Doubly committed ventricular septal defect closure using eccentric occluder via ultraminimal incision

This study aimed to investigate the safety, feasibility and availability of doubly committed ventricular septal defect (DCVSD) closure via an ultraminimal intercostal incision under the guidance of transoesophageal echocardiography in children. From August 2014 to August 2016, 35 children with DCVSDs (a parts per thousand<currency>5 mm in diameter) were enrolled in this study. A left parasternal ultraminimal intercostal incision (a parts per thousand<currency>1 cm) and a pericardium hanging technique were employed without sternal incision. DCVSDs were closed through a short delivery sheath assembled with an eccentric occluder device. Transoesophageal echocardiography was used to guide and monitor the entire procedure. All patients were followed up. All 35 children had complete closures with an operation success rate of 100%. The average size of DCVSDs was 3.50 +/- 0.79 (range 2.2-5.0) mm, and the average device size was 5 +/- 2 (range 4-9) mm. The average operation duration was 45.42 +/- 11.77 (range 25-70) min, and the average hospital stay was 8 +/- 2 (range 7-16) days. The median follow-up period was 17 months (range 6 months-2.5 years). Pre-existing aortic regurgitation disappeared after surgery in 1 patient and remained the same in 4 patients. No other complications were found during the operation or during follow-up. Under transoesophageal echocardiography guidance, DCVSD closure using an eccentric occluder via an ultraminimal intercostal incision is feasible, safe and effective in children. The use of this approach is recommended.