Minimally Invasive Treatment for Ventricular Septal Defect: Is It Feasible?

Ventricular Septal Defect (VSD) is generally not recommended for minimally invasive treatment. However, certain approaches such as the right axillary incision fall under the category of minimally invasive surgery and are still considered surgical interventions. These procedures require careful evaluation, especially when using devices like occluders or small incisions below the xiphoid process to insert the device.

Understanding the Risks of Minimally Invasive VSD Repair

VSD involves complex anatomical structures, particularly the tricuspid valve and the cardiac conduction system. The conduction system functions like an invisible electrical wire that coordinates the rhythmic contraction of the atria and ventricles. During traditional surgical repair, surgeons use magnifying loupes to suture tissues thinner than 2mm, carefully avoiding damage to the conduction pathways.

Why Occluder Devices May Pose Risks

Occluder devices often require at least 2mm of tissue engagement, sometimes even 3-4mm, to securely anchor in place. This can pose a risk if the edges of the device compress or entrap the conduction system. In some cases, patients who underwent occluder placement for VSD have developed complete heart block (third-degree AV block) months after the procedure. By that time, the device is often encapsulated by tissue, making it extremely difficult to remove.

Guidelines for Appropriate Use of Minimally Invasive Techniques

The indications for minimally invasive VSD treatment must be strictly evaluated. For instance, defects located at the base of the septum may be suitable for occluder therapy, as they are farther from critical structures. However, perimembranous VSDs, which are close to the conduction system and the tricuspid valve, are not ideal candidates for this approach.

In conclusion, while minimally invasive techniques offer benefits in terms of recovery and cosmetic outcomes, they must be used with caution in VSD cases. The complexity of the heart's anatomy and the potential for serious long-term complications necessitate a careful, case-by-case assessment by a team of experienced cardiologists and cardiac surgeons.