New approach to multiple ventricular septal defect closure with intraoperative echocardiography and double patches sandwiching the septum (original) (raw)
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Techniques and results in the management of multiple ventricular septal defects
The Journal of Thoracic and Cardiovascular Surgery, 1998
The management of patients with multiple ventricular septal defects remains controversial. Primary closure, interventional catheter techniques, and palliative surgery all may have a role, and specific management guidelines remain undefined. Methods: We reviewed the records of all 33 patients with multiple ventricular septal defects undergoing repair between January 1988 and October 1996. Pulmonary artery hypertension was present in 21 patients (group 1), and pulmonary stenosis was present in the remaining 12 (group 2). Closure was accomplished from a right atriotomy alone in most patients, although an apical left ventriculotomy was used for apical defects. Among group 1 patients, the mean age at repair was 5.9 ؎ 0.9 months. Major associated anomalies included coarctation (n ؍ 6), straddling tricuspid valve (n ؍ l), and critical aortic stenosis (n ؍ 1). Reoperation was performed in two patients for residual ventricular septal defects. Among group 2 patients, the mean age at repair was 6.6 ؎ 3.2 years. Major associated anomalies included tetralogy of Fallot (n ؍ 2), pulmonary stenosis (n ؍ 4), double-outlet right ventricle with hypoplastic left ventricle (n ؍ 1), and isolated left ventricular hypoplasia (n ؍ 1). Three required reoperation for residual ventricular septal defect. Results: There were no early or late deaths, no episodes of heart block, and no significant residual ventricular septal defects among group 1 patients. All group 1 patients remain free of significant residual cardiovascular conditions at a mean of 23.4 ؎ 5.1 months. Among group 2 patients, there was one early death in a patient with double-outlet right ventricle and left ventricular hypoplasia. Complete heart block occurred in two patients and one required late mitral valve replacement. There were no late deaths, seven remain alive without significant residual defects at a mean of 36.2 ؎ 8.0 months, and two required transplantation for left ventricular failure. Conclusions: Primary repair for infants with multiple ventricular septal defects is associated with good late outcomes. The right atrial approach is satisfactory for most muscular defects, although limited apical left ventriculotomy was used for apical defects. Pulmonary artery banding should be limited to patients with complex associated defects. (J Thorac Cardiovasc Surg 1998;115:848-56)
Repair of Multiple Muscular Ventricular Septal Defects: Septal Obliteration Technique
Journal of Cardiac Surgery, 2005
Background: The management of the apical multiple muscular ventricular septal defects (VSDs) remains still controversial. There are various surgical techniques and approaches for closure of "Swisscheese" VSDs. In this study, we report the outcome of multiple muscular VSDs repair, using the septal obliteration technique. Methods: We used the septal obliteration technique in five "Swiss-cheese" ventricular septal defects cases through right atriotomy. Four of the cases had isolated multiple VSDs. One case also had an aortic arch interruption type A, which was repaired prior to cardiopulmonary bypass. Their ages varied between 43 days and 6 years. Results: We did not experience any mortality or serious morbidity. Tracheostomy was required in one patient. There was no important residual shunt in postoperative period, except a minimal shunt in one case. Conclusion: The closure technique of "Swiss-cheese" trabecular multiple VSDs using a large single patch was not troubling. Transatrial approach prevented postoperative problems of ventricular incision. Using a large needle with a large pledgett is the key, which provides deep tissue penetration to avoid residual shunt.
Multiple Ventricular Septal Defects
The Annals of Thoracic Surgery, 1972
Multiple ventricular septa1 defects (VSD) were closed in 24 children aged 3 to 13 years (mean 6.7). The number of defects ranged from 2 to 7 (mean 4). There were 3 hospital deaths and 1 late death. Three patients required reoperation to close defects which had reopened or had been overlooked previously, and 1 of these died (the late death in the series). High defects in addition to low muscular ones were present in 20 of the patients. Cardiac failure due to large shunts had necessitated previous pulmonary artery banding in 10 patients (42%), compared to 13% of patients with single VSDs. Preoperative angiocardiography correctly predicted multiple defects in 13 patients. Closure of multiple low muscular defects was found to be facilitated by an external buttress technique.
Outcomes of Patients Undergoing Surgical Management of Multiple Ventricular Septal Defects
Seminars in thoracic and cardiovascular surgery, 2018
Surgical treatment of multiple ventricular septal defects (VSDs) has advanced significantly in recent years, yet remains technically challenging. With high rates of complications and reoperations, we sought to assess the outcomes of patients undergoing a variety of management techniques for multiple VSDs. From 1988 to 2015, 157 consecutive patients underwent surgical management of multiple VSDs at a median age of 2.2 months (2 days-16 years). Sixty-nine patients (44%) had exclusively multiple VSDs, 62 patients (39%) had multiple VSDs with concomitant intracardiac anomalies, and 26 patients (17%) had multiple VSDs with aortic arch anomalies. The predominant techniques used at the initial operations were patch closure (84 patients), pulmonary artery band (83 patients), suture closure (37 patients), and sandwich technique (13 patients). Eighteen patients underwent ventriculotomies. There were 3 hospital deaths (2%). Mean follow-up time was 8.6 ± 6 years (1 day-22 years). Four patients ...
Pathophysiology, Investigations, and Management of Ventricular Septal Defect
Zenodo (CERN European Organization for Nuclear Research), 2021
Background: Ventricular septal defects (VSDs) are still one of the most prevalent surgical indications in newborns and children with congenital heart disease. With advances in echocardiography, cardiac catheterization is no longer necessary in the treatment of these individuals. Although perioperative mortality and morbidity for isolated defects are still low, unique scenarios such as surgical care of numerous VSDs and decision-making in patients with pulmonary hypertension remain difficult. This chapter examines both classic and recent evidence that has shaped the management of this condition, as well as the facts underlying developing interventional methods utilized in both the catheterization lab and the operating room. Conclusion: VSD is the most common congenital abnormality at birth. Small flaws should close on their own within the first year of life; however, larger faults can cause serious difficulties. The major interventions for big problems are surgical VSD closure and device closure.
Kosuyolu Heart Journal, 2020
Introduction: The purpose of this study is to evaluate the mortality, morbidity, postoperative course, and mid-term complications of patients who underwent surgical repair of ventricular septal defect (VSD) after the infantile period. Patients and Methods: We retrospectively reviewed 80 patients, older than 1 year, who were operated in our center between 2014 and 2018. We defined "prolonged" as the condition in which the mechanical ventilation was more than 24 hours, ICU stay was longer than 3 days, and hospital stay was longer than 7 days. We considered cardiopulmonary resuscitation, need for extracorporeal membrane oxygenator, complete atrioventricular block requiring permanent pacemaker (PM) implantation, diaphragm paralysis, neurological complications, acute renal failure, and unplanned reoperation as the major adverse events (MAE). Results: The median age of patients was 3 (1.5-20) years. There were 31 (38.8%) female patients in our study. The median operation weight was 12.3 kg (8-60). Indications for operations were pulmonary hypertension (PH) in 30 (37.5%) patients, aortic regurgitation and aortic valve prolapse in 30 (37.5%) patients, and left ventricular (LV) dilatation in 20 (25%) patients. We did not observe mortality in any of the cases. We observed MAE only in one patient (1.3%) (PM implantation). The mean follow-up period was 2.9 ± 1.9 years. Pulmonary arterial pressure decreased significantly after surgery (20% vs. 0% of patients with severe PH, p < 0.001). Left ventricular end-diastolic diameters (LVEDDs) were significantly decreased after operation, and this condition persisted in the mid-term follow-ups (LVEDD: 36.9 ± 9.7 vs. 33.0 ± 6.6, p= 0.02). Conclusion: Patients with VSD who are awaiting spontaneous closure after the infantile age are highly recommended to undergo rigorous follow-ups. A meticulous examination of patients with late onset VSD preoperatively with a prompt referral to surgery will maintain satisfactory outcomes in early and late mortality and morbidity rates.
Surgery for doubly committed ventricular septal defects
Interactive CardioVascular and Thoracic Surgery, 2016
OBJECTIVES: Doubly committed ventricular septal defects (VSDs) account for up to almost one-third of isolated ventricular septal defects in Asian countries, compared with only 1/20th in western populations. In our surgical experience, this type of defect accounted for almost three-quarters of our practice. To date, patch closure has been considered the gold standard for surgical treatment of these lesions. Our objectives are to evaluate the indications and examine the outcomes of surgery for doubly committed VSDs. METHODS: Between October 2013, when our service of paediatric cardiac surgery was opened, and December 2014, 24 patients were referred for surgical closure of VSDs. Among them, 17 patients (71%), with the median age of 6 years, ranging from 2 to 9 years, and with a median body weight of 19 kg, ranging from 11 to 56 kg, underwent surgical repair for doubly committed defects. In terms of size, the defect was considered moderate in 4 and large in 13. Aortic valvular regurgitation (AoVR) was present in 11 patients (65%) preoperatively, with associated malformations found in 14 (82%), with 5 patients (29%) having two or more associated defects. RESULTS: After surgery, there was trivial residual shunting in 2 patients (12%). AoVR persisted in 6 (35%), reducing to trivial in 5 (29%) and mild in 1 (6%). Mean stays in the intensive care unit and hospital were 2.6 ± 1.2 days, ranging from 2 to 7 days, and 6.8 ± 0.8 days, ranging from 6 to 9 days, respectively. The mean follow-up was 14 ± 4 months, ranging from 6 to 20 months, with no early or late deaths and without clinical deterioration. CONCLUSIONS: The incidence of doubly committed lesions is high in our experience, frequently associated with AoVR and other associated malformation. Early detection is crucial to prevent further progression of the disease. Patch closure remains the gold standard in management, not least since it allows simultaneous repair of associated intracardiac defects.