One-Stop Device Closure for Ventricular Septal Defect with Atrial Septal Defect Guided by Transesophageal Echocardiography.

BACKGROUND

Ventricular septal defect (VSD) with atrial septal defect (ASD) is a common complex congenital heart disease. This study aimed to evaluate the clinical efficacy and safety of transesophageal echocardiography (TEE)-guided percardiac or combined percutaneous techniques for treating VSD with ASD in patients with varying anatomies.

METHODS

This retrospective cohort study reviewed 40 cases of VSD with ASD treated in our center from June 2015 to July 2023. Under TEE guidance, peratrial, perventricular, or combined percardiac/percutaneous approaches were used based on the VSD type and secundum-type ASD. Follow-up examinations, including electrocardiography, transthoracic echocardiography, and X-ray, were performed after surgery at 24 hours, 1, 3, 6, and 12 months, and yearly.

RESULTS

All patients underwent surgery successfully (100%), with 24, 5, and 11 patients undergoing simultaneous closure via the peratrial, perventricular, and combined percardiac/percutaneous approaches, respectively. Among them, there were six cases of a mild residual shunt, three instances of a mild tricuspid regurgitation, two cases of a mild aortic valve regurgitation, one case of a mild mitral regurgitation, and three cases of an incomplete right bundle branch block, all observed after VSD closure; all had resolved within 6 months of the operation. The chi-square test showed no significant differences in adverse event rates among the three surgical approaches (χ2 = 0.09, df = 2, p = 0.957). The Friedman test compared the preoperative and postoperative left ventricular end-diastolic diameter for the three approaches, providing p < 0.001, p = 0.589, and p = 0.445, respectively. None of the patients required reoperation during the follow-up period.

CONCLUSIONS

Under TEE guidance, using diverse percardiac or combined percutaneous device closure techniques for the one-stop treatment of different types of VSDs combined with ASD is safe, effective, and feasible. These approaches can be performed as a valuable alternative therapy for selected patients.