INTRAOPERATIVE DEVICE CLOSURE OF VENTRICULAR SEPTAL-DEFECTS

Background. Surgical repair of muscular ventricular septal defects (VS Ds) has been associated with significant morbidity and mortality when the defects are multiple, associated with complex cardiac lesions, or requiring left ventriculotomy. Transcatheter VSD closure may be diffic ult in patients weighing less than 7 kg or those with limited vascular access. We attempted intraoperative device closure of muscular VSDs d uring surgical repair of associated lesions. Methods and Results. We c onsidered intraoperative umbrella closure in 10 patients, 8 with addit ional complex heart lesions. ''Swiss cheese'' defects were present in 4. Median patient age was 4.7 months. Device closure was not attempted in 1 patient due to an inadequate septal rim. Nine umbrellas, 12 to 4 0 mm in diameter, were positioned to straddle the septum in all 9 pati ents. There were 3 early deaths, 2 in patients who were moribund preop eratively. The third was due to severe ventricular dysfunction. Among the 6 survivors, 3 had a Qp:Qs less-than-or-equal-to 2 and right ventr icular or pulmonary artery pressure less than half systemic. These pat ients had no further intervention. The other 3 had a Qp:Qs >2. One die d unexpectedly 5 weeks after cardiac surgery. The other 2 had subseque nt closure of residual VSDs. All 5 survivors are well at follow-up of 8 to 25 months. Conclusions. Intraoperative umbrella VSD closure appea rs less successful than VSD closure in the catheterization laboratory. In selected patients, particularly very small infants, intraoperative device placement may be advantageous. Completeness of closure is diff icult to assess intraoperatively.