Strategy for ventricular septal defect closure after prior gastric pull-through

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Defects
• Gastrointestinal Reconstruction

Background:

• A 9-year-old boy presented with a perimembranous ventricular septal defect (VSD).
• He had a history of complex neonatal surgeries including tracheoesophageal fistula ligation and gastric tube reconstruction.
• Previous retrosternal gastric tube placement complicated surgical access.

Observation:

• The patient's prior retrosternal gastric tube reconstruction posed a potential challenge for subsequent cardiac surgery.
• A right anterolateral thoracotomy was performed to mobilize the gastric tube anteriorly.

Findings:

• A median sternotomy was successfully completed after mobilizing the gastric tube.
• The perimembranous ventricular septal defect was subsequently closed under cardiopulmonary bypass.

Implications:

• This case highlights the importance of careful surgical planning in patients with complex prior reconstructions.
• Successful management demonstrates the feasibility of median sternotomy in such cases, enabling definitive VSD repair.