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Perventricular device closure of the ventricular septal defects in children-first experience in the United Arab
Aleksandr Omelchenko1, Neerod Kumar Jha2, Nishant Shah3
1Division of Pediatric Cardiac Surgery, Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, 768010, United Arab Emirates.
Insights
Perventricular device closure offers a safe and effective alternative for pediatric ventricular septal defects (VSDs), avoiding cardiopulmonary bypass. This minimally invasive approach leads to faster recovery and shorter hospital stays for children with VSD.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease Treatment
Background:
- Ventricular septal defect (VSD) is the most common congenital heart defect.
- Conventional surgical repair is invasive, requiring cardiopulmonary bypass and leading to prolonged recovery.
- Perventricular device closure is an evolving, less invasive alternative for VSD treatment.
Purpose of the Study:
- To evaluate the initial experience with perventricular device closure for VSDs in children.
- To assess the risks and benefits of this minimally invasive approach.
- To determine the safety and efficacy of perventricular device closure without cardiopulmonary bypass.
Main Methods:
- 13 children with VSD underwent perventricular device closure using transesophageal echocardiography guidance.
- The procedure was performed without cardiopulmonary bypass support.
- A MemoPart™ VSD occlusion device was implanted via a small sternal incision.
Main Results:
- Successful device closure was achieved in all 13 patients.
- No cardiopulmonary bypass, inotropic support, or blood transfusions were required.
- Patients experienced short ventilation times, minimal ICU stays, and rapid recovery with an average hospital stay of 4.4 days.
- No mortality, arrhythmias, or major complications were observed at follow-up.
Conclusions:
- Perventricular device closure is a safe, effective, and less invasive option for pediatric VSDs.
- The procedure offers rapid recovery, shorter hospitalization, and improved cosmetic outcomes.
- Further refinements in device technology and techniques may expand indications and improve long-term results.
Background:
Ventricular septal defect (VSD) is the most common congenital cardiac malformation, accounting for approximately 30% of congenital heart defects. Conventional surgical repair using cardiopulmonary bypass is invasive and associated with morbidities and prolonged hospital stay. With the advent of interventional approaches and availability of different occluding devices, the technique of perventricular device closure is evolving and being implemented successfully in larger groups of patients. We present herein, our initial experience of perventricular device closure for the ventricular septal defects in children to assess risks and benefits.
Methods:
From March, 2023 to February, 2024, we have performed perventricular closure of ventricular septal defects in 13 children, under guidance of transesophageal echocardiography without cardiopulmonary bypass support. The median age at operation was 2 year (range 1.3-10 years) with the median body weight 11 kg (range 8.7-16.6 kg). Sixty-nine percent were males. The ventricular septal defect sizes ranged from 2.7 to 6 mm (mean 4.7 mm). Seven defects were perimembranous, four sub-aortic and two were muscular. One patient also underwent pulmonary artery de-banding with pulmonary artery balloon angioplasty and other one patent ductus arteriosus ligation, concomitantly. For defect closure, we used ventricular septal defect occlusion device (MemoPart™, Lepu Medical Technology Company, China) through a 3-cm skin incision in the lower- third of the sternum. The device sizes ranged from 5 to 8 mm (mean 6.9+-1.8 mm) and all patients except for two required symmetrical devices.
Results:
All patients underwent device closure successfully. The procedural duration ranged between 32 and 52 min. None of the patients required cardiopulmonary bypass. The mean ventilation time and intensive care unit stay was 3 and 24 h, respectively. None of the patients required inotropic support or blood transfusions. Moreover, no patients developed any arrhythmias including heart block. The average length of hospital stay was 4.4 days. At the latest follow up, there were no residual shunts, conduction disturbances, device dislodgement or major aortic or tricuspid valve complications seen in any patients. There was no mortality.
Conclusions:
Perventricular device closure of ventricular septal defects is a less invasive, extremely safe and effective method in children. It is associated with very fast recovery, shorter hospitalization time and better cosmetic incision. Moreover, it avoids cardiopulmonary bypass. The modifications and refinements in the design, material and implantation techniques will help in expanding the indications and prevent complications in the long-term.
