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Related Experiment Videos

Multiple ventricular septal defects: how and when should they be repaired?

F Seddio1, V M Reddy, D B McElhinney

  • 1Division of Cardiothoracic Surgery, University of California, San Francisco, USA.

The Journal of Thoracic and Cardiovascular Surgery
|December 31, 1998
PubMed
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Primary repair of multiple ventricular septal defects in infants is associated with lower morbidity than palliation. Complete repair is feasible without ventriculotomy, avoiding complications of pulmonary artery banding.

Area of Science:

  • Pediatric Cardiac Surgery
  • Congenital Heart Disease
  • Surgical Outcomes

Background:

  • Multiple ventricular septal defects (VSDs) present a significant surgical challenge.
  • Current surgical strategies include ventriculotomy or pulmonary artery banding (PAB) for palliation.
  • Clear guidelines for repair versus palliation and surgical approaches are lacking.

Purpose of the Study:

  • To evaluate the outcomes of primary repair versus palliation for multiple VSDs.
  • To assess the feasibility of repairing multiple VSDs without ventriculotomy.
  • To compare morbidity associated with different surgical strategies.

Main Methods:

  • A retrospective review of 45 infants with multiple VSDs (>/=2) from July 1992 to January 1998.
  • Patients underwent primary complete repair (n=31), palliation (n=8), or repair after prior palliation (n=6).

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  • Surgical approaches included right atriotomy or trans-semilunar valve, avoiding ventriculotomy.

    • Main Results:

    • Primary repair (Group 1) had one early death; no residual defects.
    • Palliation (Group 2) had 50% reoperation rate for PAB issues and one cardiac transplant.
    • No patient undergoing primary repair required ventriculotomy.

    Conclusions:

    • Primary repair of multiple VSDs in infancy is associated with lower morbidity than palliation.
    • Complete repair without ventriculotomy is achievable for most multiple VSD cases.
    • "Swiss-cheese" septum may be an indication for palliation.