Minimally invasive transthoracic device closure of isolated ventricular septal defects without cardiopulmonary bypass: Long-term follow-up results Quansheng.

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Minimally invasive transthoracic device closure of isolated ventricular septal defects without cardiopulmonary bypass: Long-term follow-up results Quansheng Xing, MD, Qin Wu, MD, Lei Shi, MB, Yuhan Xing, MB, Guiling Yu, MS The Journal of Thoracic and Cardiovascular Surgery Volume 149, Issue 1, Pages 257-265 (January 2015) DOI: 10.1016/j.jtcvs.2014.07.078 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Perimembranous ventricular septal defect (VSD) concentric occluder (concentric); B, perimembranous VSD eccentric occluder (eccentric); C, muscular VSD occluder (muscular); D, patent ductus arteriosus occluder; E, saddlelike occluder for subarterial VSD. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 257-265DOI: (10.1016/j.jtcvs.2014.07.078) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Concentric perimembranous ventricular septal defect occluders, 4 mm waist height (different waist diameters from left to right: 4 mm, 5 mm, 6 mm, 7 mm, 8 mm, 10 mm, 12 mm). The Journal of Thoracic and Cardiovascular Surgery 2015 149, 257-265DOI: (10.1016/j.jtcvs.2014.07.078) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Concentric perimembranous ventricular septal defect occluders, 6 mm waist diameter (different waist heights from left to right: 3 mm, 4 mm, 5 mm, 6 mm, 7 mm). The Journal of Thoracic and Cardiovascular Surgery 2015 149, 257-265DOI: (10.1016/j.jtcvs.2014.07.078) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 The incisions for minimally invasive transthoracic device closure of isolated ventricular septal defects. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 257-265DOI: (10.1016/j.jtcvs.2014.07.078) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 The steps involved in deployment of an eccentric occluder through the right ventricular free wall. A, A trocar was punctured into the right ventricle through the free wall and a 0.9-mm (0.035-inch) flexible guidewire was advanced through the trocar to pass the defect. B, The dilator and delivery sheath were advanced over the guidewire through the defect into the left ventricle, then the guidewire and the dilator were removed. C, The loading sheath was introduced into the delivery sheath, and the device was advanced to the tip of the sheath. The left disk was deployed in the left ventricle, and adjusted by the platinum marker on the left disk, to make the hyperechoed mark correctly deviate from the aortic valve and face the apex, and then the loading sheath was withdrawn to deploy the waist and the right disk of the occluder. D, After complete assessment by transesophageal echocardiography for the absence of residual shunting, left and right ventricular outlet tract obstruction, valve interference and arrhythmia, the device was released. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 257-265DOI: (10.1016/j.jtcvs.2014.07.078) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 The distribution of the size of VSDs and implanted devices. MITDC, Minimally invasive transthoracic device closure; VSD, ventricular septal defect. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 257-265DOI: (10.1016/j.jtcvs.2014.07.078) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions