Heart Center, Children's Hospital of Qingdao University, Qingdao, China.
Eur J Cardiothorac Surg. 2011 Sep;40(3):591-7. doi: 10.1016/j.ejcts.2010.12.026. Epub 2011 Feb 4.
Both surgical and percutaneous device closure of ventricular septal defect (VSD) have drawbacks and limitations in infants. We report our experiences and midterm results of transthoracic device closure of VSDs (TDCVs) without cardiopulmonary bypass (CPB) in infants.
Between September 2007 and September 2009, 32 patients, with a mean age of 7.2 ± 4.7 months, body weight of 6.8 ± 2.8 kg, underwent this procedure. The procedure was performed in the operating room. A small subxiphoid incision was made. A purse-string suture was placed on the right ventricular free wall. The free wall was punctured using a trocar, then a guide wire was inserted and advanced to cross the VSD into the left ventricle under transesophageal echocardiographic guidance. A modified delivery sheath was then introduced over the guide wire. The device was delivered and deployed in position along the sheath to close the defect.
A total of 30 cases (94%) were successfully closed, and the remaining two cases (6%) were converted to open heart repair. No patients received transfusion. There was no perioperative mortality, or any major complication. The mean size of the devices was 7.6 ± 3.4mm. The total operative time was less than 60 min, and the mean time for device implantation was 18.3 ± 9.4 min. All patients were extubated within 2h, and were discharged within 5 days after operation. The follow-up period ranged from 6 to 31 months (18.3 ± 9.6 months). There was no late major complication detected.
Minimally invasive TDCV without CPB is a safe and effective alternative to the conventional operation in low-body-weight infants.
在婴儿中，心脏直视手术和经皮器械闭合室间隔缺损（VSD）都存在缺点和局限性。我们报告了我们在无体外循环（CPB）的情况下经胸器械闭合 VSD（TDCV）的经验和中期结果。
在 2007 年 9 月至 2009 年 9 月期间，32 名平均年龄为 7.2±4.7 个月、体重为 6.8±2.8kg 的患者接受了该手术。手术在手术室进行。在剑突下做一个小切口。在右心室游离壁上放置一个荷包缝线。在经食管超声心动图引导下，用套管针穿刺游离壁，插入导丝并穿过 VSD 进入左心室。然后将改良的输送鞘套在导丝上。将器械沿鞘套输送并放置到位以闭合缺损。
共有 30 例（94%）成功闭合，其余 2 例（6%）转为开胸修复。无患者输血。无围手术期死亡或任何重大并发症。器械的平均直径为 7.6±3.4mm。总手术时间不到 60 分钟，器械植入时间平均为 18.3±9.4 分钟。所有患者均在 2 小时内拔管，术后 5 天内出院。随访时间为 6 至 31 个月（18.3±9.6 个月）。未发现晚期重大并发症。
在低体重婴儿中，微创 TDCV 无需 CPB 是传统手术的一种安全有效的替代方法。
