title: Flap valve double patch closure of ventricular septal defects in children with increased pulmonary vascular resistance.
abstract: BACKGROUND
  Closure of a large ventricular septal defect (VSD) in children with elevated pulmonary vascular resistance (PVR) is associated with significant morbidity and mortality. Sophisticated medications and circulatory assist devices may not be available to assist in the care of children with elevated PVR undergoing VSD closure. We designed a fenestrated flap valve double VSD patch to decrease the morbidity and mortality associated with the closure of a large VSD in this high-risk group.
  
  
  METHODS
  Ninety-one children (median age 4.0 +/- 3.1 years) with a large VSD and elevated PVR (10.5 +/- 4.9 Wood units) underwent double patch VSD closure. The routine VSD patch was fenestrated (4 to 8 mm), and on the left ventricular side of the patch, a second smaller patch was attached to the upper third of the fenestration before VSD patch placement.
  
  
  RESULTS
  Fifty-six children with a VSD as the primary lesion, 16 with complete atrioventricular canal, 10 with double outlet right ventricle/VSD, 2 with interrupted aortic arch/VSD, 2 with truncus arteriosus, and 1 each with transposition/VSD, corrected transposition/VSD, total anomalous pulmonary venous connection/VSD, VSD/left pulmonary artery atresia, and aortopulmonary window underwent operation; the overall early mortality rate was 7.7% (7 of 91). There have been 7 late deaths: 2 VSD and 5 complex defects.
  
  
  CONCLUSIONS
  Closure of a large VSD with elevated PVR can be performed with reasonable mortality and morbidity.
authors.affiliation: Department of Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA. ichfno@aol.com
authors.forename: William M
authors.initials: WM
authors.lastname: Novick
authors.forename: Nestor
authors.initials: N
authors.lastname: Sandoval
authors.forename: Vasiliy V
authors.initials: VV
authors.lastname: Lazorhysynets
authors.forename: Victor
authors.initials: V
authors.lastname: Castillo
authors.forename: Alexander
authors.initials: A
authors.lastname: Baskevitch
authors.forename: Xiomung
authors.initials: X
authors.lastname: Mo
authors.forename: Robert W
authors.initials: RW
authors.lastname: Reid
authors.forename: Branko
authors.initials: B
authors.lastname: Marinovic
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Di Sessa
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015150:Echocardiography, Doppler; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000517:prevention & control*; D007223:Infant; D015993:Life Tables; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D011300:Preoperative Care; D011312:Pressure; D013524:Surgical Flaps; D016019:Survival Analysis; D016896:Treatment Outcome; D014655:Vascular Resistance