New approach to multiple ventricular septal defect closure with intraoperative echocardiography and double patches sandwiching the septum (original) (raw)

Abstract

Objective: This was an evaluation of a new approach to the management of multiple muscular ventricular septal defects. The defects were located with epicardial echocardiography, then transfixed with a guide wire inserted directly through the right ventricular free wall. They were closed with a custom-made multilayered doublepatch device under cardioplegic arrest through a standard right atriotomy. Methods: This was a retrospective study of 14 consecutive patients. Results: The median age and body weight at repair were 40 days (range 1 week-8 years, 3 months) and 4.1 kg (2.8-24 kg), respectively. Five patients (36%) had undergone at least one previous sternotomy; 11 patients (78%) had associated cardiac lesions. Closure of the multiple septal defects was successful in 12 patients (85%). Failure to localize all defects led to pulmonary artery banding in 2 patients. One patient had the residual septal defect closed with a percutaneous device 6 months later, and in the second patient the residual defect was closed with a conventional approach 11 months afterward. Two patients had permanent pacemaker insertion. In 279 patient-months of follow-up, there was 1 cardiac arrest on day 1 and no early or late deaths; all children but one are free of cardiac medications, and no significant residual left-to-right shunts were demonstrated in any patient. Conclusion: The reported management of multiple ventricular septal defects has been successful in this series, even in neonates and infants with complex associated cardiac lesions. It appears safe, simple, and effective. T he management of patients with multiple ventricular septal defects (VSDs) remains a surgical challenge, with primary surgical repair to avoid palliation increasingly favored. 1-3 In the neonate and infant, primary repair can be demanding. The intraoperative identification of muscular defects is difficult through the right atriotomy. Often this requires long aortic crossclamp and cardiopulmonary bypass (CPB) times and right or left ventriculotomies. Left ventriculotomies have long-term complications. 4,5 Eventually some VSDs may never be found, despite extensive resection of muscular trabeculations, and may generate large residual shunts. Alternately, the initial palliation with pulmonary artery banding has inherent morbidity From the Cardiac Surgery Unit and Depart

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References (13)

  1. Kitagawa T, Durham LA, Mosca RS, Bove EL. Techniques and results in the management of multiple ventricular septal defects. J Thorac Cardiovasc Surg. 1998;115:848-56.
  2. Seddio F, Reddy MV, McElhinney DB, Tworetzky W, Silverman NH, Hanley FL. Multiple ventricular septal defects: how and when should they be repaired? J Thorac Cardiovasc Surg. 1999;117:134-40.
  3. Serraf A, Lacour-Gayet F, Bruniaux J, Ouaknine R, Losay J, Petit J, et al. Surgical management of isolated multiple ventricular septal defects: logical approach in 130 cases. J Thorac Cardiovasc Surg. 1992;103: 437-43.
  4. Hanna B, Colan SD, Bridges ND, Mayer JE, Castaneda A. Clinical and myocardial status after left ventriculotomy for ventricular septal defect closure. J Am Coll Cardiol. 1991;17:110A.
  5. Wollenek G, Wyse R, Sullivan I, Elliott M, de Leval M, Stark J. Closure of muscular ventricular septal defects through a left ventric- ulotomy. Eur J Cardiothorac Surg. 1996;10:595-8.
  6. Kapoor L, Gan MD, Das MB, Mukhopadhyay S, Bandhopadhyay A. Technique to repair multiple muscular ventricular septal defects. J Thorac Cardiovasc Surg. 1999;117:402-3.
  7. Ootaki Y, Yamaguchi M, Yoshimura N, Oka S, Yoshida M, Hasegawa T. Surgical management of trabecular ventricular septal defects: the sandwich technique. J Thorac Cardiovasc Surg. 2003;125:508-12.
  8. Macé L, Dervanian P, Le Bret E, Folliguet TA, Lambert V, Losay J, et al. "Swiss cheese" septal defects: surgical closure using a single patch with intermediate fixings. Ann Thorac Surg. 1999;67:1754-9.
  9. Black MD, Shukla V, Rao V, Smallhorn JF, Freedom RM. Repair of isolated multiple muscular ventricular septal defects: the septal oblit- eration technique. Ann Thorac Surg. 2000;70:106-10.
  10. Amin Z, Gu X, Berry JM, Titus JL, Gidding SS, Rocchini AP. Perventricular closure of ventricular septal defects without cardiopul- monary bypass. Ann Thorac Surg. 1999;68:149-54.
  11. Fishberger SB, Bridges ND, Keane JF, Hanley FL, Jonas RA, Mayer JE, et al. Intraoperative device closure of ventricular septal defects. Circulation. 1993;88(Suppl):II205-9.
  12. Okubo M, Benson LN, Nykanen D, Azakie A, Van Arsdell G, Coles J, et al. Outcomes of intraoperative device closure of muscular ven- tricular septal defects. Ann Thorac Surg. 2001;72:416-23.
  13. Bonnet D, Patkaï J, Tamisier D, Kachaner J, Vouhé P, Sidi D. A new strategy for the surgical treatment of aortic coarctation associated with ventricular septal defect in infants using an absorbable pulmonary artery band. J Am Coll Cardiol. 1999;34:866-70.