title: Multiple ventricular septal defects: a new strategy.
abstract: BACKGROUND
  A multicenter prospective study was conducted to evaluate a new strategy for multiple Ventricular Septal Defects (VSDs).
  
  
  METHODS
  From 2004 to 2012 17 consecutive children (3 premature, 14 infants), mean age 3.2 months (9 days-9 months), mean body weight 4.2 kg (3.1-6.1 kg), with multiple VSDs underwent Pulmonary Artery Banding (PAB) with an adjustable FloWatch-PAB(®). Associated cardiac anomalies included patent ductus arteriosus (1), aortic coarctation (2), hypoplastic aortic arch (2), and left isomerism (3). Five patients (5/17 = 29.4%) required pre-operative mechanical ventilation, with a mean duration of 64 days (7-240 days)
  
  
  RESULTS
  There were no early or late deaths during a mean follow-up of 48 months (7-98 months), with either FloWatch removal or last observation as end-points. FloWatch-PAB(®) adjustments were required in all patients: a mean of 4.8 times/patient (2-9) to tighten the PAB, and a mean of 1.1 times/patient (0-3) to release the PAB with the patient's growth. After a mean interval of 29 months (8-69 months) 10/17 (59%) patients underwent re-operation: 7/10 PAB removal, with closure of a remaining unrestrictive VSD in 6 (peri-membranous in 3 patients, mid-muscular in 2, and inlet in 1) and Damus-Kaye-Stansel, bi-directional Glenn, and atrial septectomy in 1; 3/9 patients required only PAB removal. All muscular multiple VSDs had closed in all 10 patients. PA reconstruction was required in 1/10 patient. In 5/7 of the remaining patients with the PAB still in situ, all muscular VSDs had already closed. The only 2 patients with persistent muscular multiple VSDs are the 2 patients with the shortest follow-up.
  
  
  CONCLUSIONS
  This reproducible new strategy with an adjustable PAB simplifies the management of infants with multiple VSDs and provides the following advantages: (a) good results (0% mortality), delayed surgery with a high incidence (15/17 = 88%) of spontaneous closure of multiple muscular VSDs, and facilitated closure of residual unrestrictive VSD (peri-membranous, mid-muscular, or inlet) at an older age and higher body weight; PAB with FloWatch-PAB(®) and its subsequent removal can potentially be the only procedure required for Swiss cheese multiple VSDs without an associated peri-membranous unrestrictive VSD.
authors.affiliation: King Fahad Medical City Riyadh, Saudi Arabia.
authors.forename: Antonio F
authors.initials: AF
authors.lastname: Corno
authors.affiliation: Alder Hey Children's NHS Foundation Trust Liverpool, UK.
authors.forename: Pramod R
authors.initials: PR
authors.lastname: Kandakure
authors.affiliation: Alder Hey Children's NHS Foundation Trust Liverpool, UK.
authors.forename: Ramana Rao V
authors.initials: RR
authors.lastname: Dhannapuneni
authors.affiliation: Alder Hey Children's NHS Foundation Trust Liverpool, UK.
authors.forename: Gordon
authors.initials: G
authors.lastname: Gladman
authors.affiliation: Alder Hey Children's NHS Foundation Trust Liverpool, UK.
authors.forename: Prem
authors.initials: P
authors.lastname: Venugopal
authors.affiliation: Alder Hey Children's NHS Foundation Trust Liverpool, UK.
authors.forename: Nelson
authors.initials: N
authors.lastname: Alphonso
keywords: congenital heart defects; multiple ventricular septal defects; palliation; pulmonary artery banding; surgical repair