title: The hybrid perventricular closure of apical muscular ventricular septal defect with Amplatzer duct occluder.
abstract: OBJECTIVE
  Apical muscular ventricular septal defects (MVSDs), especially in small infants, can be difficult to manage using surgical and percutaneous closure. An intraoperative perventricular procedure is a good option for closing apical MVSDs in small children with or without associated cardiac anomalies. We evaluated the results of hybrid perventricular closure of apical MVSDs performed using an Amplatzer duct occluder (ADO).
  
  
  METHODS
  We retrospectively reviewed the medical records of 5 patients who underwent hybrid perventricular closure of MVSDs with ADOs, from March 2006 to May 2011. The median patient age at the time of the procedure was 12 months (range, 25 days to 25 months), and the median body weight was 9.1 kg (range, 4.3 to 15 kg). Two patients had multiple ventricular septal defects (VSDs; additional perimembranous VSD in 1 patient and multiple MVSDs in the other) and 3 patients had associated cardiac anomalies; complete transposition of the great arteries in 1 patient and an atrial septal defect in 2 patients. All the procedures were performed on beating hearts, exception in 1 case. The ADO selected for the aortic side was at least 1 to 2 mm larger than the largest VSD in the left ventricle side.
  
  
  RESULTS
  The procedure was successful in all patients and each device was well positioned. During the median follow-up of 2.4 years, a small residual VSD was noted in 2 patients who had multiple VSDs and no leakage was seen in the other 3 patients.
  
  
  CONCLUSIONS
  Perventricular closure of MVSD with an ADO is a good option for patients with apical MVSD. However, careful manipulation is important, especially in the case of small infants.
authors: Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: Soo Jin
authors: SJ
authors: Kim
authors: June
authors: J
authors: Huh
authors: Jin Young
authors: JY
authors: Song
authors: Ji-Hyuk
authors: JH
authors: Yang
authors: Tae-Gook
authors: TG
authors: Jun
authors: I-Seok
authors: IS
authors: Kang
keywords: Amplatzer duct occluder; Device closure; Hybrid procedure; Muscular VSD; Perventricular closure
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