Title : A novel approach for residual ventricular septal defect closure via percutaneous intercostal puncture

Background: Residual shunting is a common complication after ventricular septal defect (VSD) closure. Conventional surgical repair is invasive, and cardiopulmonary bypass-associated complications, although rare, may occur. Transcatheter device closure is minimally invasive, but may fail, and is also associated with complications. Having performed nearly 800 non-fluoroscopic hybrid transcatheter–surgical device closures over the past 20 years, we have developed a new approach to hybrid closure via percutaneous intercostal puncture, and successfully applied it in three patients.

Methods: Three patients with residual VSDs 2.9–4.5 mm that had persisted or enlarged over 6–24 months after primary surgical repair underwent hybrid device closure via intercostal puncture. A cannula was advanced intercostally through the chest wall and the right ventricular free wall into the right ventricular cavity. An occluder was deployed through the residual VSD into the left ventricle or the aorta.

Results: All three procedures were completed successfully in 25–55 minutes. Complete defect closure was achieved with no recurrent shunting or major complications except for one case of transient pneumothorax.

Conclusions: While the safety and effectiveness of intercostal closure may require further validation in larger cohorts, our initial experience has demonstrated its feasibility and efficacy. When anatomically suitable, intercostal puncture closure represents a minimally invasive and radiation-free management option for postoperative residual VSDs that potentially minimizes trauma to the cardiac valves, the myocardium, and the conduction system, and facilitates rapid recovery.

Key words: residual ventricular septal defect, percutaneous, cardiac surgical procedures, echocardiography

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