title: Echocardiographic assessment and guidance in minimally invasive surgical device closure of perimembranous ventricular septal defects.
abstract: BACKGROUND
  The primary aim of this study was to explore the safety and feasibility of minimally invasive surgical device closure of perimembranous ventricular septal defects (PMVSDs) in children using echocardiography for preoperative assessment and intraoperative guidance.
  
  
  METHODS
  We enrolled 942 children diagnosed with PMVSDs from April 2010 to October 2013. All children underwent full evaluation by transthoracic echocardiography (TTE) and multiplane transesophageal echocardiography (MTEE) to determine the sizes, types and spatial positions of defects and their proximity to the adjacent tissues. The PMVSDs were surgically occluded using MTEE for guidance.
  
  
  RESULTS
  Eight hundred eighty-nine (94.37%) of 942 children underwent successful closure of PMVSDs. Symmetric devices were used in 741 children (including 38 A4B2 occluders) and asymmetric devices were used in the other 148. All patients received follow-ups at regular intervals after successful occlusion. The occluders remained firmly in place. No noticeable residual shunt or valvular regurgitation was discovered, with the exception of one child whose original mild aortic regurgitation progressed to moderate by the 18 month follow-up. Overall there were no significant arrhythmias with the exception of 3 children, all of whom experienced postsurgical acute attacks of Adams-Stokes syndrome.
  
  
  CONCLUSIONS
  Minimally invasive surgical device closure of PMVSDs is safe and feasible. TTE and MTEE play vital roles in all stages of treatment of PMVSDs.
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Research Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
authors.forename: Yifeng
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Echocardiography, Central South University, Changsha, Hunan, 410011, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Gao
authors.affiliation: Department of Echocardiography, Central South University, Changsha, Hunan, 410011, China.
authors.forename: Xinhua
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Research Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
authors.forename: Tianli
authors.initials: T
authors.lastname: Zhao
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Research Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
authors.forename: Jinfu
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Research Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
authors.forename: Zibo
authors.initials: Z
authors.lastname: Gao
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Research Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
authors.forename: Ni
authors.initials: N
authors.lastname: Yin
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Research Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
authors.forename: Lian
authors.initials: L
authors.lastname: Xiong
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Research Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
authors.forename: Li
authors.initials: L
authors.lastname: Xie
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Research Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
authors.forename: Can
authors.initials: C
authors.lastname: Huang
authors.affiliation: Department of Echocardiography, Central South University, Changsha, Hunan, 410011, China.
authors.forename: Wancun
authors.initials: W
authors.lastname: Jin
authors.affiliation: Department of Echocardiography, Central South University, Changsha, Hunan, 410011, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D055989:Septal Occluder Device; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome