Double patch closure of ventricular septal defect with increased pulmonary vascular resistance

Advances in diagnosis and treatment of pulmonary arterial hypertension in neonates and children with congenital heart disease

“…In 1998, Novick et al [141] designed a fenestrated fl ap valve double ventricular septal defect patch (Fig. 3).…”

Unidirectional valved patches for closure of septal defects in patients with severe pulmonary hypertension

“…One patient died due to acute right ventricular failure and another due to respiratory failure. In the initial 18 patients reported by Novick,[18] there were no early deaths and one late death occurred while the child was awaiting detailed evaluation for suspected pulmonary stenosis. In Novick's later experience[19] spread over more than 10 centers around the world, there were seven early deaths.…”

“…Novick et al ,[18] introduced the first modification [Figures 1 and 3]. They constructed the UVP from sauvage Dacron (C.R.…”

“…In 2005, they published a modified technique and proposed a fenestration size that was half of the expected aortic annulus diameter for each child. [18] Following this, a separate flap patch at least 4 mm larger than the fenestration was constructed and sewn onto the superior margin of the fenestration along one-third of the circumference. A separate tethering stitch was placed at the inferior apex of the flap valve and tied loosely over a Hegar dilator that was the same size as the fenestration.…”

“…The VSD patch was sewn into place orienting the patch in such a way that the flap valve was placed on the left ventricular (LV) side with the flap opening towards the LV apex to avoid subaortic obstruction. Novick et al .,[1819] recommend the use of this technique to improve the quality of life even for those patients who are declared inoperable and in whom alternative therapies for irreversible PAH, like heart-lung transplantation are not an option.…”