Intraoperative customized double-patch device with twin sutures for multiple muscular septal defects
Autor: | Nilesh S Bhadane, Shreepal Jain, Raman Krishna Kumar, Krishnanaik Shivaprakash, Manglesh S Nimbalkar, Sandip S Katkade, Jeril Kurien, Bharti Sharma, Bharat Dalvi, Gananjay G Salve |
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Rok vydání: | 2017 |
Předmět: |
Pulmonary and Respiratory Medicine
Heart Septal Defects Ventricular Male medicine.medical_specialty 030204 cardiovascular system & hematology Pulmonary artery banding Cohort Studies 03 medical and health sciences 0302 clinical medicine medicine Multiple muscular ventricular septal defects Humans Atrium (heart) Child Tetralogy of Fallot Heart septal defect Sutures business.industry Cardiovascular Surgical Procedures Infant Prostheses and Implants medicine.disease Surgery medicine.anatomical_structure Clamp Treatment Outcome 030228 respiratory system Ventricle Echocardiography Child Preschool Female Cardiology and Cardiovascular Medicine business Shunt (electrical) |
Zdroj: | Interactive cardiovascular and thoracic surgery. 27(3) |
ISSN: | 1569-9285 |
Popis: | Objectives Closure of multiple muscular ventricular septal defects (VSDs) remains a challenge because of anatomical complexity. Methods We mapped all the VSDs using en face reconstruction of the right ventricular septal surface through echocardiography and then performed an 'Intraoperative Customized Double-Patch Device' technique to surgically close them in 39 patients (male:female = 25:14). The median age of the patients was 6 months (2 months-10 years), and mean weight was 5.98 ± 4.21 kg. A patch of polytetrafluoroethylene was placed on the left ventricular side of the defect and another on the right ventricular side, and they were anchored to each other using 2 polypropylene sutures. Residual shunts were evaluated using intraoperative echocardiography and measurements of right atrial-pulmonary arterial saturation were taken in all patients. Results The distribution of muscular VSDs was as follows: anterior muscular 12, posterior muscular 18, mid-muscular 11 and apical 9. The associated lesions included perimembranous VSD (n = 28), tetralogy of Fallot (n = 6), double-outlet right ventricle (n = 2) and supramitral membrane (n = 2). Mean clamp time and bypass time were 93 ± 19 min and 147 ± 26 min, respectively. Mean hospital stay was 11 ± 3.39 days with no in-hospital mortality. Five patients with significant residual shunts needed concomitant PA banding. All patients remained in New York Heart Association Class I. There was either no residual shunt (n = 3) or trivial shunt (n = 2) among the banded patients. All patients remained symptom-free and continued to thrive well at the most recent follow-up (3.48 ± 1.51 years). Conclusions Muscular VSDs can be mapped through en face reconstruction and closed using intraoperative customized double-patch device technique in a variety of situations with satisfactory immediate and short-term results. |
Databáze: | OpenAIRE |
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