title: Initial results of primary device closure of large muscular ventricular septal defects in early infancy using perventricular access.
abstract: OBJECTIVE
  To report our experience with the use of the Amplatzer muscular ventricular septal defect (VSD) occluder, using direct right ventricle free wall puncture for primary closure of muscular VSDs in infants.
  
  
  BACKGROUND
  Young infants with heart failure due to large or multiple muscular VSDs often require intervention at a stage when percutaneous device closure is impractical due to delivery system limitations. There are considerable benefits to avoiding bypass in these infants.
  
  
  METHODS
  Patients with suitable muscular VSDs, considered too small for transvenous closure, underwent periventricular muscular VSD closure under transesophageal echo (TEE) guidance.
  
  
  RESULTS
  Eight infants underwent the procedure. The median age was 14 weeks (2-41) with median weight of 4 kg (3-6.6). Four patients had additional VSDs and one patient had previous repair of coarctation. One patient had dextrocardia and severe left ventricular impairment due to an associated cardiomyopathy. The median VSD size was 8 mm (range, 4-10 mm). A single device (6-12 mm) was deployed in each patient, the size chosen being 1-2 mm larger than the TEE measurement. Two patients had subsequent pulmonary artery banding, with absorbable bands, because of moderate residual shunting through additional VSDs. The latest echo study at a median of 7.2 weeks (0.5-66) post device implantation revealed no patients with a hemodynamically significant shunt.
  
  
  CONCLUSIONS
  Perventricular muscular VSD closure can be safely and effectively undertaken in small infants with suitable muscular defects, and this strategy can avoid the need for bypass.
authors: Department of Cardiology, Royal Children's Hospital, Melbourne, Australia.
authors: D S
authors: DS
authors: Crossland
authors: Department of Cardiology, Royal Children's Hospital, Melbourne, Australia.|Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Melbourne, Australia.
authors: J L
authors: JL
authors: Wilkinson
authors: Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia.|Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Melbourne, Australia.
authors: A D
authors: AD
authors: Cochrane
authors: Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia.|Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Melbourne, Australia.
authors: Y
authors: Y
authors: d'Udekem
authors: Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia.|Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Melbourne, Australia.
authors: C P
authors: CP
authors: Brizard
authors: Department of Cardiology, Royal Children's Hospital, Melbourne, Australia.
authors: G K
authors: GK
authors: Lane
mesh_terms: D006348:Cardiac Surgical Procedures / Q000295:instrumentation*; D017548:Echocardiography, Transesophageal; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional