ObjectiveTo investigate the efficacy and safety of hybrid perventricular device closure (PVDC) for the treatment of muscular ventricular septal defect (MVSD) in pediatric patients. MethodsWe retrospectively analyzed clinical data of 35 pediatric patients with MVSD who received hybrid PVDC in West China Hospital between 2009 and 2012. There were 16 males and 19 females with their median age of 3.9 years (range, 1 month to 7 years). There were 10 patients with single MVSD, 12 patients with multiple MVSD, 6 patients with other congenital heart defects, and 7 patients with post-surgical residual MVSD. ResultsAmong the 35 patients, immediate complete closure was achieved in 28 (80.0%) patients. Residual shunt was noted in 7 (20.0%) patients. Median device size was 5 mm. Cardiopulmonary bypass was avoided in 19 patients. Two (5.7%) patients died postoperatively due to postoperative heart failure resulted from complex congenital heart defect. All survival patients were followed up for a mean duration of 6 months, and there was no late death. Thirty-one (93.9%) patients had good positioning of the closure devices but no residual shunt. Small residual shunt at the apex was noted in 2 (6.1%) patients. ConclusionHybrid PVDC is an effective treatment for MVSD with relatively high successful rate but low mortality and morbidity, and its short-term results are satisfactory.
ObjectiveTo assess the safety and efficacy of a new surgical strategy, perventricular device closure, for the treatment of subarterial ventricular septal defect (VSD). MethodsThirty-nine patients younger than 10 years with subarterial VSD who received surgical repair in West China Hospital from November 2010 to May 2012 were included in this study. There were 18 male and 21 female patients with their age of 5.9±3.2 years. Perventricular device closure was performed with eccentric device under the guidance of transesophageal echocardiography (TEE). Residual shunt, valvular regurgitation (including aortic regurgitation)and arrhythmias during perioperative period and follow-up were analyzed. ResultsThirty-three patients successfully received perventricular device closure, and 6 patients received conversion to open surgical repair. Postoperative ICU stay was 2.2±0.8 days, and length of hospital stay was 4.8±1.8 days. Major postoperative complications included residual shunt and mild or less aortic regurgitation. Mean follow-up duration was 7±2 months. No obvious arrhythmia, moderate or severe valvular regurgitation was observed during follow-up. ConclusionPerventricular device closure is safe, efficacious and minimally invasive for the treatment of subarterial VSD in pediatric patients with suitable anatomic characteristics with good mid-term results.