Surgical off-pump closure of perimembranous ventricular septal defects

Objective: To present our first experience in perventricular closure of ventricular septal defect, which is in our opinion, an important adjunct to current ventricular septal defect treatment options. Background: Surgical closure under cardiopulmonary bypass is the treatment of choice for a perimembranous ventricular septal defect. Percutaneous techniques have technical limitations. To date, an off-pump approach and device deployment through the wall of the right ventricle is not widespread and has only been reported from China and Germany. We think this approach is promising in selected patients. Methods: In July 2012, 7 pediatric patients with an isolated perimembranous ventricular septal defect (age range, 4 months to 8 years, mean 2.5 years, all female) with a body weight of 5 to 27 kg, mean 12.7 kg, underwent minimally invasive perventricular device closure. Results: In all patients, the ventricular septal defect was occluded successfully based on transesophageal echocardiographic confirmation. There were no cases of occluder dislocation noted in the operating room or in the postoperative period. No residual shunts were observed. There was no transient or persistent rhythm disorder in any of the patients. All patients were discharged 4-5 days postoperatively, in excellent physical condition. Conclusions: The described off-pump approach showed excellent results. It offers such advantages as avoidance of the morbidity associated with cardiopulmonary bypass, significantly shorter hospital stay and therefore reduced costs, and a cosmetic advantage.