title: Transthoracic device closure of ventricular septal defects without cardiopulmonary bypass: experience in infants weighting less than 8 kg.
abstract: OBJECTIVE
  Both surgical and percutaneous device closure of ventricular septal defect (VSD) have drawbacks and limitations in infants. We report our experiences and midterm results of transthoracic device closure of VSDs (TDCVs) without cardiopulmonary bypass (CPB) in infants.
  
  
  METHODS
  Between September 2007 and September 2009, 32 patients, with a mean age of 7.2 ± 4.7 months, body weight of 6.8 ± 2.8 kg, underwent this procedure. The procedure was performed in the operating room. A small subxiphoid incision was made. A purse-string suture was placed on the right ventricular free wall. The free wall was punctured using a trocar, then a guide wire was inserted and advanced to cross the VSD into the left ventricle under transesophageal echocardiographic guidance. A modified delivery sheath was then introduced over the guide wire. The device was delivered and deployed in position along the sheath to close the defect.
  
  
  RESULTS
  A total of 30 cases (94%) were successfully closed, and the remaining two cases (6%) were converted to open heart repair. No patients received transfusion. There was no perioperative mortality, or any major complication. The mean size of the devices was 7.6 ± 3.4mm. The total operative time was less than 60 min, and the mean time for device implantation was 18.3 ± 9.4 min. All patients were extubated within 2h, and were discharged within 5 days after operation. The follow-up period ranged from 6 to 31 months (18.3 ± 9.6 months). There was no late major complication detected.
  
  
  CONCLUSIONS
  Minimally invasive TDCV without CPB is a safe and effective alternative to the conventional operation in low-body-weight infants.
authors.affiliation: Heart Center, Children's Hospital of Qingdao University, Qingdao, China. xingqs0532@163.com
authors.forename: Quansheng
authors.initials: Q
authors.lastname: Xing
authors.forename: Qin
authors.initials: Q
authors.lastname: Wu
authors.forename: Silin
authors.initials: S
authors.lastname: Pan
authors.forename: Yueyi
authors.initials: Y
authors.lastname: Ren
authors.forename: Hao
authors.initials: H
authors.lastname: Wan
mesh_terms: D001835:Body Weight; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D011474:Prosthesis Design; D055989:Septal Occluder Device; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods