title: New approach to multiple ventricular septal defect closure with intraoperative echocardiography and double patches sandwiching the septum.
abstract: OBJECTIVE
  This was an evaluation of a new approach to the management of multiple muscular ventricular septal defects. The defects were located with epicardial echocardiography, then transfixed with a guide wire inserted directly through the right ventricular free wall. They were closed with a custom-made multilayered double-patch device under cardioplegic arrest through a standard right atriotomy.
  
  
  METHODS
  This was a retrospective study of 14 consecutive patients.
  
  
  RESULTS
  The median age and body weight at repair were 40 days (range 1 week-8 years, 3 months) and 4.1 kg (2.8-24 kg), respectively. Five patients (36%) had undergone at least one previous sternotomy; 11 patients (78%) had associated cardiac lesions. Closure of the multiple septal defects was successful in 12 patients (85%). Failure to localize all defects led to pulmonary artery banding in 2 patients. One patient had the residual septal defect closed with a percutaneous device 6 months later, and in the second patient the residual defect was closed with a conventional approach 11 months afterward. Two patients had permanent pacemaker insertion. In 279 patient-months of follow-up, there was 1 cardiac arrest on day 1 and no early or late deaths; all children but one are free of cardiac medications, and no significant residual left-to-right shunts were demonstrated in any patient.
  
  
  CONCLUSIONS
  The reported management of multiple ventricular septal defects has been successful in this series, even in neonates and infants with complex associated cardiac lesions. It appears safe, simple, and effective.
authors.affiliation: Cardiac Surgery Unit and Department of Cardiology, Royal Children's Hospital, Parkville 3052, Victoria, Australia. cardiac.surgery@rch.org.au
authors.forename: Christian P
authors.initials: CP
authors.lastname: Brizard
authors.forename: Christian
authors.initials: C
authors.lastname: Olsson
authors.forename: James L
authors.initials: JL
authors.lastname: Wilkinson
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000379:methods; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007432:Intraoperative Period; D019736:Prostheses and Implants; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome