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Per-ventricular Device Closure of doubly committed Subarterial Ventricular Septal Defects
Objective: Doubly committed Sub-arterial ventricular septal defect (VSD) is a specific anatomic type of VSD locating just beneath the aortic valve. The purpose of this video was to demonstrate the perventricular closure technique in managing this type of VSD.
Methods:
Surgical incision: through 2-3cm left anterior mini-thoracotomy. Procedure: A domestic made eccentric VSD device (SHAMA Corp, Shanghai, China) was used during the procedure. A mattress suture was placed in RV surface, and a 20-gauge needle was inserted into the RV cavity. A wire was introduced into the left ventricular through the defect. A double-lumen delivery sheath was advanced into the left ventricle over the guide wire and the device was delivered through the prepared loader sheath and the delivery sheath. Once the expanded left ventricular disc, the device was rotated until the eccentric side of the disc was opposite to the site of the aortic valve. Then the cable and delivery sheath were simultaneously withdrawn, the waist as well as the RV disc were subsequently deployed under the guidance of the trans-esophageal echocardiogram

Results: Our initial result of this procedure was encouraging with no mortality as well as severe complication such as device embolism, significant arrhythmias and noticeable valve regurgitation during both hospital stay and follow-up (data is showed in table 1)
Conclusion: Perventricular closure of doubly committed subarterial VSDs appears to be safe, effective and minimal invasive technique.

Category	Complication rate (%)
	In operation room	At discharge	Follow up
Residual shunt	18% (all ≤ 2mm)	7%( all ≤ 2mm)	0%
Aortic regurgitation	18% (5 Trivial)	18% (5 Trivial)	4% (1 Trivial)
Pulmonary regurgitation	11% (3 Trivial)	4% (1 Trivial)	14% (4 Trivial)
Complete heart block	0	0	0
Incomplete right bundle branch block	0	7% (2 patient)	0

Table 1: Complications of the 28 patients (mean age 7.9±5.8year and Mean VSD size 4.9±1.6mm) with successful per-ventricular device closure in our institution with mean follow-up time 2.3 years