title: Minimally Invasive Peratrial Device Closure of Perimembranous Ventricular Septal Defect Through a Right Infraaxillary Route: Clinical Experience and Preliminary Results.
abstract: BACKGROUND
  Both percutaneous and perventricular device closures of perimembranous ventricular septal defects (PmVSD) present certain drawbacks. We report our experiences with a new, minimally invasive surgery using a peratrial device closure of PmVSD through a right infraaxillary route.
  
  
  METHODS
  Between January 2014 and October 2015, 145 patients (71 male, 74 female) with PmVSD, aged 0.5 to 9.7 years (mean 2.8 ± 2.2) and weighing between 6.1 kg and 43 kg (mean 14.0 ± 6.6 kg) were included in this study. In patients with left lateral position, a 2- to 3-cm incision was made along the right midaxillary line. The thoracic cavity was entered through the fourth intercostal space. With the help of transesophageal echocardiography guidance, a specially designed hollow probe was inserted into the right atrium. The probe was passed 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 inserted into the left ventricle through the channel of the probe to establish a delivery pathway. Then, the device was deployed to close the defect.
  
  
  RESULTS
  A total of 142 cases (97.9%) were successfully occluded, whereas 3 cases failed and were converted to cardiopulmonary bypass operation through the original incision. The device size ranged from 4.0 to 10.0 mm (mean 5.1 ± 1.4 mm), and all devices were concentric. Follow-up in all patients ranged from 1.0 to 22.8 months (mean 9.9 ± 5.6) and revealed no evident valve regurgitation, no complete atrioventricular block, and no device dislocation.
  
  
  CONCLUSIONS
  This new minimally invasive technique of peratrial device closure through a right infraaxillary route under transesophageal echocardiography guidance was shown to be a safe, effective, feasible, and cosmetically superior treatment for PmVSD.
authors: Department of Cardiovascular Surgery, Henan Provincial People's Hospital, Zhengzhou, China.
authors: Shubo
authors: S
authors: Song
authors: Department of Cardiovascular Surgery, Henan Provincial People's Hospital, Zhengzhou, China. Electronic address: fantb@zzu.edu.cn.
authors: Taibing
authors: T
authors: Fan
authors: Department of Cardiovascular Surgery, Henan Provincial People's Hospital, Zhengzhou, China.
authors: Bin
authors: B
authors: Li
authors: Department of Cardiovascular Surgery, Henan Provincial People's Hospital, Zhengzhou, China.
authors: Weijie
authors: W
authors: Liang
authors: Department of Cardiovascular Surgery, Henan Provincial People's Hospital, Zhengzhou, China.
authors: Haoju
authors: H
authors: Dong
authors: Department of Cardiovascular Surgery, Henan Provincial People's Hospital, Zhengzhou, China.
authors: Kaiyuan
authors: K
authors: Wu
authors: Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, China.
authors: Lin
authors: L
authors: Liu
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000175:diagnosis / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D055989:Septal Occluder Device; D016896:Treatment Outcome