Intraoperative device closure of subaortic ventricular septal defects.

OBJECTIVES: To evaluate the safety and the indication for percardiac device closure of subaortic ventricular septal defects (VSDs) under guidance of transesophageal echocardiography. METHODS: A total of 62 patients with VSDs immediately below the aortic valve underwent percardiac device closure without cardiopulmonary bypass. RESULTS: There were no deaths. Of 62 patients, 52 (83.9%) underwent successful closure and 10 (16.1%) were converted to open-heart surgery due to tricuspid regurgitation, aortic regurgitation, and a residual shunt. Multiple logistic regression analysis showed the type and diameter of VSD were associated with the failure of device closure. There were no severe adverse events. Follow-up ranged from 13 to 31 months (mean, 22.3 ± 5.2 months). Early and late complications occurred in 10 patients (19.2%) and two patients (3.8%), respectively. CONCLUSIONS: Excellent short-term results can be achieved in selected patients with percardiac device closure of subaortic ventricular septal defects.

Transesophageal echocardiographic guidance of percardiac device closure of intracardiac defects in patients weighing less than 10 kg.

BACKGROUND: To evaluate the technology of transesophageal echocardiographic guidance of percardiac closure in patients with low weight. METHODS: Forty-two patients with intracardiac defects, aged from two months to five years (median, 18.4 months) and weighted from 4 to 10 kg (median, 8.9 kg), underwent attempted percardiac device closure under transesophageal echocardiographic guidance. RESULTS: Thirty-nine (93%) patients successfully underwent occlusion, whereas three patients (7.1%) were converted to conventional open-heart surgery. There was no mortality. They were followed up from 3 months to 15 months (median, 9.4 months). First degree atrioventricular block was detected in one patient at the time of discharge. The most common electrocardiogram change was bundle-branch block, which developed in three (7.7%) patients during follow-up. New mild mitral valve regurgitation (MR) was detected in three patients after operation and disappeared in one but remained in two others. Pericardial perfusion and recurrent intubation developed in one patient, respectively. The incidence of late complications is 5.1% (2/39) including low cardiac output syndrome and residual shunt in one patient, and moderate pericardial perfusion in one patient, respectively. No complication such as device dislocation, thrombosis, and obstruction of left or right ventricular outflow tract was found during the follow-up. CONCLUSIONS: This initial success indicates that transesophageal echocardiographic guidance of percardiac device closure will aid in the treatment of intracardiac defects in selected patients weighing less than 10 kg with good early outcomes.