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Objective Surgical repair of doubly-committed subarterial ventricular septal defect (VSD) under cardiopulmonary bypass(CPB) has been the gold standard. Perventricular device closure of muscular and then perimembranous VSD on beating heats with a small subxiphoid or inferior sternotomy has been attempted in the past few years with good results. We have tried perventricular closure of doubly committed subarterial VSD through a left anterior minithoracotomy as an alternative procedure with a modified occluder.
Methods 21 selected patients with doubly committed subarterial VSD between January 2008 and December 2012, were recruited for modified device closure on beating hearts off pump through left anterior minithoracotomy through a short incision in the third intercostal space. Their ages ranged from 13 to 61 months and their body weights from 11 to 27 kg. A single per-right ventricular “U” like suture under pulmonary annulus was established, and a delivery system was introduced, aided by an 18G trocar, including a guidewire, delivery sheath, and loading sheath. A proper device was selected according to the VSD size established by transesophageal echocardiography (TEE), and then the device was released under real-time monitoring of TEE if no residual shunt, increased aortic prolapse or regurgitation, abnormal atrioventricular valvular motion appeared.
Results In 19 of the 21 children, a saddle-like occluder was successfully closed through a left minithoracotomy with satisfactory cosmetic effects. In the other two children, the procedure was converted to conventional open-heart repair because the relatively larger occluder induced significantly increased aortic regurgitation. There was no operative or late mortality or major morbidity. All children were followed up longer than 10 months. No residual shunt, increased aortic prolapsed or regurgitation, or serious atrioventricular block was recorded until the most recent follow-up.
Conclusions Selected doubly committed subarterial VSD can be safely closed with a saddle-like occluder through left anterior minithoracotomy.