Perventricular device closure of perimembranous ventricular septal defects in 61 young children: early and midterm follow-up results.
OBJECTIVE
Perventricular device closure of perimembranous ventricular septal defect as a novel technique has recently been described in several small series with initial experience. Further studies with larger cohorts and longer-term follow-up are needed to confirm the validity of this new approach. This report describes our recent experience with perventricular device closure of perimembranous ventricular septal defects on beating hearts in 61 young children with over 1 year of follow-up.


METHODS
Between April 2007 and April 2008, 61 patients with perimembranous ventricular septal defects were enrolled for a prospective study of perventricular device closure of their defects. The hospital course and the immediate and midterm complications during follow-up were herein reported.


RESULTS
The defects were closed successfully with devices in 57 (93.4%) patients without mortality or major morbidity. Four (6.6%) patients were converted to surgical repair when device closure was deemed unsuccessful; the failure of device closure was associated with the subaortic rim (odds ratio = 21.471; P = .038). Residual shunt was observed in 4 (6.6%) patients during the procedure. One of them was converted into surgical repair, and the residual shunt of the other 3 resolved during the 6-month follow-up period. Two (3.3%) patients had complete atrioventricular block develop in the operating room or during follow-up. One was converted into surgical repair and the other patient converted to sinus rhythm after treatment with steroids.


CONCLUSIONS
Perventricular device closure of ventricular septal defect is a safe and efficacious treatment option with acceptable midterm outcomes. For infants with poor vascular access, it might be the procedure of choice.
Tao
Kaiyu
K
Department of Thoracic and Cardiovascular Surgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China.
Lin
Ke
K
Shi
Yingkang
Y
Song
Haibo
H
Lui
Raphael C
RC
Gan
Changping
C
An
Qi
Q
D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D006348:Cardiac Surgical Procedures; D016009:Chi-Square Distribution; D002675:Child, Preschool; D002681:China; D017548:Echocardiography, Transesophageal; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D016017:Odds Ratio; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D018570:Risk Assessment; D012307:Risk Factors; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome