Double patch closure of ventricular septal defect with increased pulmonaryvascular resistance

Background. Closure of a large ventricular septal defect (VSD) in children with elevated pulmonary vascular resistance is associated with significant morbidity and mortality. Pulmonary hypertensive episodes continue to be a m ajor cause of postoperative morbidity and mortality. We designed a fenestra ted flap valve double VSD patch in an effort to decrease the morbidity and mortality associated with the closure of a large VSD with elevated pulmonar y vascular resistance. Methods. Eighteen children (mean age, 5.7 years) with a large VSD and eleva ted pulmonary vascular resistance (mean, 11.4 Wood units) underwent double patch VSD closure using moderately hypothermic cardiopulmonary bypass and c ardioplegic arrest. The routine VSD patch was fenestrated (4 to 6 mm) and o n the left ventricular side of the patch, a second, smaller patch was attac hed to the fenestration along its superior margin before closure of the VSD . Results. All children survived operation and were weaned from inotropic and ventilator support within 48 hours postoperatively. Postoperative pulmonar y artery pressures were significantly lower than preoperative values. One c hild died 9 months postoperatively. Conclusions. Closure of a large VSD in children with elevated pulmonary vas cular resistance can be performed with low morbidity and mortality when a n ap valve double VSD patch is used. (C) 1998 by The Society of Thoracic Surg eons.