title: Multicenter experience with perventricular device closure of muscular ventricular septal defects.
abstract: Hybrid procedures are becoming increasingly important, especially in the management of congenital heart lesions for which there are no ideal surgical or interventional options. This report describes a multicenter experience with perventricular muscular venticular septal defect (VSD) device closure. Three groups of patients (n = 12) were identified: infants with isolated muscular VSDs (n = 2), neonates with aortic coarctation and muscular VSDs (n = 3) or patients with muscular VSDs and other complex cardiac lesions (n = 2), and patients with muscular VSDs and pulmonary artery bands (n = 5). Via a sternotomy or a subxyphoid approach, the right ventricle (RV) free wall was punctured under transesophageal echocardiography guidance. A guidewire was introduced across the largest defect. A short delivery sheath was positioned in the left ventricle cavity. An Amplatzer muscular VSD occluding device was deployed across the VSD. Cardiopulmonary bypass was needed only for repair of concomitant lesions, such as double-outlet right ventricle, aortic coarctation, or pulmonary artery band removal. No complications were encountered using this technique. Discharge echocardiograms showed either mild or no significant shunting across the ventricular septum. At a median follow-up of 12 months, all patients were asymptomatic and 2 patients had mild residual ventricular level shunts. Perventricular closure of muscular VSDs is safe and effective for a variety of patients with muscular VSDs.
authors.affiliation: The Congenital Heart Center, The University of Chicago Hospitals, Chicago, IL 60637, USA. ebacha@surgery.bsd.uchicago.edu
authors.forename: E A
authors.initials: EA
authors.lastname: Bacha
authors.forename: Q L
authors.initials: QL
authors.lastname: Cao
authors.forename: M E
authors.initials: ME
authors.lastname: Galantowicz
authors.forename: J P
authors.initials: JP
authors.lastname: Cheatham
authors.forename: C E
authors.initials: CE
authors.lastname: Fleishman
authors.forename: S W
authors.initials: SW
authors.lastname: Weinstein
authors.forename: P A
authors.initials: PA
authors.lastname: Becker
authors.forename: S L
authors.initials: SL
authors.lastname: Hill
authors.forename: P
authors.initials: P
authors.lastname: Koenig
authors.forename: E
authors.initials: E
authors.lastname: Alboliras
authors.forename: R
authors.initials: R
authors.lastname: Abdulla
authors.forename: J P
authors.initials: JP
authors.lastname: Starr
authors.forename: Z M
authors.initials: ZM
authors.lastname: Hijazi
mesh_terms: D021721:Balloon Occlusion; D006328:Cardiac Catheterization; D013504:Cardiovascular Surgical Procedures; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D012307:Risk Factors; D014463:Ultrasonography