Congenital Heart Surgery Nomenclature and Database Project: ventricular septal defect

ESC Guidelines for the management of grown-up congenital heart disease (new version 2010)

“…Spontaneous closure is frequent. Several locations of the defect within the interventricular septum are possible and can be divided into four groups (nomenclature varies and synonyms are added): 28 † Perimembranous/paramembranous/conoventricular (most common, 80% of VSDs; located in the membranous septum with possible extension into inlet, trabecular or outlet septum; adjacent to tricuspid and aortic valve; aneurysms of the membranous septum are frequent and may result in partial or complete closure) † Muscular/trabecular (up to 15 -20%; completely surrounded by muscle; various locations; frequently multiple; spontaneous closure particularly frequent) † Outlet supracristal/subarterial/subpulmonary/infundibular/ supracristal/conal/doubly committed juxta-arterial [ 5%; located beneath the semilunar valves in the conal or outlet septum; often associated with progressive aortic regurgitation (AR) due to prolapse of the aortic cusp, usually right] † Inlet/AV canal/AVSD type (inlet of the ventricular septum immediately inferior to the AV valve apparatus; typically occurring in Down syndrome).…”

Development Gone Awry

“…One system divides VSDs into four types: conoseptal, conoventricular, muscular, and atrioventricular canal-type. 16 Only a small fraction of patients with VSDs ever become symptomatic, thus the diagnosis of VSD is usually initially suspected based on the physical examination alone: a murmur appears as PVR falls and a pressure gradient develops across the defect. Left-to-right shunts through moderate to large VSDs become hemodynamically significant in the first 2 to 6 weeks of life.…”

Mattress Stitch—A Modified Shallow Stitching in the Surgical Closure of Large Perimembranous Ventricular Septal Defect in Infants

“…17) However, the disturbance of conduction system, residual ventricular shunt, neurologic injury, and postoperative mortality are still major postoperative complications, especially in infants with malnutrition. [6][7][8][9][10][11] Our current series reported excellent postoperative outcomes using mattress suturing technique: there was no incidence of complete heart block, reoperation for residual VSD and postoperative mortality. Some may argue that the results can be attributed simply to a learning curve of the surgeon but the comparatively good outcomes are encouraging, and the new technique can be an addition to the armamentarium of pediatric cardiac surgeons.…”

“…12) Although the significant hemodynamic residual shunt is less than 1%, 5) the global rate of small residual shunt still ranges from 15% to 25% on intraoperative transoesophageal echocardiography and 30% to 46% on postoperative transthoracic echocardiography. 9,10) Low weight at operation is a predictive factor for a residual shunt because of the difficulty in balancing prosthesis compliance with tissue friability in such patients. 11) Using the new technique, the suture is routed in a flask-bottom way.…”

“…4,5) Complications are rare but still include injury of conduction system, residual shunt, emergent reoperation, and postoperative death, mainly in malnourished infants suffering from large perimembranous VSDs. [6][7][8][9][10][11][12] Since 2011, we have adopted the mattress suturing technique to close the infero-posterior margin of large perimembranous VSDs. In the current series, we retrospectively reviewed 120 infants with poor weight suffering from large perimembranous VSDs to assess this new method and evaluate its effectiveness.…”