title: Realignment of the ventricular septum using partial direct closure of the ventricular septal defect in Tetralogy of Fallot.
abstract: OBJECTIVE
  The aim is to describe our technique of partial direct closure of the ventricular septal defect (VSD) in Tetralogy of Fallot (TOF), and assess its influence on the realignment and remodeling of the left ventricular outflow tract.
  
  
  METHODS
  Between 2004 and 2010, 32 non-consecutive patients with TOF underwent a direct or partial direct closure of VSD. Median age and weight were 5.2 months and 6.7 kg, respectively. An approach through the right atrium was used in 30 patients and through the infundibulum in two patients. The conal septum was mobilized by transecting the hypertrophic trabeculae to facilitate the approximation of the VSD. The membranous part of the VSD was closed (in the later part of the series) with a small xenopericardial patch to avoid tension on the suture line traversing the area of risk to the bundle of His. Follow-up was complete, with a median duration of 46.9 (range 12-75.3) months.
  
  
  RESULTS
  The VSD could be closed successfully in all patients. A residual VSD was partly responsible for one early postoperative re-operation. There were no early or late deaths. At follow-up, all patients were in sinus rhythm. Three patients showed a small residual VSD. Thirty patients had none, one showed trivial, and one had mild aortic regurgitation. The left ventricular outflow showed a good realignment of the ventricular septum in all the patients.
  
  
  CONCLUSIONS
  Partial direct closure of the VSD corrects the primary defect in TOF, that is, the malalignment of the septum. It results in a straight, wide open left ventricular outflow tract and brings better support to the aortic root.
authors.affiliation: Department of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Katherina
authors.initials: K
authors.lastname: Till
authors.forename: Hitendu H
authors.initials: HH
authors.lastname: Dave
authors.forename: Maurice
authors.initials: M
authors.lastname: Comber
authors.forename: Urs
authors.initials: U
authors.lastname: Bauersfeld
authors.forename: Rene
authors.initials: R
authors.lastname: Prêtre
mesh_terms: D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010496:Pericardium / Q000637:transplantation; D011665:Pulmonary Valve Insufficiency / Q000209:etiology; D012086:Reoperation / Q000379:methods; D013771:Tetralogy of Fallot / Q000601:surgery*; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000209:etiology; D020257:Ventricular Remodeling; D054088:Ventricular Septum / Q000000981:diagnostic imaging / Q000601:surgery