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J Thorac Cardiovasc Surg 2004;128:684-692
© 2004 The American Association for Thoracic Surgery
Surgery for congenital heart disease |
a Cardiac Surgery Unit and Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
b Thoraxkirurgiska kliniken, Akademiska sjukhuset, Uppsala, Sweden
Read at the Eighty-third Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 4-7, 2003.
Received for publication May 5, 2003; revisions received April 30, 2004; accepted for publication May 7, 2004. * Address for reprints: Christian Brizard, MD, Director, Cardiac Surgery Unit, Royal Children's Hospital, Parkville 3052, Victoria, Australia (E-mail: cardiac.surgery{at}rch.org.au).
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 double-patch 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.
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