A review of the therapeutic management of multiple ventricular septal defects

Abstract

Background and Aim We showed in our anatomical review, ventricular septal defects existing as multiple entities can be considered in terms of three major subsets. We address here the diagnostic challenges, associated anomalies, the role and techniques of surgical instead of interventional closure, and the outcomes, including reinterventions, for each subset. Methods We reviewed 80 published investigations, noting radiographic findings, and the results of clinical imaging elucidating the location, number, size of septal defects, associated anomalies, and the effect of severe pulmonary hypertension. Results Overall, perioperative mortality for treatment of residual multiple defects has been cited to be between 0% and 14.2%, with morbidity estimated between 6% and 13%. Perioperative mortality is twice as high for perimembranous compared to muscular defects, with the need for reoperation being over four times higher. Perventricular hybrid approaches are useful for the closure of high anterior or apical defects. Overall, the results have been unsatisfactory. Pooled data reveals incidences between 2.8% and 45% for device‐related adverse events. Currently, however, outcomes cannot be assessed on the basis of the different anatomical subsets. Conclusions We have addressed the approaches, and the results, of therapeutic treatment in terms of coexisting discrete defects, the Swiss‐cheese septum, and the arrangement in which a solitary apical muscular defect gives the impression of multiple defects when viewed from the right ventricular aspect. Treatment should vary according to the specific combination of defects.

Multiple ventricular septal defects associated to anomalous venous returns, mitral valve disease, myocardium hypertrophy, and right outflow obstruction: a multimodality imaging assessment

“…The staged approach promotes spontaneous closure of small defects. 5 We did not evaluate this option because after only 2 months from birth the patient developed severe hypertrophy of the infundibulum and severe RV outflow obstruction with consequent biventricular hypertrophy of the apical portion, which led to hypoxia and acute heart failure.…”

A game of Whack‐A‐Mole: Closing multiple ventricular septal defects

“…By their expert review of the existing literature on multiple ventricular septal defects (m‐VSD), Chowdhury et al 1 have described a systematic approach to this challenging clinical problem. m‐VSD can be onerous to manage.…”

Letter to the Editor: Percardiac closure of large apical ventricular septal defects in infants: Novel modifications and mid-term results

“…Numerous surgical and interventional procedures and short-term follow-up studies that reveal an unfavorable incidence of perioperative mortality and morbidity demonstrate that this ideal has not yet been attained. 4 Proponents of an apical right ventriculotomy have established the safety and efficacy of this technique for large solitary apical lesions with several overlaying trabeculations and for apical and anterior defects. A modest incision is made in the right ventricle near to the left anterior interventricular coronary artery without harming the blood vessel.…”