title: Surgery for doubly committed ventricular septal defects.
abstract: Doubly committed ventricular septal defects (VSDs) account for up to almost one-third of isolated ventricular septal defects in Asian countries, compared with only 1/20th in western populations. In our surgical experience, this type of defect accounted for almost three-quarters of our practice. To date, patch closure has been considered the gold standard for surgical treatment of these lesions. Our objectives are to evaluate the indications and examine the outcomes of surgery for doubly committed VSDs.
  
  
  
  Between October 2013, when our service of paediatric cardiac surgery was opened, and December 2014, 24 patients were referred for surgical closure of VSDs. Among them, 17 patients (71%), with the median age of 6 years, ranging from 2 to 9 years, and with a median body weight of 19 kg, ranging from 11 to 56 kg, underwent surgical repair for doubly committed defects. In terms of size, the defect was considered moderate in 4 and large in 13. Aortic valvular regurgitation (AoVR) was present in 11 patients (65%) preoperatively, with associated malformations found in 14 (82%), with 5 patients (29%) having two or more associated defects.
  
  
  
  After surgery, there was trivial residual shunting in 2 patients (12%). AoVR persisted in 6 (35%), reducing to trivial in 5 (29%) and mild in 1 (6%). Mean stays in the intensive care unit and hospital were 2.6 ± 1.2 days, ranging from 2 to 7 days, and 6.8 ± 0.8 days, ranging from 6 to 9 days, respectively. The mean follow-up was 14 ± 4 months, ranging from 6 to 20 months, with no early or late deaths and without clinical deterioration.
  
  
  
  The incidence of doubly committed lesions is high in our experience, frequently associated with AoVR and other associated malformation. Early detection is crucial to prevent further progression of the disease. Patch closure remains the gold standard in management, not least since it allows simultaneous repair of associated intracardiac defects.
authors.affiliation: Pediatric and Congenital Cardiac Surgery Unit, Department of Surgery, School of Medical Sciences, Health Campus, University of Sains Malaysia, Kubang Kerian, Kelantan, Malaysia amahir@gmail.com.
authors.forename: Ahmad Mahir
authors.initials: AM
authors.lastname: Shamsuddin
authors.affiliation: Pediatric and Congenital Cardiac Surgery Unit, Department of Surgery, School of Medical Sciences, Health Campus, University of Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
authors.forename: Yen Chuan
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Pediatric Cardiology Unit, Department of Pediatrics, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia.
authors.forename: Abdul Rahim
authors.initials: AR
authors.lastname: Wong
authors.affiliation: Department for Structural and Congenital Heart Disease, Heart Center Bremen, Klinikum Links der Weser, Bremen, Germany.
authors.forename: Trong-Phi
authors.initials: TP
authors.lastname: Le
authors.affiliation: Institute of Genetic Medicine, Newcastle University, International Centre for Life, Newcastle upon Tyne, UK.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Anderson
authors.affiliation: Pediatric and Congenital Cardiac Surgery, East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK.
authors.forename: Antonio F
authors.initials: AF
authors.lastname: Corno
mesh_terms: D000015:Abnormalities, Multiple; D000293:Adolescent; D001022:Aortic Valve Insufficiency / Q000151:congenital / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D008297:Male; D055815:Young Adult
keywords: Aortic valvular regurgitation; Device closure; Doubly committed and juxta-arterial ventricular septal defect; Surgery; Ventricular septal defect