Surgical Management of Apical Muscular Ventricular Septal Defects Using the Sandwich Technique

Abstract

We performed closure of apical muscular ventricular septal defects (VSDs) using the sandwich technique and assessed its role in the treatment of the defects. Twenty-one patients (nine males and 12 females) underwent VSD closure at a mean age of 15.4 months (range, 1 month to 6 years) and a mean weight of 8.3 kg (range, 4 to 20 kg). Associated cardiac malformations were present in all of the patients. VSDs were exposed through the tricuspid valve and also from the left ventricular (LV) side through a coexisting large perimembranous VSD or through the mitral valve through an interatrial septostomy. All the apical muscular VSDs were closed using the sandwich technique. There were no hospital deaths, and the postoperative course was uneventful in all patients. There was no residual shunt in 13 patients, and a minimal residual shunt (diameter ≤2 mm) was observed in four patients. Mild residual shunt (diameter ≤4 mm) was observed in two patients. At the latest follow-up, all the residual shunts had disappeared except in one patient. The wall motion of the interventricular septum and cardiac function were normal in all the patients one month after surgery. All patients were free of cardiac medications. We conclude that the sandwich technique is safe and reliable. Even in cases when a residual shunt is present, the shunt tends to decrease with time. Further experience and longer follow-up of these patients are necessary to conclude whether this technique is applicable to neonates and young infants.