Intraoperative Device Closure of Doubly Committed Subarterial Ventricular Septal Defects: Initial Experience

Background. The purpose of this study was to evaluate the safety and feasibility of intraoperative device closure of the doubly committed subarterial ventricular septal defect (VSD). Methods. From January 2009 to January 2010, we enrolled 15 patients with doubly committed subarterial VSD who underwent intraoperative device closure in our institution. Our method involved a minimal inferior median incision that was performed after full evaluation of the doubly committed subarterial VSD by real-time transesophageal echocardiographic guidance, and the insertion of the device through the delivery sheath to occlude the VSD. The proper size of the device was determined by means of transesophageal echocardiographic analysis. An asymmetric, domestically made device was chosen for closure (Shanghai Xingzhuangjiyi Alloy Material Co, Ltd). Results. Implantation was ultimately successful in 13 patients (86.7%). The complete closure rates at 24 hours and 3 months were 69.2% and 100%, respectively. In 5 of 13 patients, minor complications occurred: transient arrhythmia (n = 5) and blood transfusion (n = 3). In a follow-up period of 1 to 12 months there was no residual shunt, noticeable aortic regurgitation, significant arrhythmias, thrombosis, or device failure. Conclusions. Minimally invasive transthoracic device closure of the doubly committed subarterial VSD with an asymmetric domestically made device without cardiopulmonary bypass is safe and feasible under transesophageal echocardiographic guidance. However, it is necessary to evaluate the long-term results.