Operative Techniques for Repair of Muscular Ventricular Septal Defects

An Alternative Technique of Intraoperative Identification of Multiple Muscular Ventricular Septal Defects

“…Myriad of surgical techniques have been described, including initial pulmonary artery banding, use of an "oversized pericardial patch" into the left or right ventricle after dividing the moderator band, and septomarginal trabeculae, use of a composite patch of pericardium and Dacron with or without transfixation sutures in the middle of the patch, use of biologic glue, the felt sandwich technique, transatrial reendocardialization technique, septal obliteration technique, two-patch, and right ventricular apex exclusion technique, and a hybrid strategy with perventricular device closure. [3][4][5][6][7][8][9][10][11][12][13][14] Although different groups have achieved successful results with individual strategies, each technique is associated with important limitations, and long-term results of most of these techniques are not available.…”

“…Despite advancements in surgical and interventional techniques, closure of multiple muscular ventricular septal defects (VSDs) is associated with significant perioperative mortality, residual VSDs, ventricular dysfunction, and complete heart block. [1][2][3][4] An analysis of operations in the STS Congenital Heart Surgery Database during the 4-year time period of 2005 through 2008 inclusive, revealed the following four findings:…”

Outcomes of Patients Undergoing Surgical Management of Multiple Ventricular Septal Defects

“…With arrhythmias and heart block, ventricular dysfunction, and residual VSDs as common complications, these patients carry significantly worse outcomes than patients with a single VSD. 2,4,8 Previously, there have been 2 large studies on patients with multiple VSDs. Serraf et al have reported on a large series of 130 patients with multiple VSDs, noting an operative mortality rate of almost 8%, with a mean follow-up of 5 years.…”

“…16 The sandwich technique has become a widely accepted option for multiple VSD management following positive initial results. 4,7,9,17 The technique avoids the need for trabecular resection and ventriculotomy, although can involve considerable patch material. Similar to standard patch closure, the volume of patch material has been associated with ventricular and septal dysfunction.…”

Swiss-cheese ventricular septal defect closure by combination sandwich patch

“…1 Although there are various approaches, the surgical management of this type of VSD remains controversial because the rates of heart block, unplanned reoperation, and hospital mortality in patients with this condition are two- to three-times higher compared to those with perimembranous VSDs. 2 We describe a case of almost complete closure of an isolated sieve-like “Swiss-cheese” VSD in a child, using a combination sandwich patch technique.…”