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Published on: September 22, 2023
Strategy for ventricular septal defect closure after prior gastric pull-through
Sivakumar Sivalingam1, Sivakumar Krishnasamy2, Mohd Azhari Yakub2
1Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia sivaprotoss77@yahoo.com.
Insights
This case study details the successful surgical repair of a perimembranous ventricular septal defect in a 9-year-old boy. The procedure required prior gastric tube reconstruction and mobilization to enable safe median sternotomy and defect closure.
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.
Abstract:
A 9-year-old boy was referred with a perimembranous ventricular septal defect. At birth, he had undergone a right thoracotomy with ligation of a tracheoesophageal fistula, cervical esophagostomy, and feeding gastrostomy. At 2 years of age, he had gastric tube reconstruction with a pull-through retrosternally, anterior to the heart, and an end-to-end esophagogastric anastomosis. Via a right anterolateral thoracotomy through the previous scar, the entire gastric tube was mobilized away from the sternum to facilitate a median sternotomy. With the patient supine, a median sternotomy was performed without difficulty, and the ventricular septal defect was closed under cardiopulmonary bypass.
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