Transaortic closure of residual intramural ventricular septal defect

Background. Residual intramural ventricular septal defect is an unusual cau se of left-to-right shunt after biventricular repair of conotruncal anomali es. It results from the insertion of the patch within the trabeculated righ t ventricular free wall related to the ventriculoinfundibular fold creating a communication through the inter-trabeculated spaces to the right ventric ular cavity. This complication often leads to unsuccessful reoperations unl ess the exact mechanism of the shunt has been identified. Methods and Results. Five patients presented with residual intramural ventr icular septal defects. Three had double outlet right ventricle, one pulmona ry atresia with ventricular septal defect, and one tetralogy of Fallot. One patient was unsuccessfully reoperated on for closure of the residual ventr icular septal defect through the right ventricular approach. The surgical t reatment, which consisted of patch closure of the residual intramural ventr icular septal defect through aortotomy, was successful in 3 patients. In th e 2 remaining patients the hemodynamically insignificant residual intramura l ventricular septal defect remained untouched. No mortality or morbidity o ccurred. Conclusions. Residual intramural ventricular septal defect should be suspec ted in presence of a residual ventricular septal defect after biventricular repair of conotruncal anomalies. It is not accessible through either atrio tomy or right ventriculotomy. The transaortic approach allows an easy treat ment of this rare complication. (C) 2000 by The Society of Thoracic Surgeon s.