• Hui Yang, Jie Mu, Yuyi Zhao, Zizhu Chen, Haibo Song, and Jin Liu.
• Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu.
• Medicine (Baltimore). 2021 May 14; 100 (19): e23854.

IntroductionVentricular septal defect (VSD) accounts for up to 40% of all congenital cardiac malformations. Transthoracic closure of VSDs has been well described in literature. In the current report, we described a procedure to successfully close a VSD with 2 occluders from different incisions simultaneously under the guidance of trans-esophageal echocardiography (TEE), to save the patient from undergoing another surgery.Patient ConcernsA 52-year-old man was referred to our clinic for repeating palpitations for 6 months without chest pain and polypnea after activity.DiagnosisThe diagnosis of VSD was established due to the findings of a juxtatricuspid VSD with a left-to-right shunt at ventricular level and mild mitral regurgitation by TTE.InterventionsA transcatheter VSD closure was firstly performed but failed to repair the VSD. After the failure of transcatheter VSD closure, the patient received transthoracic closure of VSD operated by a cardiac surgeon. The VSD was closed with 2 occluders from different incisions (median thoracic skin incision and subxiphoid incision) simultaneously under the TEE guidance.OutcomesThe patient was extubated in intensive care unit and was discharged 4 days after the operation. During the follow up, there were no significant clinical nor laboratory side-effects of the procedure found as compared to the patient's condition before the procedure.ConclusionVSD can be closed with 2 occluders from different incisions simultaneously under the TEE guidance to save the patient from undergoing repeated surgeries. Meanwhile, TEE plays a significant role in cardiac surgery.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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