Is Left Ventriculotomy Feasible for Muscular Ventricular Septal Defects in Infants?
DOI:
https://doi.org/10.1532/HSF98.20071202Abstract
Optimal management of muscular ventricular septal defects (MVSDs) remains controversial. Left ventriculotomy is the cornerstone of surgical repair but is frequently complicated by residual shunts, left ventricular dysfunction, apical aneurysm, or arrhythmias. In this study, we evaluated the long-term outcomes of surgical repairs in infants with isolated MVSDs. We retrospectively analyzed clinical data from 56 children with MVSDs (31 males, 25 females). Follow-up by questionnaire and Doppler echocardiography was performed at discharge and between 2 and 124 months after surgery. Patient age was 2 to 40 months (median, 21 months) and weight was 3.0 to 15.3 kg (median, 5.3 kg). Two patients died after surgery (hospital mortality, 3.57%). One patient with MVSDs died of low cardiac output caused by the long duration of cardiopulmonary bypass. Another patient with Swiss cheese MVSD received a single patch closure but died of low cardiac output immediately after cardiopulmonary bypass. Immediate complications such as a third-degree atrial-ventriclar block occurred in 2 patients, but they recovered before discharge and showed no residual shunt. No deaths occurred during follow-up, but a residual shunt was found in 1 patient. Delayed complete heart block requiring a pacemaker occurred in 1 patient. One patient showed paroxysmal supraventricular tachycardia that was treated with amiodarone. The left ventricular ejection fraction was 0.45-0.55 in 8 patients and 0.55-0.73 in 46 patients. No apical aneurysm was found. All the surviving patients returned to normal school life. Our results indicate that surgery is a suitable treatment option in infants and children with isolated MVSDs and that preoperative diagnosis is crucial to a successful outcome. Infants can tolerate a left ventriculotomy incision for MVSDs in the lower or apical ventricular septum.References
Alsoufi B, Karamlou T, Osaki M, et al. 2006. Surgical repair of multiple muscular ventricular septal defects: the role of re-endocardialization strategy.; Thorac Cardiovasc Surg 132(5): 1072-80.nBecker P, Frangini P, Heusser F, et al. 2004. New surgical approach to device closure of multiple apical ventricular septal defects. Ev Esp Cardiol 57(12): 123 8-40.nDiab KA, Hijazi ZM, Cao QL, et al. 2005. A truly hybrid approach to perventricular closure of multiple muscular ventricular septal defects. J Thorac Cardiovasc Surg 130(3):892-3.nJoshua DC Robinson Frank J, et al. 2006. Cardiac conduction disturbances seen after transcatheter device closure of muscular ventricular septal defects with the Amplatzer occluder. Am J Cardiol 97(4):558-60.nKitagawa T, Lucian LA, Mosca RS, et al. 1998. Techniques and results in the management of multiple ventricular septal defects. J Thorac Cardiovasc Surg 115:848-56.nLeca F, Karam J, Vouhe PR, et al. 1994. Surgical treatment of multiple ventricular septal defects using a biologic glue. J Thorac Cardiovasc Surg 107:96-107.nMacé L, Dervanian P, Le Bret E, et al. 1999. "Swiss cheese" septal defects: surgical closure using a single patch with intermediate fixings. Ann Thorac Surg 67(6):1754-9.nSerraf A, Lacour Gayet F, Bruniaux J, et al. 1992. Surgical management of isolated multiple ventricular septal defects: logical approach in 130 cases. J Thorac Cardiovasc Surg 103:437-42.nSpevak PJ, Mandell VS, Colan SD, et al. 1993. Reliability of Doppler color flow mapping in the identification and localization of multiple ventricular septal defects. Echocardiography 10:573-81.nWollenek G, Wyse R, Sullivan I, et al. 1996. Closure of muscular ventricular septal defects through a left ventriculotomy. Eur J Cardiothorac Surg 10:595-8.n