Muscular ventricular septal defects repaired with left ventriculotomy

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Defects
• Surgical Techniques

Background:

• Muscular ventricular septal defects (VSDs) present surgical challenges, particularly in young children.
• Limited data exists on the long-term outcomes of left ventriculotomy for these defects.

Purpose of the Study:

• To evaluate the safety and efficacy of left ventriculotomy for muscular VSD repair in pediatric patients.
• To assess the impact on coronary circulation and overall cardiac function.

Main Methods:

• A retrospective review of nine pediatric patients (10 months to 4 years) who underwent left ventriculotomy for muscular VSD closure between 1974 and 1979.
• Analysis of intraoperative details, postoperative electrocardiograms, cardiac catheterization, echocardiography, and angiography.

Main Results:

• Complete VSD closure was achieved in surviving patients, confirmed by cardiac catheterization in four.
• Three early postoperative deaths occurred. Six patients survived long-term (2-7 years) with good cardiac function, particularly those utilizing cardioplegia or deep hypothermia.
• Two survivors exhibited cardiomegaly and left ventricular dysfunction; electrocardiograms showed myocardial ischemia or necrosis in some patients, but no left bundle branch block developed.

Conclusions:

• Limited left ventriculotomy is a viable surgical option for complex muscular VSDs in children.
• Careful surgical technique is crucial to minimize risks of coronary artery compromise.
• The use of cardioplegia and deep hypothermia may be associated with better outcomes.