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"Swiss cheese" septal defects: surgical closure using a single patch with intermediate fixings.
L Macé1, P Dervanian, E Le Bret
1Department of Cardiovascular and Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Paris-Sud University, Paris, France. mace@ccml.com
The Annals of Thoracic Surgery
|July 3, 1999
Summary
A novel surgical technique effectively closes "Swiss cheese" defects, a type of ventricular septal defect, without causing septal bulging. This method ensures secure closure, even with complex cardiac conditions, promoting good patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- "Swiss cheese" defects, a form of ventricular septal defect, present surgical challenges including residual defects and septal dysfunction.
- A novel surgical approach using a single patch with intermediate fixings was developed to address these challenges.
- The technique aims to close the defect via right atriotomy without inducing septal bulging.
Purpose of the Study:
- To evaluate the safety and efficacy of a new surgical technique for closing "Swiss cheese" defects.
- To assess the technique's applicability in pediatric patients with complex congenital heart conditions.
- To determine the impact of the procedure on septal integrity and function.
Main Methods:
- The technique was applied to 5 pediatric patients (mean age 17 months) with "Swiss cheese" defects since April 1993.
- Three patients had associated complex cardiac lesions: tetralogy of Fallot, Taussig Bing heart, and mitral stenosis.
- The procedure involves a right atriotomy and closure with a single patch and intermediate fixings.
Main Results:
- No early or late deaths were recorded in the study cohort.
- Mean follow-up was 29 months, with all patients remaining asymptomatic.
- Echocardiography confirmed intact septa in 4 patients and insignificant residual shunting in one; septal wall motion was preserved in most patients.
Conclusions:
- The described surgical technique offers a secure method for closing "Swiss cheese" defects, including those with associated cardiac anomalies.
- This approach represents a valuable addition to the surgical armamentarium for complex ventricular septal defects.
- Further long-term studies are needed to fully ascertain the consequences of this procedure on septal wall motion.