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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 437-442, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
A Serraf, F Lacour-Gayet, J Bruniaux, R Ouaknine, J Losay, J Petit, JP Binet and C Planche
From January 1980 through September 1990, 130 children underwent surgical
closure of isolated multiple ventricular septal defects (mean age 14 +/- 18
months, mean weight 7.0 +/- 4.4 kg). Sixty-one were less than 1 year of
age. Sixty-one children had pulmonary protection, 51 had pulmonary artery
banding, and 10 had pulmonary valve stenosis. All other patients had severe
pulmonary hypertension (mean systolic pressure 75.7 +/- 20.5 mm Hg and
already disabling heart failure (New York Heart Association classes III and
IV). The surgical management was based on the location of the defects and
the ventricular dominance that were assessed preoperatively and
intraoperatively. Midtrabecular ventricular septal defects were always
centered by the moderator band and were therefore divided into low
trabecular, midtrabecular, and high trabecular defects. The perimembranous
septum was involved in 102 patients, the trabecular in 121, the inlet
septum in 12, and the infundibular septum in 9. Fifty patients had the
"Swiss cheese" form of the lesion. Closure of the ventricular septal
defects included Dacron patch and mattress sutures. They were always first
approached through a right atriotomy, which was sufficient for complete
repair in 82 patients. In midtrabecular ventricular septal defects, section
of the moderator band (n = 24) allowed closure of all the defects with a
single Dacron patch. In 48 patients a right atriotomy and a right (n = 32)
or left (n = 14) (particularly for low trabecular ventricular septal
defects) or both right and left (n = 2) ventriculotomies were necessary to
secure the repair. The hospital mortality rate was 7.7% (10 patients). The
causes of deaths were residual ventricular septal defect (n = 5), pulmonary
hypertension (n = 2), hypoplastic right ventricle (n = 1) and left
ventricle (n = 1), and myocardial infarction (n = 1). Among eighteen
survivors with residual ventricular septal defect, six were reoperated on;
there were two deaths. A permanent pacemaker was necessary in four
patients. Low trabecular ventricular septal defects and left ventriculotomy
were significant risk factors for morbidity (death, residual ventricular
septal defect), p less than 0.01. At 7 years of follow-up, 90% of survivors
were in New York Heart Association class I. Actuarial survival and freedom
from reoperation at 7 years were 89.6% and 87.5%, respectively.
ARTICLES
Surgical management of isolated multiple ventricular septal defects. Logical approach in 130 cases
Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Universite Paris-Sud, France.
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