Objectives This study focused on the exploratory development of the safety and feasibility of min-invasive surgical device closure of types of perimembranous ventricular septal defects (PMVSDs) in children and the clinical criteria in assessment and guidance by echocardiography.
Methods We enrolled 730 children diagnosed as PMVSDs from April 2010 to November 2012. All children underwent full evaluation by transthoracic echocardiography (TTE) and multiplane transesophageal echocardiography (MTEE), such as the sizes, types, spatial positions of defects and the relationship with the adjacent tissures. The chosen domestic device was inserted to occlude the PMVSDs under the guidance of MTEE. If the closure was unsatisfactory, the occluder would be changed or the patient would be transformed to open-heart surgery. More than 2 years of follow-ups were made after successful occlusion.
Results 690 (94.55%) of the 730 children underwent successful closure. Symmetric devices were used in 575 children (including 33 A4B2 occluders) and asymmetric in other 115. All patients received follow-ups at regular intervals after successful occlusion. The occluders had stayed firmly. No noticeable residual shunt or valve regurgitation were discovered except for 1 child, whose original mild aortic regurgitation aggravated to nearly moderate in the follow-up of 18th month. Also, there were no significant arrhythmia detected except two children had sudden attack with Adame-Strokes syndrome 2 and 6 days after operation respectively.
Conclusions Min-invasive surgical device closure of PMVSDs is mostly safe and feasible. Echocardiography plays a vital role and provides relatively reliable basis in all stages of closure. MTEE is more accurate in evaluating the defects, such as the shape and size which is important in determining the right occluder.