Perimembranous ventricular septal defect repair: keeping it simple

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.