J Thorac Cardiovasc Surg 1999;117:403-404
© 1999 Mosby, Inc.
Technique to repair multiple muscular ventricular septal defects
Reply to the Editor:
My colleagues and I appreciate the thoughtful comments by Kapoor and associates on our recent article concerning the techniques used for the closure of multiple muscular ventricular septal defects (VSDs). They have underscored some of the difficulties encountered in the exposure of muscular defects and describe a variation on one of the techniques that we included in our report. As these authors point out, and as emphasized in our manuscript, muscular VSDs will appear as multiple openings when viewed from the right side, but are often a single defect as seen from the left. Therefore, an oversized patch can be an effective means to close the defects when placed on the left ventricular surface. Because the pressure in the left ventricle will be higher than that in the right after repair, only a few sutures are required to anchor the patch in position. Although the authors' technique uses an outlet VSD to gain access to the left ventricular side, the basic principle described in our report is the same. Additionally, some patients will not have an additional outlet VSD of sufficient size to permit access to the left side of the septum. Kapoor and associates note that the approach described in our article may be "cumbersome," but we have not found that to be the case. As noted, the relatively few sutures required to hold the patch in place make the technique straightforward. Furthermore, in our experience only a single patch has been necessary to effectively close all the defects in the anterior and midmuscular septum, in contrast to the need for up to 3 patches in the patients described by Kapoor and his associates. Possibly, the more direct approach through the anterior muscular septum used in our patients permits more accurate placement of the patch over the center of the VSDs such that only a single patch is required.
Although the surgical management of multiple muscular VSDs remains a challenge, it is clear that secure and complete closure can be achieved in most patients using the techniques described in our report, as well as those illustrated in the letter by Kapoor and colleagues. Early repair in infancy, before secondary muscle hypertrophy makes exposure even more difficult, facilitates the procedures described and results in better outcomes.
Edward L. Bove, MD
Pediatric Cardiovascular Surgery
Mott Children’s Hospital
University of Michigan
1500 E Medical Center Dr
F7830 Mott, Box 0223
Ann Arbor, MI 48109
12/8/94230
References
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Kitagawa S, Durham LA, Mosca RS, Bove EL. Techniques and results in the management of multiple muscular ventricular septal defects. J Thorac Cardiovasc Surg 1998;115:848-56. [Abstract/Free Full Text]
