PERIMEMBRANOUS VENTRICULAR SEPTAL-DEFECT REPAIR - KEEPING IT SIMPLE

OBJECTIVE: A simplified method of repairing perimembranous ventricular septal defects (VSDs) was employed to reduce the incidence of complet e heart block and significant residual defects. PATIENTS AND INTERVENT IONS: Twenty-three children (mean age 1.2 +/- 0.3 years, range 0.1 to 5.8; mean weight 8.2 +/- 0.9 kg, range 3.7 to 20), one adolescent (16 years old) and one adult (30 years old) with perimembranous VSDs were operated on using the simplified method to correct the defect. The rep airs were done from a right atrial approach by sewing the patch direct ly the rim of the defect, by using very small bites in the area of the conduction tissue. In 36% of cases, the tricuspid valve was temporari ly detached close to the annulus to improve operative exposure. Concom itant procedures were required in 91% of children. MAIN RESULTS: Early postoperative echocardiography show a tiny residual ventricular septa l defect in 28% (seven of 25) of patients, none requiring reoperation. There were no perioperative deaths. At follow-up there were no signif icant residual VSDs, and no patient required reoperation. Postoperativ e electrocardiography revealed no evidence of heart block, but 64% sho wed a right bundle branch block pattern. There were no problems with t ricuspid valve function postoperatively. At late follow-up (22 +/- 2 m onths) there were no significant problems related to the VSD repair. C ONCLUSIONS: This simplified method of VSD repair produces excellent re sults avoiding significant leaks and the need for reoperation. This me thod had shown freedom from complete heart block and the need for pace maker implantation. Temporary detachment of the tricuspid valve improv es visualization in many children and is a safe practice.