title: Minimally invasive perventricular device closure of ventricular septal defect in infants under transthoracic echocardiograhic guidance: feasibility and comparison with transesophageal echocardiography.
abstract: BACKGROUND
  A hybrid approach to minimally invasive perventricular closure of VSD in infants is safe and effective, and has been performed under guidance of transesophageal echocardiography (TEE). We applied transthoracic echocardiographic (TTE) guidance to this hybrid approach, and compare results guided by TTE with those by TEE.
  
  
  METHODS
  From January 2011 to January 2012, 71 infants with VSD were enrolled to undergo a minimally invasive device closure. After evaluation of VSD by TTE, either TEE or TTE was used to guide the minimally invasive device closure. 30 patients had TEE guidance, and 41 patients had TTE. All patients were followed for 3 months after the operation.
  
  
  RESULTS
  The TEE group had a success rate of 93.3% (28/30) for device implantation, compared with 92.7% (38/41) in the TTE group. Two patients in the TEE group turned to surgical closure, one for involvement of the inlet area of VSD demonstrated by TEE, another for moderate aortic regurgitation after device implantation. Two patients in the TTE group also transferred to surgical closure, one for residual shunt, another for failure of the floppy wire across the defect. In addition, one patient in the TTE group experienced dropout of the occluder one day postoperatively. At 3-month follow-up, one patient had mild aortic regurgitation in the TEE group and in two patients in the TTE group. There were no episodes of cardiac block, thromboembolism, or device displacement in either group.
  
  
  CONCLUSIONS
  TTE-guided VSD closure is feasible in infants, with results similar to those of TEE guidance, although caution is advisable.
authors.affiliation: Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, PR China. guicanzhang@yahoo.com
authors.forename: Gui-Can
authors.initials: GC
authors.lastname: Zhang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Chen
authors.forename: Hua
authors.initials: H
authors.lastname: Cao
authors.forename: Liang-Wan
authors.initials: LW
authors.lastname: Chen
authors.forename: Li-ping
authors.initials: LP
authors.lastname: Yang
authors.forename: Dao-zhong
authors.initials: DZ
authors.lastname: Chen
mesh_terms: D004452:Echocardiography / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging* / Q000601:surgery; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D016343:Monitoring, Intraoperative / Q000379:methods*; D011474:Prosthesis Design; D012189:Retrospective Studies; D055989:Septal Occluder Device; D016896:Treatment Outcome