Jin Yu

and 7 more

Object: Investigate the value of transesophageal echocardiography (TEE) in perimembranous ventricular septal defect (PmVSD) closure via a left parasternal ultra‐minimal trans intercostal incision in children. Methods: From January 2015 and December 2020, 212 children with PmVSD were performed device occlusion via an ultraminimal intercostal incision. TEE is used throughout the perioperative period, including TEE assessment, TEE-guided localization of the puncture site, TEE guidance. All patients were followed up using transthoracic echocardiography for over 6 months. Results: A total of 207 cases successfully occluded, the successful rate was 97. 64%. one hundred and forty-five patients had single orifice, and 62 patients had multiple orifices in the AMS. During the operation, the surgeon readjusted the device or replaced the larger device in 17 cases. After operation, there were 19 cases of slight residual shunts, 13 cases of pericardial effusion and 4 cases of pleural effusion. And all were back to normal during the 4- month follow-up period. Mild mitral regurgitation was presented in 1 patient and remained the same during the follow-up period. No other complications were found. Conclusions: TEE was used to evaluate and determine the defect in PmVSDs with an concentric occluder via a left parasternal ultra‐minimal trans intercostal incision. TEE guidance and immediate postoperative efficacy evaluation are of great value, which can effectively guide the treatment of PmVSD occlusion.

Zhan Gao

and 4 more

Aims:This study aimed to investigate the safety, feasibility and availability of perimembranous ventricular septal defect (PmVSD) closure via a left parasternal ultra-minimal trans intercostal incision in children. Methods and results:From January 2015 to January 2019, 131 children with restrictive PmVSDs were enrolled in this study and successfully done in 126 patients (96.18%). PmVSDs were occluded via an ultra-minimal trans intercostal incision (≤1 cm), and the entire occlusive process was guided and monitored by TEE. A pericardium hanging technique was employed without sternal incision. PmVSDs were closed through a short delivery sheath assembled using a concentric occluder device. All patients were followed up for a perid ranging from18 months to 24 months. Thirteen patients with PmVSD had aneurysm of membranous septum (AMS). Multistream (more than or equal to 2) PmVSDs with AMS were found in eleven cases. After the operation, mild residual shunt beside the amplatzer occluder in one patient was found and had self-healing result during the 5-month follow-up period. Five patients transferred to ventricular septal defect repair operation under direct visualization with a cardiopulmonary bypass. One reason was ventricular fibrillation when guide wire passed the PmVSD, another was device dislocation, and others were the guide wire cannot pass through the PmVSD. Conclusions:PmVSDs closure using a concentric occluder via a left parasternal ultra-minimal trans intercostal incision under TEE guidance is feasible, safe, and effective in children. This approach can be considered as an alternative treatment to open-heart surgery for restrictive PmVSDs.

Qiang Gao

and 5 more