A novel method of hybrid intraoperative catheter-based closure of ventricular septal defects using the Amplatzer® PDA occluder.
BACKGROUND
In five patients, an apical muscular septal defect was closed in a hybrid approach using the Amplatzer® duct occluder during open heart surgery, whereas concomitant defects were treated surgically. In addition to their different heart defects that needed surgery, all had a muscular ventricular septal defect in the apex of the heart, poorly accessible for traditional, surgical approach. We describe the method and outcome in these patients.


METHODS
The tip of a forceps was advanced from the left into the right ventricle through the ventricular septal defect. The delivery sheath was caught under visual control in the right ventricle and pulled back into the left ventricle. The disc was developed and pulled back until it was felt tugging at the septum. Then the core was developed. The end of the device was visible in the right ventricle and was secured with a Prolene® suture.


RESULTS
The procedures were event-free. During early follow-up there were either no or only insignificant shunts in the region of the prior trabecular defects in four patients. The unsatisfactory result in the last patient was caused by inaccurate preoperative assessment.


CONCLUSIONS
The method seems valuable in patients in need of other intracardiac surgery.
Unit for Heart and Lung Disease, Paediatric Clinic, Rikshospitalet (National Hospital), University of Oslo, Oslo, Norway. christian.neukamm@rikshospitalet.no
Christian
C
Neukamm
Per G
PG
Bjørnstad
Gunther
G
Fischer
Bjarne
B
Smevik
Harald L
HL
Lindberg
D000015:Abnormalities, Multiple; D006328:Cardiac Catheterization / Q000295:instrumentation*; D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007223:Infant; D009664:Norway; D018579:Patient Selection; D011474:Prosthesis Design; D011859:Radiography; D055989:Septal Occluder Device; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography