Perimembranous ventricular septal defect repair: keeping it simple.

OBJECTIVE

A simplified method of repairing perimembranous ventricular septal defects (VSDs) was employed to reduce the incidence of complete heart block and significant residual defects.

PATIENTS AND INTERVENTIONS: Twenty-three children (mean age 1.2 +/- 0.3 years, range 0.1 to 5.8; mean weight 8.2 +/- 0.9 kg, range 3.7 to 20), one adolescent (16 years old) and one adult (30 years old) with perimembranous VSDs were operated on using the simplified method to correct the defect. The repairs were done from a right atrial approach by sewing the patch directly to the rim of the defect, by using very small bites in the area of the conduction tissue. In 36% of cases, the tricuspid valve was temporarily detached close to the annulus to improve operative exposure. Concomitant procedures were required in 91% of children.

MAIN

RESULTS

Early postoperative echocardiography showed a tiny residual ventricular septal defect in 28% (seven of 25) of patients, none requiring reoperation. There were no perioperative deaths. At follow-up there were no significant residual VSDs and no patient required reoperation. Postoperative electrocardiography revealed no evidence of heart block, but 64% showed a right bundle branch block pattern. There were no problems with tricuspid valve function postoperatively. At late follow-up (22 +/- 2 months) there were no significant problems related to the VSD repair.

CONCLUSIONS

This simplified method of VSD repair produces excellent results avoiding significant leaks and the need for reoperation. This method has shown freedom from complete heart block and the need for pacemaker implantation. Temporary detachment of the tricuspid valve improves visualization in many children and is a safe practice.