Results of minimally invasive surgery for the treatment of infundibular ventricular septal defect in children

Objective: evaluate the feasibility and results of minimally invasive surgery for the treatment of infundibular ventricular septal defect in children. Summary: infundibular ventricular septal defect is located below the pulmonary and aortic valve, accounting for about 6% of ventricular septal defect. In Asians, infundibular defects are more common, accounting for about 30% of all ventricular septal defect cases. Currently, early surgery is indicated in cases of heart failure, pulmonary hypertension that cannot be controlled with medication and to prevent aortic valve prolapse. Minimally invasive surgery has been performed routinely for perimembranous ventricular septal defect. However, for the infundibular position, numerous challenges remain. Therefore, we conducted this study. Subjects and methods: Prospective, descriptive study. From December 2022 to July 2024, 33 children with infundibular ventricular septal defect underwent minimally invasive surgery through infra-axillary incision. Results: Mean age was 11.47 months, mean weight was 7.35 kg. Echocardiography showed an average hole diameter of 6.2 mm. Pulmonary artery pressure: 32.6 mmHg. Cardiopulmonary bypass and cross-clamping aortic times were 68.5 minutes and 47.3 minutes, respectively. No patients required sternotomy. Average ventilation time was 14.4 hours. No cases of fatality or neurological, bleeding and arrhythmias complications. Postoperative echocardiography demonstrated the perfect closure of VSD, no aortic valve regurgitation. The average postoperative follow-up time was 9 months, clinical heart failure according to ROSS classification at grade 1, echocardiography showed closed ventricular septal defect without the appearance of pulmonary hypertension. Conclusion: Minimally invasive surgery through the right axillary approach to treat infundibular ventricular septal defect in children can be performed safely with promising results.