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Minimally invasive transthoracic device closure of ventricular septal defect without cardiopulmonary bypass: 5-year fellow-up results
Quansheng Xing, Qin Wu.
Children's Hspital of Qingdao University, Qingdao, China.

OBJECTIVE:
Recently, minimally invasive transthoracic device closure (MITDC) of
ventricular septal defect (VSD) under transesophageal echocardiography (TEE)
guidance, are increasingly successfully performed with excellent results. We
retrospectively reviewed 508 cases received this treatment in our center, and
summarized 5-year follow-up results.
METHODS:
From March 2007 to March 2012, 508 cases
with VSD size from 3 to 12 cm
(5.3±4.6cm)
underwent this procedure. All
the procedures were performed in the operating room. A 3-5
cm inferior sternotomy or the left third intercostals incision
was made. Under TEE guidance, through the chosen RV free wall
point, the delivery system with occlusion device of appropriate size was introduced
into RV cavity, defect and then left ventricular (LV) cavity. Then following the LV disc, waist and the RV disc were deployed
in LV, septum
and RV respectively. After complete TEE assessing for absence of complications, the device was released. Patients were followed up with a standard
protocol.
RESULTS:
485 cases were successfully closed(95.5%), and the procedure were converted to conventional
open heart repair in 23 patients (4.5%). Concentric device were used in 288 cases (59.4%), eccentric device in 184 cases
(37.9%) and special ones in 13 cases (2.7%). The mean operating time was 18.5±11.9
min (3 to 48 min). Most of the patients were discharged within 5 days after operation.
Follow-up in 467 patients (96.2%) ranged from 3 to 63 months (36.3±11.6 months) reveals no severe complications except for
one complete heart block 6 months after operation which received sinus rhythm
after the device being taken out and the defect closed surgically.
CONCLUSIONS:
MITDC of VSD on beating heart is a safe and effective alternative to
conventional treatments. The 5-year clinical outcomes are promising, and long term
follow-up is mandatory.


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