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J Thorac Cardiovasc Surg 2008;135:603-609
© 2008 The American Association for Thoracic Surgery

Evolving Technology

Beating-heart patch closure of muscular ventricular septal defects under real-time three-dimensional echocardiographic guidance: A preclinical study

Nikolay V. Vasilyev, MDa, Ivan Melnychenko, MDa, Kazuo Kitahori, MD, PhDa, Franz P. Freudenthal, MDb, Alistair Phillips, MDc, Rainer Kozlik-Feldmann, MDd, Ivan S. Salgo, MD, MSe, Pedro J. del Nido, MDa, Emile A. Bacha, MDa,*

a Departments of Cardiac Surgery and Anesthesia, Children's Hospital Boston, Harvard Medical School, Boston, Mass
b Department of Pediatric Cardiology, Kardiozentrum, La Paz, Bolivia
c Department of Pediatric Cardiothoracic Surgery, Columbus Children's Hospital, Columbus, Ohio
d Department of Pediatric Cardiology, Grosshadern University Hospital, University of Munich, Munich, Germany
e Ultrasound Division, Philips Medical Systems, Andover, Mass

* Address for reprints: Emile A. Bacha, MD, Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 (Email: emile.bacha{at}cardio.chboston.org).

Objectives: Safe and effective device closure of ventricular septal defects remains a challenge. We have developed a transcardiac approach to close ventricular septal defects using a patch delivery and fixation system that can be secured under real-time three-dimensional echocardiographic guidance.

Methods: In Yorkshire pigs (n = 8) a coring device was introduced into the left ventricle through a purse-string suture placed on the left ventricular apex, and a muscular ventricular septal defect was created. The patch deployment device containing a 20-mm polyester patch was advanced toward the ventricular septal defect through another purse-string suture on the left ventricular apex, and the patch was deployed under real-time three-dimensional echocardiographic guidance. The anchor delivery device was then introduced into the left ventricle through the first purse-string suture. Nitinol anchors to attach the patch around the ventricular septal defect were deployed under real-time three-dimensional echocardiographic guidance. After patch attachment, residual shunts were sought by means of two-dimensional and three-dimensional color Doppler echocardiography. The heart was then excised, and the septum with the patch was inspected.

Results: A ventricular septal defect was created in the midventricular (n = 4), anterior (n = 2), and apical (n = 2) septum. The mean size was 9.8 mm (8.2–12.0 mm), as determined by means of two-dimensional color Doppler scanning. The ventricular septal defects were completely closed in 7 animals. In one a 2.4-mm residual shunt was identified. No anatomic structures were compromised.

Conclusions: Beating-heart perventricular muscular ventricular septal defect closure without cardiopulmonary bypass can be successfully achieved by using a catheter-based patch delivery and fixation system under real-time three-dimensional echocardiographic guidance. This approach might be a better alternative to cardiac surgery or transcatheter device closure.

Abbreviations and Acronyms ASD = atrial septal defect; LV = left ventricle; RT3DE = real-time three-dimensional echocardiography; 3D = three-dimensional; 3DUS = three-dimensional ultrasonography; VSD = ventricular septal defect


Related Article

Beating-heart patch closure of muscular ventricular septal defects under real-time three-dimensional echocardiographic guidance: A preclinical study
Nikolay V. Vasilyev, Ivan Melnychenko, Kazuo Kitahori, Franz P. Freudenthal, Alistair Phillips, Rainer Kozlik-Feldmann, Ivan S. Salgo, Pedro J. del Nido, and Emile A. Bacha
J. Thorac. Cardiovasc. Surg. 2008 135: 603-609. [Abstract] [Full Text] [PDF]





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