Perventricular Closure of Perimembranous Ventricular Septal Defects Using the Concentric Occluder Device

This report summarizes the authors’ clinical experience with perventricular closure of the perimembranous ventricular septal defect (PmVSD) using the concentric occluder as a minimally invasive technique without cardiopulmonary bypass and following transesophageal echocardiography (TEE) guidance. Between July 2011 and March 2013, 61 patients with PmVSD underwent perventricular concentric device closure using a minimally invasive inferior sternotomy approach. The basal diameter of the PmVSD ranged from 2.5 to 7 mm. The diameter of the occlusion device waist ranged from 4 to 8 mm. A ventricular septal aneurysm or an adhesive tricuspid valve was present in 49 patients. Multiple orifices in the aneurysm were treated in ten patients, including dispersed orifices in four patients and comparatively concentrated orifices in the remaining six patients. The occlusion devices were deployed via the right ventricle with TEE guidance and no cardiopulmonary bypass. Complete shunt occlusion was achieved for all the patients in the operating room. The orifices of the ventricular septal aneurysm were closed in 46 patients, with the left disc of the concentric devices placed in the aneurysms, whereas the PmVSDs in the remaining 15 patients were closed from the ventricular septal defect (VSD) basal part following the rule that the upper rim of the PmVSD be more than 2 mm from the aortic valve. Ventricular premature beats occurred in one patient. The follow-up period ranged from 1 to 21 months (median 13.5 ± 8.2 months), and the patients had stable heart function postoperatively. None of the patients had more than mild valvular regurgitation, and no worsening regurgitation was observed in those who had tricuspid or aortic regurgitation before surgery. No complete atrioventricular block, position shift of the occlusion devices, thrombosis, or residual VSD occurred during the follow-up period. The perventricular concentric device closure of PmVSD with an inferior sternotomy in selected patients is a safe, feasible, and simple treatment. The concentric device is easier to anchor than the eccentric device and has proved to be a reasonable choice for PmVSD occlusion, especially in patients with a perimembranous aneurysm formation or PmVSD extending to the inflow tract.