title: Delayed closure of multiple muscular ventricular septal defects in an infant after coarctation repair and a hybrid procedure--a case report.
abstract: There are several strategies of surgical approach for the repair of multiple muscular ventricular septal defects (mVSDs), but none leads to a fully predictable, satisfactory therapeutic outcome in infants. We followed a concept of treating multiple mVSDs consisting of a hybrid approach based on intraoperative perventricular implantation of occluding devices. In this report, we describe a 2-step procedure consisting of a final hybrid approach for multiple mVSDs in the infant following initial coarctation repair with pulmonary artery banding in the newborn. At 7 months, sternotomy and debanding were performed, the right ventricle was punctured under transesophageal echocardiographic guidance, and the 8-mm device was implanted into the septal defect. Color Doppler echocardiography results showed complete closure of all VSDs by 11 months after surgery, probably via a mechanism of a localized inflammatory response reaction, ventricular septum growth, and implant endothelization.
authors.affiliation: Department of Pediatric Cardiac Surgery, Mikołaj Kopernik Pomeranian Centre of Traumatology, Gdańsk, Poland.
authors.forename: Ireneusz
authors.initials: I
authors.lastname: Haponiuk
authors.forename: Maciej
authors.initials: M
authors.lastname: Chojnicki
authors.forename: Radosław
authors.initials: R
authors.lastname: Jaworski
authors.forename: Jacek
authors.initials: J
authors.lastname: Juściński
authors.forename: Mariusz
authors.initials: M
authors.lastname: Steffek
authors.forename: Lucyna
authors.initials: L
authors.lastname: Pałkowska
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery*; D001017:Aortic Coarctation / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome