• Ina Michel-Behnke, Peter Ewert, Andreas Koch, Harald Bertram, Mathias Emmel, Gunther Fischer, Roland Gitter, Rainer Kozlik-Feldman, Reinald Motz, Erwin Kitzmüller, Oliver Kretschmar, and Investigators of the Working Group Interventional Cardiology of the German Association of Pediatric Cardiology.
• Department of Pediatric Cardiology, Pediatric Heart Center, Giessen, Germany. ina.michel-behnke@meduniwien.ac.at
• Catheter Cardiovasc Interv. 2011 Feb 1;77(2):242-51.

ObjectiveThis study reports on the feasibility, efficacy, and outcome of hybrid procedures to close ventricular septal defects (VSD), reflecting the experience of 11 centers in Germany, Austria, and Switzerland.BackgroundBeating heart closure of VSD has attracted interest in small infants, complex anomalies and postinfarction scenarios where patients are at high risk during surgery. Perventricular or intraoperative device placement allows access to the lesions where percutaneous delivery is limited.MethodsBetween December 2001 and April 2009, placement of Amplatzer septal occluders was attempted in 26 patients. The defects were located in the perimembranous (n = 5) and muscular septum (n = 21). In 20 patients, a perventricular approach was used, and, in six, the occluders were placed under direct visualization being part of a complex heart surgery.ResultsIn 23 of 26 procedures, device placement was successful (88.5%). The mean defect size was 7.8 mm (range, 3.5-20). The occluder types were perimembranous VSD occluder (n = 4), muscular VSD occluder (n = 20), postinfarct VSD occluder (n = 1), and ASD occluder (n = 1) with a ratio device/defect of 0.9-2.4 (median 1.15). Device removal was necessary in three due to arrhythmia, malpositioning, and additional defects. Pericardial effusion occurred once. In the remaining 22 patients, there were no procedure or device-related complications. During mean follow up of 1.4 years (range, 1 day-3.9 years), a residual shunt that was more than trivial was observed in one patient out of 21 successful procedures.ConclusionsPerventricular and intraoperative device closure of VSD is as effective as a surgical patch and averts the increased morbidity of conventional surgical repair in a subgroup of high-risk patients.Copyright © 2010 Wiley-Liss, Inc.

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