Background: A hybrid approach to minimally invasive perventricular closure of VSD in infants is safe and effective,\r\nand has been performed under guidance of transesophageal echocardiography (TEE). We applied transthoracic\r\nechocardiographic (TTE) guidance to this hybrid approach, and compare results guided by TTE with those by TEE.\r\nMethods: From January 2011 to January 2012, 71 infants with VSD were enrolled to undergo a minimally invasive\r\ndevice closure. After evaluation of VSD by TTE, either TEE or TTE was used to guide the minimally invasive device\r\nclosure. 30 patients had TEE guidance, and 41 patients had TTE. All patients were followed for 3 months after the\r\noperation.\r\nResults: The TEE group had a success rate of 93.3% (28/30) for device implantation, compared with 92.7% (38/41)\r\nin the TTE group. Two patients in the TEE group turned to surgical closure, one for involvement of the inlet area of\r\nVSD demonstrated by TEE, another for moderate aortic regurgitation after device implantation. Two patients in the\r\nTTE group also transferred to surgical closure, one for residual shunt, another for failure of the floppy wire across\r\nthe defect. In addition, one patient in the TTE group experienced dropout of the occluder one day postoperatively.\r\nAt 3-month follow-up, one patient had mild aortic regurgitation in the TEE group and in two patients in the TTE\r\ngroup. There were no episodes of cardiac block, thromboembolism, or device displacement in either group.\r\nConclusions: TTE-guided VSD closure is feasible in infants, with results similar to those of TEE guidance, although\r\ncaution is advisable.
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