Perventricular device closure of doubly committed sub-arterial ventricular septal defects via a left infra-axillary approach

作者：Zhou, Sijie; Zhao, Liyun; Fan, Taibing^*; Li, Bin; Liang, Weijie; Dong, Haoju; Song, Shubo; Liu, Lin

来源：Journal of Cardiac Surgery, 2017, 32(6): 382-386.

DOI：10.1111/jocs.13155

• doubly committed subarterial ventricular septal defect
• device closure of dcVSD
• cosmetic effect
• left infra-axillary route
• perventricular device closure

Background: This study sought to evaluate the feasibility, safety, and efficacy of perventricular device closure of a doubly committed sub-arterial ventricular septal defect (dcVSD) through a left infra-axillary approach. @@@ Method: Forty-five patients, with a dcVSD of less than 8 mm in diameter, were enrolled in this study. The pericardium was exposed and opened through a left infra-axillary mini-incision. Two parallel purse-string sutures were placed on the right ventricle outflow tract and under transesophageal echocardiography guidance, a delivery sheath loaded with the device was inserted into the right ventricle and advanced through the defect into the left ventricle. The device, connected to a delivery cable, was then deployed. @@@ Results: Forty-one patients achieved successful device closure. In four patients, the device failed to occlude the VSD due to device dislodgement, device-related aortic regurgitation, and residual shunts, and open surgical repair was required. The mean dcVSD diameter was 4.5 +/- 1.0mm (range, 3.0-8.0 mm). The implanted device size was 6.0 +/- 1.5mm (range, 4-10 mm). All patients were implanted with an eccentric device. The mean intracardiac manipulation time was 20.9 +/- 7.1 min (range, 9-45 min). The procedure time was 62.5 +/- 19.5min (range 34-105 min). There were no severe adverse events. @@@ Conclusions: Perventricular device closure of a dcVSD through a left infra-axillary approach is feasible, safe, and efficacious in selected patients with dcVSD.

• 出版日期2017-6
• 单位郑州大学; 河南省人民医院