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      Perventricular device closure of a large residual perimembranous interventricular septal defect after previous surgical correction

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          Abstract

          A 21 years albanian patient was referred with important residual left to right shunt. He was undergone 7 years before conventional surgical correction of a perimembranous ventricular septal defect (VSD). The patient underwent sternotomy and perventricular device closure of the residual employing a 16 mm multifenestrated atrial septal defect occlude, which was positioned through the anterior wall of the right ventricle. across the defect. The previous autologous pericardial patch was compressed into the double umbrella device. We may conclude that perventricular device closure can employed successfully in patients with residual perimembranous VSD after previous surgical repair as an alternative to the conventional surgery with excellent hemodynamic and postoperative outcome. Such a technique should be part of the surgical armamentarum.

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          Device closure of perimembranous ventricular septal defects with a minimally invasive technique in 12 patients.

          Both surgical management and percutaneous device closure of perimembranous ventricular septal defects without cardiopulmonary bypass have drawbacks and limitations. This report describes the experience with intraoperative device closure of perimembranous ventricular septal defects without cardiopulmonary bypass by a minimally invasive technique. Twelve patients who had perimembranous ventricular septal defects underwent perventricular closure by a minimally invasive incision without cardiopulmonary bypass. A subxiphoid minimally invasive incision was performed. The right ventricle free wall was punctured, and a guidewire was introduced into the right ventricular cavity. A delivery sheath was advanced over the wire and through the defect into the left ventricular cavity under the guidance of transesophageal echocardiography. The device was released under the guidance of transesophageal echocardiography without cardiopulmonary bypass. The procedure was successful in the 12 patients. Patients stayed in the intensive care unit 1 day and were in the hospital 4 days. At follow-up of 2 to 4 months, there was no operative mortality, atrioventricular block, new aortic incompetence, or residual shunt. The minimally invasive technique appeared to be safe and efficacious for closure of perimembranous ventricular septal defects in the operating room with acceptable short-term outcomes.
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            Perventricular device closure of perimembranous ventricular septal defect in pediatric patients: technical and morphological considerations.

            We report our experience of using perventricular device closure (PVDC) in treating perimembranous ventricular septal defect (pm-VSD) with emphasis on technical and morphological considerations. Thirty-one pediatric patients with pm-VSD who underwent successful PVDC were enrolled in this study. The pm-VSDs were divided into three different types (type I: tunnel shape; type II: with subaortic rim < 2 mm; type III: membranous aneurysm formation). Four closure strategies were utilized, corresponding to the morphology of the pm-VSD. Mean age of the patients was 2.1 years with mean VSD diameter 5.8 mm. Seven patients had type I VSD, nine presented with type II, and 15 had type III. Twenty-two concentric and nine eccentric devices were used with mean device size 7.3 mm. Complete closure was achieved in 97% of cases during follow-up. Procedure-induced tricuspid regurgitation (TR) was noted in nine patients at discharge; four resolved. Multivariable analysis showed that the procedure-induced TR was associated with the device size (odds ratio = 5.059; 95% confidence interval = 1.431-17.880). Different closure strategies allow for PVDC of various types of pm-VSDs in selected pediatric patients. Georg Thieme Verlag KG Stuttgart · New York.
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              Perventricular [correction of Periventricular] closure of ventricular septal defects without cardiopulmonary bypass.

              Minimally invasive techniques are currently in use to close atrial and ventricular septal defects (VSD). Cardiopulmonary bypass (CPB) is instituted via the femoral vessels, which may cause injury to these vessels, especially in younger patients. The objectives of this study were to demonstrate the feasibility of perventricular [corrected] closure of muscular VSD (MVSD) and paramembranous VSD (PVSD) without CPB, using the Amplatz VSD device. Five Yucatan pigs with naturally occurring PVSD (3- to 7-mm diameter) and 5 dogs with surgically created MVSD (6- to 14-mm diameter) were subjects of this study. The VSDs were closed intraoperatively with a 7-French delivery sheath inserted through the free wall of the right (n = 5) or left ventricle (n = 5), under epicardial echocardiogram guidance. The animals were followed for 3 months. There was no operative mortality. All MVSD closed after placement of the device. Closure rate of PVSD was 4 of 5 after placement and 3 of 5 after 3 months. One pig developed aortic incompetence at the last follow-up. Perventricular closure of MVSD and PVSD is feasible. Avoidance of CPB can decrease recovery time, its complications, and trauma to the femoral vessels.
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                Author and article information

                Contributors
                Journal
                J Cardiothorac Surg
                J Cardiothorac Surg
                Journal of Cardiothoracic Surgery
                BioMed Central
                1749-8090
                2014
                10 January 2014
                : 9
                : 12
                Affiliations
                [1 ]Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
                [2 ]Division of Cardiac Surgery, University Hospital Center of Tirana, Rr. Dibres, 370, Tirana, Albania
                Article
                1749-8090-9-12
                10.1186/1749-8090-9-12
                3996184
                24405532
                9bbb9de1-936e-43c3-adfa-cd8c337aa98f
                Copyright © 2014 Prifti et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 3 September 2013
                : 26 December 2013
                Categories
                Case Report

                Surgery
                perventricular device closure,perimembranous ventricular septal defect
                Surgery
                perventricular device closure, perimembranous ventricular septal defect

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