title: Left ventricular function after left ventriculotomy for surgical treatment of multiple muscular ventricular septal defects.
abstract: BACKGROUND
  Optimal management of muscular ventricular septal defects (MVSD) is still not determined in the current era. Moreover, long-term left ventricular function after closure of MVSD is not well known. Thus, we investigated surgical outcomes including long-term left ventricular function after closure of MVSD through left ventriculotomy.
  
  
  METHODS
  We conducted a retrospective review of medical records of 20 children who underwent MVSD closure between March 1993 and August 2010. There were 10 boys (50%) and 10 girls (50%). Patient age ranged from 1.6 to 103.4 months (median, 26.4 months), and body weight from 2.8 to 31.5 kg (median, 11.9 kg). Electrocardiogram results were normal sinus rhythm in all except 1 patient with congenital complete atrioventricular block. There were 16 patients who previously had palliative pulmonary artery banding procedures before closure of MVSD. There were 13 patients (65%) with Swiss-cheese type VSD.
  
  
  RESULTS
  There was 1 hospital death of a patient with congenital complete atrioventricular block with pacemaker malfunction (5%). There was 1 late death of a patient with del 22q with adenoviral pneumonia. There was no reoperation. Median follow-up duration was 85.9 months (range, 4.7 to 166.7). The location of MVSD was apical portion in 10 patients (50%) and midtrabecular portion in 9 patients (45%). There were 6 Dacron patch closures and 13 direct closures of MVSD through left ventriculotomy. There was no complete atrioventricular block. Last follow-up echocardiographic data showed normal ejection fraction with 65.2% ± 8.2% after closure of MVSDs. There was no leakage in 8 patients; 11 patients had insignificant leakage, which disappeared spontaneously in 4 patients 17.9 months (median value) after operation.
  
  
  CONCLUSIONS
  Our acceptable long-term results of left ventricular function after left ventriculotomy proved that this technique might be a viable option in the management of MVSD.
authors.affiliation: Department of Cardiovascular Surgery, Konkuk University Medical Center, Seoul, Republic of Korea.
authors.forename: Hong Ju
authors.initials: HJ
authors.lastname: Shin
authors.forename: Won Kyoung
authors.initials: WK
authors.lastname: Jhang
authors.forename: Jeong-Jun
authors.initials: JJ
authors.lastname: Park
authors.forename: Jeong Jin
authors.initials: JJ
authors.lastname: Yu
authors.forename: Young-Hwue
authors.initials: YH
authors.lastname: Kim
authors.forename: Jae-Kon
authors.initials: JK
authors.lastname: Ko
authors.forename: In-Sook
authors.initials: IS
authors.lastname: Park
authors.forename: Dong Man
authors.initials: DM
authors.lastname: Seo
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011184:Postoperative Period; D020127:Recovery of Function; D012189:Retrospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*