Hybrid, perventricular closure of muscular ventricular septal defects

Muscular ventricular septal defects (VSD) located below the trabecula saepto-marginalis are difficult to approach for surgical closure through the tricuspid valve. We present the hybrid technique of perventricular closure of VSD in 2- and 5-year old children with complex congenital heart defects, employing an Amplatzer septal occluder, dedicated to muscular type of VSD. The procedures were performed during cardiopulmonary bypass in one patient and on beating heart in the other one. The perventricular device technique may be the method of choice for closing hard to reach muscular VSD.