Related Experiment Video
Updated: Aug 20, 2026
Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
Flap valve double patch closure of ventricular septal defects in children with increased pulmonary vascular
William M Novick1, Nestor Sandoval, Vasiliy V Lazorhysynets
1Department of Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA. ichfno@aol.com
Insights
Closing large ventricular septal defects (VSD) in children with high pulmonary vascular resistance (PVR) is risky. A novel double patch technique offers a safer approach, reducing mortality and morbidity in this vulnerable population.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiovascular Physiology
Background:
- Large ventricular septal defects (VSD) in children with elevated pulmonary vascular resistance (PVR) present significant surgical risks.
- Limited availability of advanced medical support for these high-risk patients necessitates innovative surgical solutions.
Purpose of the Study:
- To evaluate the safety and efficacy of a novel fenestrated flap valve double VSD patch technique.
- To reduce morbidity and mortality associated with VSD closure in children with elevated PVR.
Main Methods:
- Ninety-one children with large VSD and elevated PVR underwent surgical closure using a fenestrated double patch.
- The technique involved a fenestrated VSD patch with an additional smaller patch attached to the fenestration's left ventricular side.
Main Results:
- The overall early mortality rate was 7.7% (7 of 91 children).
- Late mortality included 2 deaths from VSD and 5 from complex associated defects.
- The study included diverse patient groups, with VSD as the primary lesion in 56 children.
Conclusions:
- Surgical closure of large VSD in children with elevated PVR is feasible with acceptable outcomes.
- The fenestrated flap valve double VSD patch technique demonstrates potential for improved patient management.
Background:
Closure of a large ventricular septal defect (VSD) in children with elevated pulmonary vascular resistance (PVR) is associated with significant morbidity and mortality. Sophisticated medications and circulatory assist devices may not be available to assist in the care of children with elevated PVR undergoing VSD closure. We designed a fenestrated flap valve double VSD patch to decrease the morbidity and mortality associated with the closure of a large VSD in this high-risk group.
Methods:
Ninety-one children (median age 4.0 +/- 3.1 years) with a large VSD and elevated PVR (10.5 +/- 4.9 Wood units) underwent double patch VSD closure. The routine VSD patch was fenestrated (4 to 8 mm), and on the left ventricular side of the patch, a second smaller patch was attached to the upper third of the fenestration before VSD patch placement.
Results:
Fifty-six children with a VSD as the primary lesion, 16 with complete atrioventricular canal, 10 with double outlet right ventricle/VSD, 2 with interrupted aortic arch/VSD, 2 with truncus arteriosus, and 1 each with transposition/VSD, corrected transposition/VSD, total anomalous pulmonary venous connection/VSD, VSD/left pulmonary artery atresia, and aortopulmonary window underwent operation; the overall early mortality rate was 7.7% (7 of 91). There have been 7 late deaths: 2 VSD and 5 complex defects.
Conclusions:
Closure of a large VSD with elevated PVR can be performed with reasonable mortality and morbidity.
More Related Videos
Related Concept Videos
01:16Heart Valves
The AV valves prevent the backflow of blood from the ventricles to the atria during ventricular contraction. These valves function with the assistance of the chordae tendineae and papillary muscles. When the ventricles are relaxed, the chordae tendineae are slack, allowing blood to flow from the atria into the...
01:22Mitral Stenosis I: Introduction
01:14Ventilatory Modes
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...