title: Double flap patch closure of VSD with elevated pulmonary vascular resistance: an experience at AFIC/NIHD.
abstract: OBJECTIVE
  To determine the 30 days outcome measured in terms of morbidity and mortality in cases of ventricular septal defect (VSD) with increased pulmonary vascular resistance (PVR) managed with double flap patch closure.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Armed Forces Institute of Cardiology (AFIC/NIHD), Rawalpindi, from December 2005 to December 2008.
  
  
  METHODS
  Forty patients with VSD having PVR 9.58 + 4.33 wood units underwent double flap patch closure. The patch was fenestrated as one half of the expected aortic annulus diameter. A separate flap patch 5 mm larger than fenestration was attached to superior upper one third margins of fenestration. The patch was placed with flap to open towards the left ventricular apex. Modified ultra filtration (MUF) was employed in every case and sildenafil was given postoperatively.
  
  
  RESULTS
  The age of patients ranged from 1 to 28 years with a mean of 6.66 + 5.70 years. There were 22 males and 18 females. All patients were weaned off from inotropic and ventilatory support as earlier as possible postoperatively with intensive care unit (ICU) stay of 77.15 + 54.56 hours. Postoperative pulmonary artery pressures were reduced to 42.63 + 10.86 mmHg as compared to pre-operative pulmonary artery pressures of 88.3 + 15.2 mmHg. Postoperatively 11 patients with suprasystemic pulmonary artery pressures and desaturation went into pulmonary hypertensive crisis in which immediate 2D echo evidenced the functioning flap valve with right to left shunt. There was only one death (early) out of 40 patients with an overall mortality of 2.5% along with limited morbidity.
  
  
  CONCLUSIONS
  Double flap patch is an inexpensive, easy to construct technique with low morbidity and mortality in cases of VSD with raised PVR.
authors: Department of Cardiac Surgery, Armed Forces Institute of Cardiology, National Institute of Heart Diseases, Rawalpindi. a.mjanjua@yahoo.com
authors: Asif Mahmood
authors: AM
authors: Janjua
authors: Kamal
authors: K
authors: Saleem
authors: Inamullah
authors: I
authors: Khan
authors: Azhar
authors: A
authors: Rashid
authors: Asif Ali
authors: AA
authors: Khan
authors: Abid
authors: A
authors: Hussain
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000517:prevention & control; D007223:Infant; D008297:Male; D019736:Prostheses and Implants; D013524:Surgical Flaps; D014655:Vascular Resistance; D055815:Young Adult