Double patch closure of ventricular septal defect with increased pulmonary vascular resistance.
BACKGROUND
Closure of a large ventricular septal defect (VSD) in children with elevated pulmonary vascular resistance is associated with significant morbidity and mortality. Pulmonary hypertensive episodes continue to be a major cause of postoperative morbidity and mortality. We designed a fenestrated flap valve double VSD patch in an effort to decrease the morbidity and mortality associated with the closure of a large VSD with elevated pulmonary vascular resistance.


METHODS
Eighteen children (mean age, 5.7 years) with a large VSD and elevated pulmonary vascular resistance (mean, 11.4 Wood units) underwent double patch VSD closure using moderately hypothermic cardiopulmonary bypass and cardioplegic arrest. The routine VSD patch was fenestrated (4 to 6 mm) and on the left ventricular side of the patch, a second, smaller patch was attached to the fenestration along its superior margin before closure of the VSD.


RESULTS
All children survived operation and were weaned from inotropic and ventilator support within 48 hours postoperatively. Postoperative pulmonary artery pressures were significantly lower than preoperative values. One child died 9 months postoperatively.


CONCLUSIONS
Closure of a large VSD in children with elevated pulmonary vascular resistance can be performed with low morbidity and mortality when a flap valve double VSD patch is used.
Novick
W M
WM
Le Bonheur Children's Medical Center, University of Tennessee, Memphis, USA. ichfno@aol.com
Gurbuz
A T
AT
Watson
D C
DC
Lazorishinets
V V
VV
Perepeka
A N
AN
Malcic
I
I
Marinovic
B
B
Alpert
B S
BS
DiSessa
T G
TG
D000293:Adolescent; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D007036:Hypothermia, Induced; D007223:Infant; D008722:Methods; D011182:Postoperative Care; D011651:Pulmonary Artery / Q000503:physiopathology*; D014655:Vascular Resistance