Introduction
Ventricular septal defect (VSD) is a common congenital heart disease in
children, and most VSDs are perimembranous ventricular septal defects
(PmVSDs).
Traditionally, PmVSDs are surgically repaired under direct visualization
with cardiopulmonary bypass. Although this surgery is effective, it is
associated with significant trauma and slow postoperative recovery.Blood
transfusion is necessary in the cardiopulmonary bypass approach.
Alternatively, the percutaneous closure of a PmVSD has the advantages of
no blood transfusion, minimal trauma and rapid
recovery[1,2] . But it is associated with exposure
of radiation and allergy to contrast agent[3,4].
Another disadvantage of the percutaneous closure technique is that it is
a complicated approach requiring an arteriovenous guidewire loop; this
procedure cannot be performed in patients with vascular access problems.
In recent years, PmVSDs closure via transthoracic minimally invasive
incision under transesophageal echocardiography(TEE) guidance has
attracted the attention of many scholars[5-10].This approach does not require cardiopulmonary bypass and radiation; it
has the advantages of a short delivery path and no restriction on weight
or vascular access. It is particularly advantageous for children
patients who cannot be treated with percutaneous catheter closure or
patients who cannot tolerate surgery and cardiopulmonary bypass.
However, this surgical method requires the sternum to be transected,
which easily causes postoperative bleeding, pain, and pectus excavatum[11]. Moreover, the incision length can reach
approximately 2-3 cm, which affects appearance. Therefore, the procedure
cannot be considered as ideal in terms of minimally invasive surgery.
Based on the minimally invasive transthoracic closures of nearly 1000
patients, our team modified this surgical incision as follows: a less
than 1cm trans intercostal incision in the left sternal margin. Via an
ultra-minimal trans intercostal incision and a pericardium hanging
technique, PmVSDs had been successfully occluded using the concentric
occluder devices under TEE guidance. In this study, we aimed to
investigate the safety, feasibility and availability of this new
surgical approach in children.