Current topics in surgery for multiple ventricular septal defects.
In this review article, we describe several topics, including the sandwich technique, the transatrial re-endocardialization technique, the limited apical left ventriculotomy approach and device closure. The sandwich technique was introduced for the closure of muscular ventricular septal defects (VSD) by sandwiching the septum between two felt patches placed in the left and right ventricle. This technique requires neither the transection of muscular trabeculae nor ventriculotomy. Although the sandwich technique has resulted in the improvement of surgical outcomes, cases of postoperative cardiac dysfunction have been reported. Multiple smaller VSDs have been closed with transatrial re-endocardialization. Septal dysfunction may be avoided through this technique, in which the septal trabeculae are approximated in two layers of superficial, endocardial running sutures. Recently, a number of reports have recommended a limited apical left ventriculotomy approach. With this technique, a much shorter incision of around 1 cm at the apex of the left ventricle may be sufficient for achieving the complete closure of apical muscular VSDs. The transcatheter or perventricular device closure of muscular VSDs has increasingly been performed with good results. Although favorable early and mid-term results of device closure have been reported, this method is not always safer or less invasive than surgical closure. Long-term evaluations should be performed to determine whether the right and left ventricular functions are affected by treatment with relatively large devices in the heart.
First Department of Surgery, University of Toyama, Graduate School of Medicine, 2630 Sugitani, Toyama, 930-0194, Japan. ynaoki@med.u-toyama.ac.jp.
Naoki
N
Yoshimura
First Department of Surgery, University of Toyama, Graduate School of Medicine, 2630 Sugitani, Toyama, 930-0194, Japan.
Kazuaki
K
Fukahara
First Department of Surgery, University of Toyama, Graduate School of Medicine, 2630 Sugitani, Toyama, 930-0194, Japan.
Akio
A
Yamashita
First Department of Surgery, University of Toyama, Graduate School of Medicine, 2630 Sugitani, Toyama, 930-0194, Japan.
Yoshinori
Y
Doki
First Department of Surgery, University of Toyama, Graduate School of Medicine, 2630 Sugitani, Toyama, 930-0194, Japan.
Katsunori
K
Takeuchi
First Department of Surgery, University of Toyama, Graduate School of Medicine, 2630 Sugitani, Toyama, 930-0194, Japan.
Tomonori
T
Higuma
First Department of Surgery, University of Toyama, Graduate School of Medicine, 2630 Sugitani, Toyama, 930-0194, Japan.
Kazutaka
K
Senda
First Department of Surgery, University of Toyama, Graduate School of Medicine, 2630 Sugitani, Toyama, 930-0194, Japan.
Masayoshi
M
Toge
First Department of Surgery, University of Toyama, Graduate School of Medicine, 2630 Sugitani, Toyama, 930-0194, Japan.
Tatsuro
T
Matsuo
First Department of Surgery, University of Toyama, Graduate School of Medicine, 2630 Sugitani, Toyama, 930-0194, Japan.
Saori
S
Nagura
First Department of Surgery, University of Toyama, Graduate School of Medicine, 2630 Sugitani, Toyama, 930-0194, Japan.
Masaya
M
Aoki
First Department of Surgery, University of Toyama, Graduate School of Medicine, 2630 Sugitani, Toyama, 930-0194, Japan.
Kimimasa
K
Sakata
First Department of Surgery, University of Toyama, Graduate School of Medicine, 2630 Sugitani, Toyama, 930-0194, Japan.
Mari
M
Sakai
D000015:Abnormalities, Multiple / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000639:trends; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D016896:Treatment Outcome
Device closure; Limited apical left ventriculotomy; Muscular VSD; Sandwich technique; Transatrial re-endocardialization