-intercostal incision method offers a viable alternative to traditional open-heart surgery.
Area of Science:
- Pediatric Cardiology
- Minimally Invasive Cardiac Surgery
- Congenital Heart Defects
Background:
- Perimembranous ventricular septal defects (PmVSDs) are common congenital heart abnormalities.
- Traditional surgical repair often involves sternotomy, carrying risks and longer recovery times.
- Exploring less invasive closure techniques is crucial for improving pediatric cardiac care.
Purpose of the Study:
- To evaluate the safety, feasibility, and availability of perimembranous VSD closure.
- To assess an ultra-minimal trans-intercostal incision technique for PmVSD repair in children.
- To determine the efficacy of this novel approach compared to standard surgical methods.
Main Methods:
- A cohort of 131 children with restrictive PmVSDs underwent closure.
- An ultra-minimal left parasternal trans-intercostal incision (≤1 cm) was used, avoiding sternal division.
- Transesophageal echocardiography (TEE) guided the occlusion process using a concentric occluder device and a pericardium hanging technique.
Main Results:
- Successful closure was achieved in 126 patients (96.18%).
- Follow-up ranged from 18 to 24 months, with one case of mild residual shunt that self-healed.
- Five patients required conversion to open-heart surgery due to complications like ventricular fibrillation or device issues.
Conclusions:
- Trans-intercostal PmVSD closure using a concentric occluder under TEE guidance is a feasible, safe, and effective pediatric procedure.
- This minimally invasive technique presents a promising alternative to conventional open-heart surgery for restrictive PmVSDs.
- Further research can optimize this approach for broader application in pediatric cardiac interventions.
Aims:
This study aimed to investigate the safety, feasibility and, availability of perimembranous ventricular septal defect (PmVSD) closure via a left parasternal ultra-minimal trans intercostal incision in children.
Methods And Results:
From January 2015 to January 2019, 131 children with restrictive PmVSDs were enrolled in this study and successfully done in 126 patients (96.18%). PmVSDs were occluded via an ultra-minimal trans intercostal incision (≤1 cm), and the entire occlusive process was guided and monitored by TEE. A pericardium hanging technique was employed without sternal incision. PmVSDs were closed through a short delivery sheath assembled using a concentric occluder device. All patients were followed up for a period ranging from18 months to 24 months. Thirteen patients with PmVSD had aneurysm of membranous septum (AMS). Multistream (≥2) PmVSDs with AMS were found in 11 cases. After the operation, mild residual shunt beside the amplatzer occluder in one patient was found and had self-healing result during the 5-month follow-up period. Five patients transferred to ventricular septal defect repair operation under direct visualization with a cardiopulmonary bypass. One reason was ventricular fibrillation when guidewire passed the PmVSD, another was device dislocation, and others were the guidewire cannot pass through the PmVSD.
Conclusions:
PmVSDs closure using a concentric occluder via a left parasternal ultra-minimal trans intercostal incision under TEE guidance is feasible, safe, and effective in children. This approach can be considered as an alternative treatment to open-heart surgery for restrictive PmVSDs.
