Atrial septal defect (ASD) is a congenital heart disease that causes blood communication between the left and right ventricles due to partial atrial septal tissue defects, accounting for about 13% of all heart malformations. Secondary ASD is the most common type of ASD and can generally be treated with minimally invasive closure. At present, the commonly used minimally invasive methods in clinical practice mainly include X-ray-guided percutaneous occlusion, transesophageal ultrasound-guided transthoracic occlusion and ultrasound-guided percutaneous occlusion. This review focuses on the basic research process of occluder materials, and advantages and disadvantages of three different surgical methods.
ObjectiveTo evaluate the safety, feasibility, and short-term surgical outcomes of a modified right vertical infra-axillary thoracotomy (MRVIAT, single 2-5 cm incision without peripheral cannulation) for the treatment of doubly committed subarterial ventricular septal defect in patients of all ages, and to summarize relevant surgical techniques. MethodsThis study retrospectively included patients of all ages with doubly committed subarterial ventricular septal defect who underwent surgical repair via MRVIAT from January 2022 to June 2025, all receiving a single 2-5 cm incision without peripheral cardiopulmonary bypass. The perioperative and follow-up data were analyzed. ResultsA total of 241 patients were enrolled, comprising 92 males and 149 females with a median age of 1.2 (0.5, 3.5) years [including 11 (4.6%) patients aged ≥18 years] and a median weight of 10.5 (7.0, 16.4) kg. Preoperative left ventricular ejection fraction was 66.9%±4.2%, and the mean defect size was (7.6±2.8) mm. All surgeries were successfully completed without conversion to median sternotomy or in-hospital mortality. Cardiopulmonary bypass time was (55.4±13.3) min, aortic cross-clamping time was (34.8±10.1) min, postoperative hospital stay was (6.5±1.9) d, ventilation time was (6.5±6.1) h, intensive care unit stay was (39.7±24.1) h, and postoperative left ventricular ejection fraction was 67.8%±7.6%. Postoperative complications included mild residual shunt in 3 (1.2%) patients, incision infection in 2 (0.8%) patients, and pulmonary infection in 1 (0.4%) patient. The median follow-up time was 1.7 years (range, 0.3-3.5 years), during which no surgery-related chest deformities or moderate-to-severe valvular regurgitation were observed. ConclusionThe MRVIAT is safe and feasible for treating doubly committed subarterial ventricular septal defect in patients of all ages, offering a smaller and more concealed incision without the need for peripheral cardiopulmonary cannulation, and may be considered an alternative to median sternotomy.