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Hybrid Perventricular device closure of doubly commited subarterial Ventricular septal defect: A single center long-term results.
Ke Lin, Da Zhu.
West China hospital of Sichuan University, Chengdu, China.

OBJECTIVE: Doubly committed subarterial ventricular septal defect (VSD) is a specific anatomic type of VSD locating just beneath the aortic valve. The purpose of this study is to evaluate the safety and feasibility of using minimal invasive perventricular device closure in managing this type of VSD.
METHODS: From July 2007 and Apr 2011, 87 Pediatric patients (Mean age 7 years) with doubly committed subarterial VSD who met the inclusion criteria for device closure were enrolled. Perventricular closure was facilitated by an unique design eccentric device under the guidance of real-time TEE guidance. Adverse events including residual shunt, valve regurgitation, arrhythmias were record in postoperative period and during follow-up.
RESULTS: Perventricular device closure was successfully done 78 patients (90%) with mean VSD size 4.8±1.5mm and mean device size 6.6±1.5mm. 9 patients were converted to open surgical repair due to residual shunt > 4mm (3 patients), obvious aortic regurgitation (4 patients) and device partial detachment (2 patients). Complete closure rate was achieved in 86% at discharge 99% during follow-up (Median 4 years). No severe complications such as device embolism, noticeable valve regurgitation and left ventricular outflow tract obstruction were noted during follow-up. Transit type I 2rd degree AV block was noted in 3 patients at 3 years follow-up. Procedure induced trivial-mild grade aortic valve was noted in 11 patients (4 mild/7 trivial) after procedure while 6 of them revolved and only 4 remain (1mild/4 trivial) during following.
CONCLUSIONS: Perventricular closure appears to be safe, effective and minimal invasive technique in selected paitent with doubly committed sub arterial VSDs with good long-term outcomes.

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