A hybrid procedure for the closure of a large muscular ventricular septal defect in a 6-month-old infant
Abstract Background: Transthoracic device closure (TTDC), also known as a Hybrid procedure, has been proposed as an alternative, less invasive approach compared to open-heart surgery for the treatment of ventricular septal defect (VSD). Case Presentation: We present our first national case of TTDC in a 6-month-old female baby with a muscular 8mm ventricular septal defect, 3 mm atrial defect, enlarged right and left ventricle and a dilated pulmonary artery complicated by severe pulmonary hypertension.Treatment consisted of two pulmonary artery banding attempts at the age of 2 months to control pulmonary hypertension – the interventions were combined with diuretics and angiotensin-converting enzymes inhibitors. Yet, the initial approach was suboptimal as we noticed a failure to thrive continuous sweating and tachypnea. Because of the worsening condition at the age of 6 months, and a weight of 6.6 kg, we performed TTDC. After median sternotomy, a 10mm muscular VSD occluder was implanted under trans-oesophagal echocardiography guidance on the beating heart. The procedure lasted 90 min and was performed without incident; the hemodynamics were stable with only a minor residual VSD. The child was extubated after 2 hours and discharged after five days from the hospital.Conclusions: Transthoracic device closure (TTDC) is a promising treatment modality for large muscular VSD in small infants with low weight. TTDC is feasible in cases with heavy myocardial right ventricle trabeculae and who previously underwent open-heart surgery.