Intraoperative customized double-patch device with twin sutures for multiple muscular septal defects. (26th March 2018)

• Record Type: Journal Article
• Authors: Salve, Gananjay G; Jain, Shreepal A; Sharma, Bharti; Nimbalkar, Manglesh S; Katkade, Sandip S; Kurien, Jeril; Bhadane, Nilesh S; Dalvi, Bharat V; Kumar, Raman Krishna; Shivaprakash, Krishnanaik
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 27:Number 3(2018)
• Page Start: 402
• Page End: 409
• Publication Date: 2018-03-26
• Subjects: Intraoperative customized double-patch device -- En face reconstruction; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivy092
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES: Closure of multiple muscular ventricular septal defects (VSDs) remains a challenge because of anatomical complexity. METHODS: We mapped all the VSDs using en face reconstruction of the right ventricular septal surface through echocardiography and then performed an 'Intraoperative Customized Double-Patch Device' technique to surgically close them in 39 patients (male:female = 25:14). The median age of the patients was 6 months (2 months–10 years), and mean weight was 5.98 ± 4.21 kg. A patch of polytetrafluoroethylene was placed on the left ventricular side of the defect and another on the right ventricular side, and they were anchored to each other using 2 polypropylene sutures. Residual shunts were evaluated using intraoperative echocardiography and measurements of right atrial-pulmonary arterial saturation were taken in all patients. RESULTS: The distribution of muscular VSDs was as follows: anterior muscular 12, posterior muscular 18, mid-muscular 11 and apical 9. The associated lesions included perimembranous VSD ( n = 28), tetralogy of Fallot ( n = 6), double-outlet right ventricle ( n = 2) and supramitral membrane ( n = 2). Mean clamp time and bypass time were 93 ± 19 min and 147 ± 26 min, respectively. Mean hospital stay was 11 ± 3.39 days with no in-hospital mortality. Five patients with significant residual shunts needed concomitant PA banding. All patients remained in New York Heart Association Class I. There was either no residual shunt ( n = 3) or trivial shunt ( n = 2) among the banded patients. All patients remained symptom-free and continued to thrive well at the most recent follow-up (3.48 ± 1.51 years). CONCLUSIONS: Muscular VSDs can be mapped through en face reconstruction and closed using intraoperative customized double-patch device technique in a variety of situations with satisfactory immediate and short-term results.