Dual-Patch Technique with Ventricular Septal Defect Closure for Straddling Chordae.

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Disease
• Cardiovascular Surgery

Background:

• Surgical repair of ventricular septal defects (VSDs) is complicated by straddling atrioventricular (AV) valve chordae, posing a risk to valve integrity.
• Patients with Down syndrome often present with complex congenital heart defects, including VSDs and AV valve abnormalities.

Purpose of the Study:

• To describe the successful application of a dual-patch technique for VSD closure in an infant with straddling AV valve chordae.
• To evaluate the efficacy and safety of this conservative approach in preserving AV valve function and preventing conduction disturbances.

Main Methods:

• A 5-month-old infant with Down syndrome underwent VSD closure via right atriotomy using a dual-patch technique with glutaraldehyde-treated autologous pericardial patches.
• The patches were placed on the superior and inferior septal margins, encasing the straddling chordae without division.
• Associated mitral and tricuspid valve clefts were repaired, and the atrial septal defect (ASD) was primarily closed.

Main Results:

• The dual-patch technique successfully closed the large inlet VSD without residual defect.
• Postoperative echocardiography revealed only mild AV valve regurgitation.
• The approach preserved native valvular geometry and avoided conduction disturbances.

Conclusions:

• The dual-patch technique provides a physiologic and conservative solution for VSD repair when straddling chordae preclude conventional methods.
• This technique avoids chordal translocation or reimplantation, maintaining native AV valve architecture and function.
• It represents a valuable alternative for complex congenital heart defect repair in pediatric patients.