Cruciate Fenestration in Ventricular Septal Defect Patch for High-Risk Patients With High Pulmonary Vascular Resistance

Abstract

Late presentation of patients with large ventricular septal defect (VSD) and elevated pulmonary vascular resistance (PVR) is not uncommon in developing countries. Surgical VSD closure in these patients carries risks of persistent pulmonary hypertension, right ventricular failure, and mortality. Several techniques for creation of valved patches or fenestrated patches have been developed to address these issues. We have successfully used a simple and easily reproducible technique in which a cruciate fenestration is created in the patch used for VSD closure.

Management of late presentation congenital heart disease

“…[12][13][14][15][16] Surgical strategies to overcome perioperative pulmonary hypertensive crises have varied from the use of a decompressive atrial communication to valved patch closure of a ventricular septal defect or atrial septal defect (Table 2), or pulmonary artery banding with excellent early survival. [12][13][14][15][16][17][18][19] Talwar et al 15 reported excellent early and midterm outcomes with unidirectional valved patch with regression of pulmonary hypertension in the midterm; however, there have also been reports of worsening pulmonary hypertension in the longer term. 16 It would appear that a standardised approach to early assessment and close postoperative follow-up would ensure that surgery is offered appropriately and not to patients with established pulmonary vascular disease, thereby offering the best possible outcomes for these high-risk patients.…”

“…[12][13][14][15][16][17][18][19] Talwar et al 15 reported excellent early and midterm outcomes with unidirectional valved patch with regression of pulmonary hypertension in the midterm; however, there have also been reports of worsening pulmonary hypertension in the longer term. 16 It would appear that a standardised approach to early assessment and close postoperative follow-up would ensure that surgery is offered appropriately and not to patients with established pulmonary vascular disease, thereby offering the best possible outcomes for these high-risk patients. 11,[20][21][22] More complex cardiac malformations such as double-outlet right ventricle, transposition of great arteries with ventricular septal defect, or truncus Complete repair during the first year of life is the surgical approach of choice for patients with tetralogy of Fallot in high-income countries.…”

“…However, some institutions have offered surgery for patients with a pulmonary vascular resistance index up to 15 Wood units/m 2 12 16 Surgical strategies to overcome perioperative pulmonary hypertensive crises have varied from the use of a decompressive atrial communication to valved patch closure of a ventricular septal defect or atrial septal defect (Table 2), or pulmonary artery banding with excellent early survival 12 19 Talwar et al 15 reported excellent early and midterm outcomes with unidirectional valved patch with regression of pulmonary hypertension in the midterm; however, there have also been reports of worsening pulmonary hypertension in the longer term 16 .…”