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Left ventricular approach to multiple ventricular septal defects
Insights
This study explored closing muscular ventricular septal defects via apical left ventriculotomy. This surgical approach offers excellent septal exposure, potentially minimizing risks of unrecognized defects in complex congenital heart cases.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Defects
Background:
- Muscular ventricular septal defects (VSDs) present surgical challenges.
- Accurate visualization of the septum is crucial for successful VSD repair.
Purpose of the Study:
- To evaluate the efficacy and safety of apical left ventriculotomy for repairing multiple muscular VSDs.
- To compare outcomes in patients with and without transposition of the great arteries.
Main Methods:
- Retrospective analysis of 11 patients undergoing VSD closure.
- Surgical approach: apical left ventriculotomy.
- Patient stratification into two groups: with and without transposition of the great arteries.
Main Results:
- Apical left ventriculotomy provided excellent septal exposure, unobstructed by trabeculae or papillary muscles.
- No deaths occurred in the group without transposition (3 patients).
- Four deaths occurred in the transposition group (8 patients), attributed to hypoplastic right ventricle, airway obstruction, or heart failure with unrecognized defects.
Conclusions:
- Apical left ventriculotomy is an effective approach for visualizing and repairing multiple muscular VSDs.
- While risks exist, this method may reduce the likelihood of missed defects compared to other techniques.
- Outcomes appear more favorable in patients without transposition of the great arteries.
Abstract:
Multiple muscular ventricular septal defects were closed through an apical left ventriculotomy in 11 patients. The patients were divided into two groups: Group 1, 8 patients who had transposition of the great arteries, and group 2, 3 patients without transposition. There were 4 deaths in Group 1 and non in Group 2. Two of the deaths were caused by a hypoplastic right ventricle, 1 by airway obstruction, and 1 by heart failure and pulmonary edema in a patient who had additional unrecognized muscular defects. An apical left ventriculotomy provides excellent exposure of the septum. The field is not obscured by trabecular bands or papillary muscles. Although 1 patient died because of residual VSDs, this approach, compared with previously described methods, minimizes the risk of unrecognized defects.