title: Peratrial device closure of perimembranous ventricular septal defects through a right parasternal approach.
abstract: BACKGROUND
  Both percutaneous and perventricular device closures of perimembranous ventricular septal defects (PmVSDs) have drawbacks. This study evaluates the feasibility, safety, and efficacy of peratrial device closure of a PmVSD using a probe-assisted delivery system.
  
  
  METHODS
  Seventy-three patients (peratrial group) were enrolled in this study. A 1.5- to 2.0-cm parasternal incision was made in the fourth right interspaces. A Z-shaped malleable hollow probe was inserted into the right atrium. Under transesophageal echocardiographic guidance, it was advanced through the tricuspid valve into the right ventricle. The tip of the probe was adjusted to point to or cross the defect. A flexible guidewire was sent to the left ventricle through the probe to establish a delivery pathway. Then the device was delivered and deployed. Seventy matched control patients, who underwent perventricular device closure of PmVSDs, were identified and assigned to the perventricular group.
  
  
  RESULTS
  Successful device placement was achieved in 70 of 73 (96%) patients in the peratrial group. The minimal PmVSD diameter ranged from 2.0 to 7.0 mm (median, 3.0 mm). Although the intracardiac manipulation time was longer in the peratrial group, the procedural time and postoperative hospital stays were shorter than in the perventricular group (all p<0.01). During the follow-up period of 6 to 24 months, no significant device-related complication was found in either group.
  
  
  CONCLUSIONS
  The peratrial device closure of PmVSDs is feasible, safe, and efficacious. Compared with the perventricular technique, it has the advantages of less trauma, shorter hospital stays and procedure time, and better cosmetic results.
authors.affiliation: Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China. Electronic address: hongxinli@hotmail.com.
authors.forename: Li
authors.initials: L
authors.lastname: Hongxin
authors.affiliation: Ultrasound Department, Provincial Hospital Affiliated to Shandong University, Jinan, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Ultrasound Department, Provincial Hospital Affiliated to Shandong University, Jinan, China.
authors.forename: Guo
authors.initials: G
authors.lastname: Wenbin
authors.affiliation: Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China.
authors.forename: Wen-Long
authors.initials: WL
authors.lastname: Zhang
authors.affiliation: Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China.
authors.forename: Zheng-Jun
authors.initials: ZJ
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Liang
authors.affiliation: Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China.
authors.forename: Cheng-Wei
authors.initials: CW
authors.lastname: Zou
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006325:Heart Atria; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D055989:Septal Occluder Device / Q000009:adverse effects; D013249:Sternum