Application value of intraoperative epicardial echocardiography in hybrid approach to perventricular device closure of muscular ventricular septal defect

Objective To evaluate the application value of intraoperative epicardial echocardiography (IEE) in the hybrid approach to perventricular device closure of muscular ventricular septal defect (mVSD). Methods Eight patients were diagnosed with isolated mVSD by preoperative transthoracic echocardiography (TTE) at the Heart Center of Children′s Hospital of Dalian Medical University from January 2014 to March 2018. All patients with mVSD were closed via the hybrid approach under IEE guidance with specific devices. The effects of the procedure was evaluated by IEE. Follow-up study was performed at 1 month, 3 months, 6 months, and 12 months after operation by TTE, electrocardiogram, and routine urine tests to observe whether complications such as sealing device migration or loss, arrhythmia, and hemolysis occurred. Results All cases were occluded successfully via the hybrid approach under IEE guidance with specific devices, and one case had residual shunt less than 2 mm, which disappeared 6 months after surgery. All patients underwent TTE, electrocardiogram, and routine urine tests at 1 month, 3 months, 6 months, and 12 months after operation, and no notable residual shunt, occluderloss or migration, or arrhythmia was found. Conclusion IEE has a high value in the hybrid approach closure of mVSD, and the image of mVSD by IEE is clearer than that by transesophageal echocardiography (TEE). IEE is easy to operate, and avoids the use of cardiopulmonary bypass, radiation, and contrast agents.