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Objective To evaluate the feasibility,safety and efficacy of perventricular device closure of supracristal or intracristal ventricular septal defects (VSD) using a minimally invasive technique through a parasternal approach.Methods 49 patients,aged 4 months to 53 years [median 4.8 years],were enrolled in this study.A 1.5 to 3 cm parasternal incision was made in the left second or third intercostal space.The pericardium was incised and cradled without entering the pleural space.Two parallel pursestring sutures were placed at the right ventricular outflow tract.After puncture,the specially designed delivery sheath loaded with the device was inserted into the right ventricle.Under transesophageal echocardiographic guidance,the sheath was advanced through the defect into the left ventricle.Then the device was deployed to close the defect.Results Successful implantation of the device was achieved in 47 patients (96％),including 26 in intracristal group and 21 in supracristal group.The concentric,eccentric,and muscular occluders were used in 17,28 and 2 patients,respectively.The mean diameter of VSD was (4.4 ± 1.7)mm in the intracristal group and (2.7 ± 0.9) mm in the supracristal group.The mean device size was (7.0 ± 2.3) mm and (4.8 ± 1.1)mm in the intralcristal and supracristal group,respectively.The mean intracardiac manipulation time was (17 ± 16) min.During the follow-up period of 3 to 24 months,no device-related complications were found.Conclusion The perventricular device closure of small-sized supracristal or under medium-sized intracristal VSD is feasible,safe,and efficacious through a left parasternal approach.
RESUMO
Objective The aim of this study was to evaluate the feasibility,safety and efficacy of peratrial device closure of ventricular septal defect (VSD) through a right parasternal approach.Methods Between May 2011 and July 2012,47 patients (peratrial group),aged 7 months to 37 years,underwent peratrial device closure of VSD through a right parasternal approach.According to the same inclusion criteria,47 patients who underwent perventricular device closure of VSD were randomly chosen as the control group (perventricular group).In the peratrial group,a 1.5 to 2.0 cm parasternal incision was made in the right fourth or third intercostal space.The pericardium was incised and cradled.Two parallel pursestring sutures were placed at the right atrium near the atrioventricular groove.After puncture,a specially designed hollow probe was inserted into the right atrium.The probe was passed through the tricuspid valve into the right ventricle.Under transesophageal echocardiographic guidance,the tip of the probe was adjusted to point to or cross the defect.A flexible guidewire was rapidly inserted into the left ventricle through the channel of the probe to establish a delivery pathway,and the delivery sheath was introduced through the defect over the wire.Then the device was deployed to close the defect.Results Successful implantation of the device was achieved in both groups of patients (100％).In the peratrial group,the entrance and the exit diameter of the VSD were (7.4 ±4.1) mm (range,2.0 to 20.0 mm) and (3.4 ± 1.2)mm (range,2.0 to 7.0 mm),respectively.The mean device size was (6.3 ± 1.5)mm (range,4.0 to 12.0 mm).The mean intracardiac manipulation time is longer in the peratrial group [(15 ± 13) min] than in the perventricular group[(8 ± 5)min],P ＜ 0.01.But the procedure time is shorter in the peratrial group[(56 ± 24) min] than in the perventricular group [(72 ± 16) min],P ＜ 0.01.During the follow-up period of 1 to 12 months,no device-related complications were found.Conclusion The peratrial device closure of VSD is feasible,safe,and efficacious.It has the advantages of less invasiveness,better cosmetic results,and a shorter procedure time.
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OBJECTIVE: This study aims to report our experience using intraoperative device closure of secundum atrial septal defects and to evaluate the feasibility and clinical outcome of this technique. METHODS: One hundred patients with secundum atrial septal defects (mean age, 29 +/- 16 years; age range, 5-71 years; mean weight, 54 +/- 18 kg; weight range, 16-94 kg) underwent intraoperative device closure through a right minithoracotomy without cardiopulmonary bypass and fluoroscopy. A 2.5- to 3-cm parasternal or submammary incision was made in the right third or fourth intercostal space. Exposed with a miniretractor, a specially designed plastic sheath loaded with the device was inserted through the purse-string sutures placed on the right atrium. Under transesophageal echocardiographic guidance, it was advanced through the atrial septal defect into the left atrium, and the device was deployed in place. RESULTS: The procedure was successful in all patients, including 5 patients with double atrial septal defects. The maximum diameter of the atrial septal defect ranged from 5 to 37 mm (mean, 21 +/- 7 mm). There were 61 patients with an atrial septal defect diameter of more than 20 mm, 16 of them with a diameter of more than 30 mm. The mean size of implanted devices was 25 +/- 7 mm (range, 8-36 mm). Residual shunts were found in 9 (9%) patients immediately after the operation. The complete occlusion rate was 95% at discharge, 99% at the 3-month follow-up, and 100% at the 1-year follow-up. There were no other late complications during the follow-up period. CONCLUSIONS: Intraoperative device closure is a safe, cost-effective, cosmetic, and less-invasive operation of most secundum atrial septal defects. Follow-up results are encouraging. It can be considered an acceptable alternative to transcatheter closure or surgical repair.
