Doubly committed ventricular septal defect closure using an eccentric occluder via minimal incision in the anterior median sternum through the left parasternal third intercostal space

A girl was 11 months and 14 days old, weighing 8.5 kg, and was diagnosed with doubly committed ventricular septal defect (DCVSD) by transthoracic echocardiography. These defects may lead to aortic valve prolapse and regurgitation, so they should be closed early. The whole operation process was completed under the guidance of transoesophageal echocardiography (TEE). The TEE showed that the DCVSD shunt port was ∼3 mm (Panel A). The 5-mm eccentric occluder was selected for occlusion (Panel C, blue arrow = a left umbrella plate, red arrow = a left umbrella plate marker away from the aortic valve, white arrow = a right umbrella plate) and delivery system (Panel B; Shanghai Shape Memory Alloy Co., Ltd, Shanghai, China). First, a skin incision ∼1.5 cm in the middle of the anterior chest (Panel D) was made to enter the chest through the left parasternal third intercostal space, and the 5-mm eccentric occluder was implanted (Panels E and F). The marker of left umbrella plate (Panels E and F, red arrow) was kept away from the aortic valve. The shunt disappeared, and there was no residual shunt or atrioventricular block. The operation time was 55 min and the hospitalization time was 8 days. No complications occurred within 6 years of postoperative follow-up.