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J Thorac Cardiovasc Surg 2009;137:924-928
© 2009 The American Association for Thoracic Surgery

Congenital Heart Disease

Surgical management of multiple ventricular septal defects: The role of the felt sandwich technique

^a First Department of Surgery, University of Toyama, Graduate School of Medicine, Toyama, Japan
^b Department of Pediatrics, University of Toyama, Graduate School of Medicine, Toyama, Japan

Received for publication May 2, 2008; revisions received July 20, 2008; accepted for publication August 31, 2008.

^_* Address for reprints: Naoki Yoshimura, MD, First Department of Surgery, University of Toyama, Graduate School of Medicine, 2630 Sugitani, 930-0194, Toyama, Japan. (Email: ynaoki{at}med.u-toyama.ac.jp).

Objective: Recently, the felt sandwich technique has been widely used to close muscular ventricular septal defects. We evaluated the early and midterm results of our strategy (a combination of the sandwich technique and direct closures) and assessed the role of the sandwich technique in the treatment of multiple ventricular septal defects.

Methods: Twenty-nine consecutive patients underwent an operation for multiple ventricular septal defects and associated cardiac malformations. They included 17 boys and 12 girls with a median age of 6.0 months. Thirteen patients had 4 or more ventricular septal defects (Swiss cheese septum).

Results: There was no surgical or follow-up mortality, and no reoperations were required. There were no cases of heart block and no significant residual shunts in the latest follow-up study. Two patients with Swiss cheese septum had postoperative congestive heart failure. Three muscular ventricular septal defects were closed with the sandwich technique in these 2 patients, whereas 1 or fewer ventricular septal defects were closed with the sandwich technique in the other 27 patients. Seven (77.8%) of 9 patients who underwent the sandwich procedure had septal dysfunction, whereas 5 (25.0%) of the other 20 patients showed septal dysfunction (P < .05).

Conclusions: The outcome of the surgical repair of multiple ventricular septal defects was satisfactory. Although the sandwich technique is simple and effective, the use of numerous felt patches disturbed the movement of the interventricular septum. An effort should be made to close the muscular ventricular septal defect directly to avoid postoperative cardiac dysfunction. Large apical ventricular septal defects, especially those located just underneath the moderator band, are considered suitable for the sandwich technique.