Minimally invasive perventricular device closure of an isolated perimembranous ventricular septal defect with a newly designed delivery system: Preliminary experience

Objective We sought to summarize the preliminary clinical experience of minimally invasive transthoracic device closure of perimembranous ventricular septal defects with a new delivery system without cardiopulmonary bypass. Methods Twenty-one patients aged 11 months to 12 years (median age, 3.6 years) with isolated perimembranous ventricular septal defects underwent minimally invasive device closure with an inferior sternotomy of 3 to 5 cm under transesophageal echocardiographic guidance. A single per–right ventricular U-like suture was established, and a new delivery system was introduced, aided by a 16-gauge trocar, including a guidewire, proper sheath, and loading sheath. The proper size of devices was determined by means of transesophageal echocardiographic analysis, and then the device was released under real-time transesophageal echocardiographic monitoring if no significant aortic regurgitation, abnormal atrioventricular valvular motion, or residual interventricular shunt appeared. Results All of the defects were successfully closed. No residual shunt, noticeable aortic or tricuspid regurgitation, or significant arrhythmias appeared during more than 5 months of follow-up. Conclusion Minimally invasive transthoracic device closure of perimembranous ventricular septal defects with a new delivery system without cardiopulmonary bypass is feasible and safe under transesophageal echocardiographic guidance. However, it is necessary to evaluate the intermediate and long-term results.