Perventricular Device Closure of Muscular Ventricular Septal Defects on the Beating Heart

Correspondence: Dr Sunita Maheshwari, Narayana Hrudayalaya, 258/A Bommasandra Industrial Area, Anekal Taluk, Bangalore 560099 e-mail: drsmaheshwari@yahoo.com Large apical muscular ventricular septal defects (VSDs) complicate management decisions, particularly when they occur in association with other congenital cardiac defects. The results of surgery for apical muscular VSDs are often suboptimal owing to difficulties in defect visualization, residual shunting, and ventricular dysfunction. If the infant is very small in size, precluding safe percutaneous closure, or if the muscular VSD is associated with other defects requiring open surgical repair (pulmonary artery debanding, double outlet right ventricle, transposition of great vessels, etc.), closure of the VSD can be achieved in the operating room prior to initiation of cardiopulmonary bypass (CPB). This procedure can also be applied to children with isolated muscular defects, the obvious advantage being the convenience to close the VSDs without the use of CPB and its attendant side effects. The cases of two children, one an 8-year-old boy and another, a 6-month-old female baby who successfully underwent VSD closure are described.