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Trans-pulmonary arterial closure of ventricular septal defect
Insights
Trans-pulmonary arterial closure effectively treats supracristal ventricular septal defects (VSDs), avoiding right ventricular scarring. Further studies are needed to assess the long-term incidence of right bundle branch block (RBBB).
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- Ventricular septal defects (VSDs) are common congenital heart abnormalities requiring surgical intervention.
- Traditional VSD repair methods can result in right ventricular scarring, potentially impacting cardiac function.
- Trans-pulmonary arterial closure offers an alternative approach for specific VSD types.
Purpose of the Study:
- To evaluate the feasibility and outcomes of trans-pulmonary arterial closure for ventricular septal defects (VSDs).
- To assess the incidence of postoperative complications, specifically right bundle branch block (RBBB), following this technique.
- To determine if trans-pulmonary arterial closure is a suitable alternative for supracristal VSDs.
Main Methods:
- Retrospective analysis of 14 patients (4 months to 28 years) undergoing trans-pulmonary arterial closure for VSD.
- VSD types included 13 supracristal and 1 bulboventricular.
- Circulatory arrest was used in two infant patients.
Main Results:
- The procedure was technically feasible and uneventful in most patients.
- Right bundle branch block (RBBB) occurred in 4 patients (28.6%).
- No postoperative right ventricular scar was observed in patients with supracristal VSDs.
Conclusions:
- Trans-pulmonary arterial closure is a viable and effective method for treating supracristal VSDs, particularly in small patients.
- This technique avoids right ventricular scarring, a significant advantage over conventional methods.
- Further large-scale studies are required to definitively assess the long-term risk of RBBB and confirm its place as a primary treatment.
Abstract:
Fourteen patients ranging in age from 4 months to 28 years underwent closure of a ventricular septal defect (VSD) through the pulmonary valve after pulmonary arteriotomy. In 13 of these the VSD was of the supracristal type and in one patient it was of the bulboventricular type. In all patients, including two infants whose VSD was closed under circulatory arrest, the operative and postoperative courses were uneventful except in one, who needed prolonged respiratory care. Right bundle branch block (RBBB) resulted in four patients, one of whom had a bulboventricular defect. The procedure is technically feasible without difficulty when the VSD is of the supracristal type and when the patient is too small. Trans-pulmonary arterial closure is the method of choice for treating a supracristal VSD, as this procedure leaves no postoperative right ventricular scar. However, the advisability of continuing to use this procedure is to be decided after statistical analysis of the frequency of postoperative RBBB can be made with a larger series of patients.