title: Perventricular device closure of perimembranous ventricular septal defect in pediatric patients: technical and morphological considerations.
abstract: BACKGROUND
  We report our experience of using perventricular device closure (PVDC) in treating perimembranous ventricular septal defect (pm-VSD) with emphasis on technical and morphological considerations.
  
  
  METHODS
  Thirty-one pediatric patients with pm-VSD who underwent successful PVDC were enrolled in this study. The pm-VSDs were divided into three different types (type I: tunnel shape; type II: with subaortic rim < 2 mm; type III: membranous aneurysm formation). Four closure strategies were utilized, corresponding to the morphology of the pm-VSD.
  
  
  RESULTS
  Mean age of the patients was 2.1 years with mean VSD diameter 5.8 mm. Seven patients had type I VSD, nine presented with type II, and 15 had type III. Twenty-two concentric and nine eccentric devices were used with mean device size 7.3 mm. Complete closure was achieved in 97% of cases during follow-up. Procedure-induced tricuspid regurgitation (TR) was noted in nine patients at discharge; four resolved. Multivariable analysis showed that the procedure-induced TR was associated with the device size (odds ratio = 5.059; 95% confidence interval = 1.431-17.880).
  
  
  CONCLUSIONS
  Different closure strategies allow for PVDC of various types of pm-VSDs in selected pediatric patients.
authors.affiliation: Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Da
authors.initials: D
authors.lastname: Zhu
authors.forename: ChangPing
authors.initials: C
authors.lastname: Gan
authors.forename: Xiao
authors.initials: X
authors.lastname: Li
authors.forename: Qi
authors.initials: Q
authors.lastname: An
authors.forename: Shuhua
authors.initials: S
authors.lastname: Luo
authors.forename: Hong
authors.initials: H
authors.lastname: Tang
authors.forename: Yuan
authors.initials: Y
authors.lastname: Feng
authors.forename: Ke
authors.initials: K
authors.lastname: Lin
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D006345:Heart Septal Defects, Ventricular / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D011474:Prosthesis Design; D012307:Risk Factors; D055989:Septal Occluder Device; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000209:etiology