title: Echocardiographic Guided Closure of Perimembranous Ventricular Septal Defects.
abstract: BACKGROUND
  Transesophageal echocardiogram-guided minimally invasive periventricular device closure of perimembranous ventricular septal defects (pmVSDs) without cardiopulmonary bypass is a treatment option for pmVSDs. We introduce our improvements to this technique and mid-term follow-up results.
  
  
  METHODS
  From May 2011 to May 2014, 187 patients with pmVSDs aged 6 months to 31 years (8.2 ± 10.2 years) were enrolled in this study. The procedure was performed through a new transthoracic approach of 1 to 2 cm without sternotomy. Device selection and the operative procedure were monitored by transesophageal echocardiogram. The patients underwent follow-up examinations of echocardiography and electrocardiogram at 1 month, 3 months, 6 months, and 1 year after the operation and annually thereafter.
  
  
  RESULTS
  The defects were closed successfully in 179 patients (95.7%), and in 8 patients the operation was converted to conventional surgical repair. Six patients (3.4%) had an incomplete right bundle branch block. One patient experienced an intermittent complete atrioventricular block on the fourth day after the operation, and sinus rhythm was restored by corticosteroid therapy after 5 days. A trivial residual shunt was observed in 8 patients (4.5%) during the procedure. The average hospital stay was 3.1 ± 0.9 days. Follow-up in all patients ranged from 1 month to 36 months (median, 12.6 months), and aortic regurgitation, malignant arrhythmia, and device dislocation were not observed in any patients. However, 3 patients (1.7%) still had a trivial residual shunt at their last follow-up.
  
  
  CONCLUSIONS
  Periventricular device closure through a modified transthoracic approach without sternotomy is a potentially safe and effective treatment option for pmVSDs. Controlled studies with long-term follow-up are necessary.
authors.affiliation: National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
authors.forename: Wen-Bin
authors.initials: WB
authors.lastname: Ou-Yang
authors.affiliation: National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
authors.forename: Shou-Jun
authors.initials: SJ
authors.lastname: Li
authors.affiliation: National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
authors.forename: Shou-Zheng
authors.initials: SZ
authors.lastname: Wang
authors.affiliation: National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
authors.forename: Da-Wei
authors.initials: DW
authors.lastname: Zhang
authors.affiliation: National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Liu
authors.affiliation: National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Ge
authors.affiliation: National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China. Electronic address: fuwaiyiyuan28@163.com.
authors.forename: Xiang-Bin
authors.initials: XB
authors.lastname: Pan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal / Q000295:instrumentation / Q000379:methods*; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods; D013997:Time Factors; D055815:Young Adult