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Perimembranous ventricular septal defect repair: keeping it simple
J C Mullen1, G Lemermeyer, S A Schipper
1Department of Surgery, University of Alberta, Edmonton. jmullen@gpu.srv.ualberta.ca
Insights
A simplified surgical technique for perimembranous ventricular septal defects (VSDs) effectively repairs the defect without causing complete heart block. This VSD repair method avoids reoperation and significant leaks, offering excellent outcomes.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Perimembranous ventricular septal defects (VSDs) are common congenital heart abnormalities.
- Traditional VSD repair methods can carry risks of heart block and residual defects.
- Developing simplified surgical techniques is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate a simplified surgical method for repairing perimembranous VSDs.
- To assess the efficacy of this technique in reducing complete heart block and residual defects.
- To determine the safety and long-term outcomes of the simplified VSD repair.
Main Methods:
- A cohort of 23 children, one adolescent, and one adult with perimembranous VSDs underwent repair using a simplified right atrial approach.
- The surgical technique involved direct patch suturing with minimal manipulation near conduction tissues.
- Temporary tricuspid valve detachment was utilized in 36% of cases to enhance operative exposure.
Main Results:
- Early postoperative echocardiography identified tiny residual VSDs in 28% of patients, none requiring reoperation.
- No perioperative deaths occurred. At follow-up, no significant residual VSDs or need for reoperation were observed.
- Postoperative electrocardiography showed no heart block, though 64% exhibited a right bundle branch block pattern. Tricuspid valve function remained normal.
Conclusions:
- The simplified VSD repair method demonstrates excellent results, effectively avoiding significant leaks and the need for reoperation.
- This technique provides freedom from complete heart block and pacemaker implantation.
- Temporary tricuspid valve detachment is a safe and beneficial practice for improving surgical visualization in pediatric VSD repair.
Objective:
A simplified method of repairing perimembranous ventricular septal defects (VSDs) was employed to reduce the incidence of complete heart block and significant residual defects.
Patients And Interventions:
Twenty-three children (mean age 1.2 +/- 0.3 years, range 0.1 to 5.8; mean weight 8.2 +/- 0.9 kg, range 3.7 to 20), one adolescent (16 years old) and one adult (30 years old) with perimembranous VSDs were operated on using the simplified method to correct the defect. The repairs were done from a right atrial approach by sewing the patch directly to the rim of the defect, by using very small bites in the area of the conduction tissue. In 36% of cases, the tricuspid valve was temporarily detached close to the annulus to improve operative exposure. Concomitant procedures were required in 91% of children.
Main Results:
Early postoperative echocardiography showed a tiny residual ventricular septal defect in 28% (seven of 25) of patients, none requiring reoperation. There were no perioperative deaths. At follow-up there were no significant residual VSDs and no patient required reoperation. Postoperative electrocardiography revealed no evidence of heart block, but 64% showed a right bundle branch block pattern. There were no problems with tricuspid valve function postoperatively. At late follow-up (22 +/- 2 months) there were no significant problems related to the VSD repair.
Conclusions:
This simplified method of VSD repair produces excellent results avoiding significant leaks and the need for reoperation. This method has shown freedom from complete heart block and the need for pacemaker implantation. Temporary detachment of the tricuspid valve improves visualization in many children and is a safe practice.