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[Experience with repair of muscular trabecular ventricular septal defects]
1Department of Cardiovascular Surgery, Shakaihoken Chukyo Hospital, Nagoya, Japan.
Insights
This study highlights diagnostic techniques for muscular trabecular ventricular septal defects in pediatric patients. Surgical repair via right atriotomy is effective, though apical defects may require specialized approaches.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiac Anatomy
Background:
- Muscular trabecular ventricular septal defects (VSDs) are a subset of congenital heart disease.
- Accurate preoperative diagnosis and intraoperative identification are crucial for successful surgical repair.
- The prevalence of these defects among pediatric open-heart surgery patients was found to be 2.0%.
Purpose of the Study:
- To evaluate diagnostic methods for muscular trabecular VSDs.
- To assess the efficacy of surgical repair techniques for these defects.
- To identify factors influencing postoperative outcomes.
Main Methods:
- Retrospective review of 9 pediatric patients undergoing VSD repair (1994-1998).
- Analysis of preoperative diagnosis using left ventricular cineangiocardiography with specific projections (60° LAO, 30° cranial).
- Intraoperative diagnostic technique involving left heart blood filling and lung inflation during VSD closure.
Main Results:
- Preoperative diagnosis was confirmed in only 6 of 9 patients, indicating challenges in identification.
- Specific angiographic views and an intraoperative technique improved defect detection.
- Complete repair was achieved via right atriotomy in most cases, with division of trabeculations.
- Postoperative residual shunts correlated with the proximity of the VSD's inferior border to the cardiac apex.
Conclusions:
- Left ventricular cineangiocardiography with specific projections aids in diagnosing muscular trabecular VSDs.
- An intraoperative technique of filling the left heart improves defect visualization.
- Right atriotomy is generally effective for repair, but apical VSDs may necessitate apical left ventriculotomy.
Abstract:
We reviewed the records of 9 pediatric patients with muscular trabecular ventricular septal defects undergoing repair between April 1994 and June 1998 (mean age 2.6 +/- 3.1 years, mean weight 9.0 +/- 5.2 kg). The prevalence rate for muscular trabecular defects in the patients undergoing open-heart surgery for congenital heart disease was 2.0%. Although only 6 of the 9 patients were diagnosed as having muscular trabecular defects preoperatively, 60 degrees left anterior oblique and 30 cranially tilted projections of left ventricular cineangiocardiogram were useful to detect these defects. The technique of filling the left heart with blood by stopping to vent the left heart and inflating the lungs during the last one or two ligatures in closure of the defects was also useful to detect these defects intraoperatively. In closure of muscular trabecular defects, division of some trabeculations including a moderator band enabled complete repair through a right atriotomy. The nearer the inferior border of the ventricular septal defects were to the heart apex, the more postoperative residual shunts were left. We consider that apical left ventriculotomy may be needed in apical defects, although the right atrial approach is satisfactory for most muscular trabecular defects.