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

Abstract

Pulmonary hypertension due to delay in presentation, diagnosis, referral, and surgery for septal defects is not uncommon in the developing world and translates into high morbidity and mortality following open heart surgery to close these defects. Leaving a small atrial communication may not always be effective. Extracorporeal membrane oxygenation and inhaled nitric oxide therapy in the immediate postoperative phase may not be available or may not be financially feasible in many institutions which are economically challenged. Unidirectional valved patch is emerging as a new and effective solution to this problem and promises to make at least the immediate postoperative results more predictable in this subset of patients.

Unidirectional Valved Patch Closure of Ventricular Septal Defect with Arterial Switch Operation in a Patient with d-Transposition of Great Arteries with Severe Pulmonary Hypertension

“…Thus, if the right ventricular pressure were to exceed the left sided pressures, there would be some right‐to left shunt and that would prevent decompensation. Such a strategy has been found to be particularly useful in patients with large septal defects and severe PAH due to delayed presentation and surgery in developing countries 2,3 . The results of our follow‐up cardiac catheterization data would also favor this approach of complete repair.…”

“…With either approach, postoperative pulmonary vasodilators, sildenafil, and nitric oxide may be essential. In developing countries, nitric oxide therapy and if needed ECMO support are extremely expensive and not always available 2,3 …”

“…In view of significant pulmonary hypertension, a standard arterial witch operation (ASO) with closure of the VSD using a fenestrated unidirectional‐valved patch was planned. This was based on the favorable results obtained by others and us with the use of the valved patch in patients with isolated left‐to‐right shunts and severe pulmonary arterial hypertension (PAH) 2,3 . As discussed below, this option was thought to be superior to performing a palliative atrial switch or a palliative arterial switch without VSD closure.…”

“…This was based on the favorable results obtained by others and us with the use of the valved patch in patients with isolated left-to-right shunts and severe pulmonary arterial hypertension (PAH). 2,3 As discussed below, this option was thought to be superior to performing a palliative atrial switch or a palliative arterial switch without VSD closure.…”

“…1). 3 This patch was used to close the VSD with interrupted pledgeted sutures. Following this, the ASO was performed in the usual fashion and the right-ventricular outflow tract was reconstructed at the undersurface of the right pulmonary artery to prevent compression of the right coronary artery by the reconstructed right ventricular outflow tract (RVOT).…”