21 Decision-making using multimodality imaging in complex muscular ventricular septal defects post pulmonary artery banding

Abstract

Large muscular ventricular septal defects below the moderator band are an interesting entity as these lesions can be surgical challenging. The conventional approach is to do pulmonary artery banding to control heart failure and allow child to grow with view to close later using interventional approach if the lesion remains significant. Hybrid approach with pulmonary artery debanding and per-ventricular VSD closure has been attempted in few centres. Current advances in multimodality imaging helps us to understand the anatomy better and help us to plan the interventional and surgical procedure well. We present 3 cases of muscular ventricular septal defects post pulmonary artery banding. The VSDs in these patients had multiple exits in right ventricle aspect extending above and below the moderator band. Assessment of ventricular septal defect using transthoracic echocardiography, 3D echocardiography, conventional angiogram and CT angiogram added more information. However along with 3D modelling and printing in these selected cases helped to preempt challenges and plan according to avoid complications. We demonstrate the use of multimodality imaging and 3D modelling in these case series.