Repair of isolated multiple muscular ventricular septal defects: The septal obliteration technique

Background. Isolated multiple ventricular septal defects (mVSDs) remain a s urgical challenge. The dilemma of whether to perform a complete repair ulti mately rests with the surgeon, who must decide if all significant septal de fects can be located. Avoidance of a pulmonary arterial band (as part of a two-stage repair) will negate the need for future pulmonary arterial recons truction and will reduce the incidence of late right ventricular diastolic dysfunction. Methods. We performed a retrospective analysis of hospital and echocardiogr aphic data of eight children who underwent a septal obliteration technique (SOT) as part of their correction of mVSDs (with and without coarctation of the aorta). Results. Eight children with a mean age of 10.5 months (range 1.5 to 36 mon ths), and weight of 6.2 kg (range 2.1 to 13.5 kg), respectively, underwent correction of mVSDs. All had a single, large, perimembranous defect, additi onal VSDs within the muscular trebecular septum (juxtaposed to the moderato r band), and apical mVSDs. All VSDs were repaired via the right atrium, wit h avoidance of either a right or left ventriculotomy. The posterior and api cal defects were excluded from the right ventricular cavity with a pericard ial patch (SOT). The follow-up period remains limited to a mean of 20.9 mon ths (8 to 39 months). Two children repaired with SOT had previous pulmonary artery bands (neonatal coarctation repair). All children were successfully discharged home with a mean postoperative Qp:Qs of 1.09:1. One pacemaker w as required, but this child has since reverted back to normal sinus rythm. Conclusions. Our initial experience using the SOT in the treatment of apica l VSDs as a component of isolated mVSDs has been rewarding. All children ar e currently alive, in normal sinus rhythm, and have no residual significant left-to-right shunts. (Ann Thorac Surg 2000;70:106-10) (C) 2000 by The Soc iety of Thoracic Surgeons.