Abstract
We propose the passage of a thick black braided silk SUTUPAK silk suture (Ethicon, Somerville, NJ) through the additional muscular ventricular septal defects to facilitate patch closure of the multiple muscular ventricular septal defects.
Highlights
Despite advancements in surgical and interventional techniques, closure of multiple muscular ventricular septal defects (VSDs) is associated with significant perioperative mortality, residual VSDs, ventricular dysfunction, and complete heart block. [1,2,3,4]An analysis of operations in the STS Congenital Heart Surgery Database during the 4-year time period of 2005 through 2008 inclusive, revealed the following four findings: 1. Multiple VSDs take longer to close.2
When compared with the more common perimembranous VSD, the rate of unplanned reoperation is over four times higher with muscular VSDs, and almost twice as high with multiple VSDs
We report the technique and results in 5 patients with multiple muscular VSDs with severe pulmonary arterial hypertension (PAH) using a No 3 SUTUPAK silk suture through a transtricuspid approach
Summary
Despite advancements in surgical and interventional techniques, closure of multiple muscular ventricular septal defects (VSDs) is associated with significant perioperative mortality, residual VSDs, ventricular dysfunction, and complete heart block. [1,2,3,4]. Between January 2019 and May 2021, 5 patients underwent patch closure of multiple muscular VSDs by a single surgeon (corresponding author) using the surgical technique described after informed written consent from their parents / guardians Their ages at the time of operation were 2, 3, 4, 3 and 3 months respectively. Gentle traction of the silk loop in different directions allowed complete closure of the VSDs without division of the moderator band or right ventricular trabeculae and avoided a left ventriculotomy. Both VSD’s were closed individually using a knitted Dacron polyester patch Bard® Savage® filamentous knitted polyester fabric, Bard Peripheral Vascular Inc., Tempe, AZ, USA), and multiple interrupted 40 polypropylene pledgeted mattress sutures. Doppler echocardiography revealed normal biventricular function and absence of any residual VSDs with systemic arterial oxygen saturation ranging from 96%-99%
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