title: Continuous versus interrupted technique of ventricular septal defect (VSD) closure in total correction for tetrology of Fallot pertaining to residal VSD.
abstract: OBJECTIVE
  To analyze the outcome of continuous versus interrupted closure technique of ventricular septal defect (VSD) closure in Tetrology of Fallot with reference to postoperative residual VSD after total correction.
  
  
  METHODS
  A randomised control study was conducted between January 2008 to December 2008 at The Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Karachi. The results of total correction (T.C) of VSD in patients with Tetralogy of Fallot, with emphasis on the suturing technique and eventually on the occurrence of residual ventricular septal defect(VSD) were analyzed. Transventricular as well as transatrial route was used to approach VSD. In thirty patients VSD was closed with 5/0 proline continuous double ended suture while in remaining 30 (50%) patients VSD was closed with interrupted 5/0 prolene double ended sutures. Postoperative echocardiography was done in all patients as a routine on second postoperative day, to document residual VSD.
  
  
  RESULTS
  The study included 60 (100%) patients with T.O.F. There were 20 (33.3%) females and 40 (66.6%) males with ages ranging between 04 to 18 years (mean 13.025 +/- 2.123 years). Postoperative echocardiography showed residual VSD in 05 (8.3%) patients at posteroinferior rim of VSD. Of these 05 cases, in four VSD had been closed with continuous 5/0 proline double ended sutures, and one had VSD closed with interrupted 5/0 double ended sutures.
  
  
  CONCLUSIONS
  Residual VSD is common with continuous suturing technique as compared to interrupted suturing technique. This is perhaps because of poor myocardium quality and higher RV pressures in our patients presenting at a late age. Small (less than 05 milimeter) residual VSD can be treated conservatively in haemodynamically stable patients.
authors.affiliation: National Institute of Cardiovascular Diseases, Karachi.
authors.forename: Riffat
authors.initials: R
authors.lastname: Tanveer
authors.forename: Arif-ur-Rehman
authors.initials: AU
authors.lastname: Khan
authors.forename: Tariq Azam
authors.initials: TA
authors.lastname: Siddiqi
authors.forename: Sohail
authors.initials: S
authors.lastname: Siddique
authors.forename: Ameena
authors.initials: A
authors.lastname: Nasreen
authors.lastname: Salman-ur-Rehman
authors.forename: Saad
authors.initials: S
authors.lastname: Badar
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000379:methods*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D013536:Suture Techniques; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome