Multiple Ventricular Septal Defects: A New Strategy

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 ...

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.

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)

The Cardiothoracic Surgeon

Background Surgical closure of multiple ventricular septal defects (VSDs) is challenging and associated with a high complication rate. Several factors may affect the outcomes after surgical repair of multiple VSDs. We aimed to report the outcomes after surgical repair of multiple VSDs before and after 1 year and identify the factors affecting the outcomes. We have studied forty-eight patients between 2016 and 2017 who had surgical repair of multiple VSDs. We grouped them according to the age at the time of repair. Study outcomes were hospital complications, prolonged hospital stay, and reoperation. Results There were 18 females (60%) in group 1 and 13 (72.22%) in group 2 (P = 0.39). There were no differences in the operative outcomes between the groups. Prolonged postoperative stay was associated with group 1 (OR 0.23 (0.055–0.96); P = 0.04) and lower body weight (OR 0.76 (0.59–0.97); P = 0.03). Hospital mortality occurred in 2 patients (6.67%) in group 1 and 1 patient (5.56%) in gr...

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.

Journal of interventional cardiology, 2018

Post-myocardial infarction (MI) ventricular septal defects (PIVSD) are an uncommon but life-threatening complication of acute MI. Although surgical closure has been the standard of care, mortality, and recurrence of VSD remain high even after emergent surgery. Transcatheter VSD closure (TCC) devices have become an alternative or adjunct to surgical closure. Online database search was performed for studies that included adults with PIVSD who underwent medical treatment (MT) alone, surgical closure (SC) (early or late), and TCC (early, late, or for post-surgical residual VSD). Twenty-six studies were included with a total of 737 patients who underwent either MT (N = 100), SC (early (n = 167), late (n = 100)), and TCC (early (n = 176), late (n = 115), or post-surgical residual VSD (n = 79)). The 30-day mortality among MT group was 92 ± 6.3%, among SC was 61 ± 22.5% (early 56 ± 23%, late 41 ± 30%), and for all TCC patients was 33 ± 24% (early 54 ± 32.7%, late 16 ± 26%), and TCC for post...

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.

Journal of Interventional Cardiology, 2014

BackgroundAdvances in interventional techniques now allow for transcatheter treatment of some ventricular septal defects (VSD), although there remain concerns about adverse events. We performed a systematic review to look at outcomes and complications associated with transcatheter closure of VSD.MethodA PubMed search for series in English on device closure of VSD from 2003 to June 2012 was performed. We excluded small series that were included in multicenter studies and patients who had acquired VSD following myocardial infarction. The random effects model was used to obtain pooled estimates of success and complications.ResultsA total of 37 publications comprising 4,406 patients with VSD (perimembranous = 3,758, muscular = 419, intracristal = 47, doubly committed subarterial = 36, multiple = 16, postsurgical = 123, unclassified = 7) were included in this analysis. The age of patients ranged from 3 days to 84 years. The pooled estimate of successful device implantation was 96.6% (95%...

Critical Care of Children with Heart Disease, 2009

2013

Acute myocardial infarction (AMI), despite advances in health care delivery systems, educa‐ tion, and primary prevention still remains a significant problem. Fortunately, with these ad‐ vances and early interventions, there has been a decline in the incidence of mechanical complications. Unfortunately, while becoming less common, when mechanical complica‐ tions occur and despite advances and evolving techniques in the surgical management of these problems, morbidity and mortality remain high. Post-myocardial infarction ventricu‐ lar septal rupture (PI-VSD) has challenged and intrigued clinicians for years. The timing of presentation can be quite variable, as they tend to occur in patients several days after their initial cardiovascular insult (acute PI-VSD) – and unfortunately, they can occur in patients who appear to otherwise be doing well. In addition, while less common, some patients might not present until weeks, if not longer, after their AMI with symptoms prompting a work-up ...