Ventricular Septal Defect Closure Research Articles

‘Ring’ in the Left Ventricular Outflow Tract

A 4-year-old boy (weight 17.1 kg, height 107 cm) presented with feeding difficulty, shortness of breath, and cyanosis. The preoperative transthoracic echocardiography examination showed a small perimembranous ventricular septal defect, severe right ventricular infundibular pulmonary stenosis with a peak gradient of 140 mmHg, right ventricular hypertrophy, right-to-left shunt, and good biventricular function. The pulmonary valve, main pulmonary artery, and branch pulmonary arteries were normal. The child was scheduled for right ventricular outflow tract infundibular resection and ventricular septal defect closure.

Pericardial cyst in a one-year-old boy with ventricular septal defect and patent ductus arteriosus

BackgroundPericardial cysts are rare, with the most common etiology being congenital. Ventricular septal defect is the most common congenital heart disease in children. However, the combination of pericardial cyst, ventricular septal defect, and patent ductus arteriosus is extremely rare.Case presentationA one-year-old boy with ventricular septal defect and patent ductus arteriosus was planned for surgical correction. Intraoperatively, we made an additional diagnosis of a large pericardial cyst; and the cyst was excised along with ventricular septal defect closure and patent ductus arteriosus ligation.ConclusionsPericardial cysts can sometimes be missed with transthoracic echocardiography. Excision of the cyst can safely be done during concomitant cardiac surgery.

Spontaneous closure of an isolated congenital perimembranous ventricular septal defect in two dogs

BackgroundThough spontaneous closure of isolated congenital ventricular septal defects in humans is very common, it has been rarely reported in dogs.Case presentationA 4 month old Havanese dog and a 4.5 month old Chihuahua x Jack Russell terrier cross were presented for murmur evaluation to the authors’ institution. Both puppies were clinically healthy and had a loud systolic murmur on the right hemithorax. Echocardiography in both dogs revealed a small, isolated, restrictive perimembranous congenital ventricular septal defect. No echocardiographic signs of left ventricular volume overload or pulmonary hypertension were present. Re-check auscultation in both dogs revealed the absence of a murmur, and echocardiography showed no flow through the interventricular septum. In the 9 kg Havanese dog and the 4 kg mixed breed dog, spontaneous closure occurred at 13–17 months and 12–30 months, respectively.ConclusionsIn both dogs the spontaneous closure of a congenital perimembranous ventricular septal defect took place in a young adult age. The mechanism of closure remains unclear.

Transcatheter closure of ventricular septal defects: preliminary results in children weighing 10 kg or less.

Ventricular septal defect is one of the commonest heart defect in children and closure of this defect with devices has seen a rapid progression over a period of time. The availability of new and safer devices has made the transcatheter closure of ventricular septal defect a suitable option even in young children. The study was done to evaluate the feasibility and complications of device closure of ventricular septal defect in children weighing 10 kg or less with different types of devices. The present study was undertaken in a newly established dedicated Paediatric Cardiac Unit at a Tertiary Care Hospital. Relevant data were obtained retrospectively from the case files and the catheterisation records and data were analysed for first 50 patients with ventricular septal defect weighing 10 kg or less between March 2018 and March 2021. Among these 50 patients selected, device closure was successfully done in 45 (90%) cases while 5 (10%) attempts were unsuccessful for various reasons. The mean weight in this study was 7.46 ± 1.89 kg (2.3-10 kg), 21 (42%) cases were females while 29 (58%) were males; mean age was 19.4 ± 11.88 months (4-48 months). Right heart catheterisation study showed 21 (42%) patients with normal pulmonary artery pressures (no pulmonary artery hypertension). Among 29 patients with pulmonary arterial hypertension, 13 patients (22%) were having mild pulmonary arterial hypertension, 4 (8%) were with moderate pulmonary arterial hypertension, and 12 (24%) were with severe pulmonary arterial hypertension. Mean Qp/Qs was 2.73 ± 0.72 (2.5-4.5) and mean pulmonary vascular resistance was 1.5 ± 1.04 (0.6-4.6 WU). Amplatzer Duct Occluder (ADOI) was used in 15 (30%) cases, 27 (52%) cases were closed with Amplatzer Duct Occluder (ADOII), and the 3 (6%) cases closure was done with Amplatzer muscular ventricular septal defect occluder. Transcatheter closure of ventricular septal defect in children 10 kg or less is feasible and safe alternative to surgical ventricular septal defect closure. The immediate and short-term outcomes have proven this method to be safe and valid.

Left ventricular assist device placement in the setting of congenital VSD

We describe the management of a 59-year-old female with an unrepaired congenital ventricular septal defect (VSD) and end stage nonischemic cardiomyopathy necessitating placement of a left ventricular assist device (LVAD) as a destination treatment. Simultaneous repair of the VSD was performed during the LVAD implantation under a beating heart. The patient remained hemodynamically stable throughout her postoperative course, without signs of hypoxia or cyanosis. Following discharge, outpatient surveillance echocardiogram demonstrated successful VSD closure and no residual shunt.

Overview of the First 500 Cardiac Surgeries Performed at Peshawar Institute of Cardiology, Peshawar, Pakistan

Objective: To examine the postoperative outcome of the first 500 cardiac surgeries performed at the newly established cardiac institute in Peshawar, Pakistan. Material and methods:This retrospective observational study examines the first 500 cases of cardiac surgery conducted at Peshawar Institute of Cardiology in Peshawar, Pakistan, between December 2020 and October 2021. Off-pump coronary artery bypass (OPCAB), on-pump coronary artery bypass (ONCAB), mitral valve replacement (MVR), aortic valve replacement (AVR), Conventional Ventricular Septal Defect closure (VSD), and congenital procedures were performed by PIC expert faculty. Results:The mean age of the patients was 51.56±17.03 years. There were 371 (74%) males and 129 (25.8%) females. EuroSCORE II recorded was 1.88±0.76. 308 (61.6%) patients presented with Triple-vessel coronary artery disease, followed by Severe symptomatic aortic regurgitation 43 (8.6%). Total 337 coronary artery bypass grafting (CABG) surgeries were performed. 303 ONCAB and 34 OPCAB surgeries. In-hospital mortality was observed in 9 (1.8%), and 17 (3.4%) patients who had postoperative surgical bleeding. The mean ventilation time recorded was 5.66±1.7 hours. The mean hospital recorded was 4.93±1.4 hours Conclusion:Establishing a high-quality cardiac institute in Peshawar has resulted in remarkable outcomes in terms of management and surgical treatment of cardiac diseases. Keywords: Cardiology, surgery

Experiences of Two Centers in Percutaneous Ventricular Septal Defect Closure Using Konar Multifunctional Occluder.

BackgroundTranscatheter closure of perimembraneous ventricular septal defect still poses a challenge due to the adjacent structures of the tricuspid and aortic valves and the risk of atrioventricular block. We report our experience at 2 centers using the KONAR-MF (multifunctional occluder) ventricular septal defect device, which gained its CE mark in May 2018.Methods A retrospective study was carried out on all patients who underwent transcatheter ventricular septal defect closure with the KONAR-MF (multifunctional occluder) ventricular septal defect device at 2 centers.Results A total of 47 patients were identified. The median age and weight of the patients were 25.8 months and 11 kg. The ventricular septal defects that were closed in 5 cases were post-operative hemodynamically significant residual ventricular septal defects. Forty-eight devices were used in the 47 cases. As for the location of the ventricular septal defect, 40/48 (83.33%) ventricular septal defects were perimembranous and 8/48 (16.66%) were muscular. The percutaneous device closure was successful in 46 procedures (95.8%). Device embolization was observed in 2 patients, and a significant residual shunt was observed in 2 cases. In the follow-up, there was no enhancement in the residual shunt in the remaining cases. Temporary atrioventricular block occurred in 2 cases during the procedure and improved after long sheath withdrawal.Conclusion Soft, flexible, and low-profile KONAR-MF (multifunctional occluder) occluders ensure easy and safe implantation, and small sheath sizes allow for their use in small infants. Although near and mid-term follow-ups did not indicate any permanent atrioventricular block, a larger sample of patients and a longer follow-up period is necessary to understand long-term outcomes.

Contemporary outcomes of the double switch operation for congenitally corrected transposition of the great arteries

ObjectiveTo determine the contemporary outcomes of the double switch operation (DSO) (ie, Mustard or Senning + arterial switch). MethodsA single-institution, retrospective review of all patients with congenitally corrected transposition of the great arteries undergoing a DSO. ResultsBetween 1999 and 2019, 103 patients underwent DSO with a Mustard (n = 93) or Senning (n = 10) procedure. Segmental anatomy was (S, L, L) in 93 patients and (I, D, D) in 6 patients. Eight patients had heterotaxy and 71 patients had a ventricular septal defect. Median age was 2.1 years (range, 1.8 months-40 years), including 34 patients younger than age 1 year (33%). Median weight was 10.9 kg (range, 3.4-64 kg). Sixty-one patients had prior pulmonary artery bands for a median of 1.1 years (range, 14 days-12.9 years; interquartile range, 0.7-3.1 years). Median intensive care unit and hospital lengths of stay were 5 and 10 days, respectively. Median follow-up was 3.4 years (interquartile range, 1-9.8 years) and 5.2 years (interquartile range, 2.3-10.7 years) in 79 patients with >1 year follow-up. At latest follow-up, aortic, mitral, tricuspid valve regurgitation, and left ventricle dysfunction was less than moderate in 96%, 98%, 96%, and 93%, respectively. Seventeen patients underwent reoperation: neoaortic valve intervention (n = 10), baffle revision (n = 5), and ventricular septal defect closure (n = 4). At latest follow-up, 17 patients (17%) had a pacemaker and 27 (26%) had cardiac resynchronization therapy devices. There were 2 deaths and 2 transplants. Transplant-free survival was 94.6% at 5 years. Risk factors for death or transplant included longer cardiopulmonary bypass time and older age at DSO. ConclusionsThe outcomes of the DSO are promising. Earlier age at operation might favor better outcomes. Progressive neoaortic regurgitation and reinterventions on the neo-aortic valve are anticipated problems.

Ventricular septal defect closure using radial incision of the tricuspid valve for exposure: is it really necessary?

To evaluate the effects of radial incision of the tricuspid valve in patients who had undergone ventricular septal defect (VSD) closure. Overall 173 patients were included in this study between 2012 and 2019. In 44 individuals, a tricuspid valve radial incision (TVRI) was included in the surgical process. There were no mortalities. The demographic data did not differ between the groups. The mean ages of the TVRI and non-TVRI groups were 2.92 ± 3.88 and 2.69 ± 2.80 years, respectively. There were no significant differences between the groups in terms of mean duration of cardiopulmonary bypass aortic cross-clamp, postoperative intubation time and intensive care unit stay. Mild tricuspid valve regurgitation was detected in only two patients in the TVRI and six patients in the non-TVRI groups. There was no tricuspid valve stenosis and all patients were in New York Heart Association functional class 1. This technique, which can facilitate exposure and closure of VSDs, did not compromise the tricuspid valve function at mid-term, therefore proving to be safe.

Unexpected Infective Endocarditis in Corrected Congenital Heart Disease: A Case Report

Objective: To describe patients with corrected Congenital Heart Disease (CHD) who experienced Infective Endocarditis (IE). Methods: Two cases of IE were observed in 2019. The first case involved a 36-year-old woman with previous percutaneous transcatheter perimembranous ventricular septal defect (VSD) closure four months before admission. Echocardiography showed vegetation at noncoronary cusps of the aortic valve. Patient received antibiotics for six weeks and underwent surgery for evacuation of vegetation and device, along with VSD closure with a cardiovascular patch (Gore-tex). The second case involved a 43-year-old woman with a history of surgical closure in secundum atrial septal defect (ASD) by pericardial patch two months before admission. Echocardiography showed vegetation at the tricuspid valve. Patient received antibiotics for four weeks and planned for surgery to evacuate vegetation. Results: IE is one of the major complications in CHD, whether uncorrected, treated, or corrected. The risk of IE increased with an invasive procedure. Post closure IE is rare. Poor dental hygiene and immunocompromised also increased patient's risk to be exposed to IE as shown in the first patient who had dental caries and the second patient who was on methylprednisolone for post-surgical pericardial effusion treatment. Conclusion: The risk of IE increases with invasive procedures in CHD patients. Although the incidence of IE is quite rare, its possibility should become of a serious concern among physicians.

Risk factors for atrioventricular block after occlusion for perimembranous ventricular septal defect.

The risk factors for complete atrioventricular block (CAVB) after device closure of perimembranous ventricular septal defect (pmVSD) remain unclear. The purpose of this study was to analyze the incidence and risk factors for CAVB after device closure for pmVSD. We reviewed 1884 patients with pmVSD who had undergone successful device occlusion between June 2005 and January 2020. Permanent CAVB was defined as CAVB requiring implantation of a permanent pacemaker (PPM) or extraction of the occluder. In total, 14 patients (0.7%) developed permanent CAVB. Of these patients, 10 (0.5%) required PPM implantation. Four permanent CAVB occurred within 7 days after the procedure (acute), 2 between 7 and 30 days (subacute), 3 between 30 days and 1 year (late), and 5 more than 1 year (very late). None of the subacute, late, and very late CAVB recovered normal conduction with medication and eventually required device removal or PPM implantation. Four patients with acute CAVB and 1 with subacute CAVB underwent device removal, and 4 (80%) recovered normal conduction. Multivariate regression revealed that the ratio of device to defect size was the only independent risk factor for permanent CAVB (odds ratio 3.027; 95% confidence interval 1.476-6.209; P = .003). The incidences of permanent CAVB after occlusion for pmVSD and PPM implantation were 0.7% and 0.5%, respectively. The ratio of device to defect size was the only independent risk factor for permanent CAVB. Device removal is an effective therapeutic modality for recovering normal conduction in acute and subacute CAVB patients.

Aortopulmonary artery fistula: A rare complication of balloon dilatation of the pulmonary artery.

Acquired aortopulmonary fistula (APF) in the setting of repaired congenital heart disease is extremely rare but potentially fatal, so timely diagnosis and treatment are critical. We present a case of an 8-year-old female with a history of complex Taussig-Bing anomaly, who underwent an arterial switch procedure with LeCompte maneuver and ventricular septal defect closure early in life. The patient developed neopulmonary stenosis and branch pulmonary artery (PA) stenosis, for which she underwent patch augmentation and balloon dilatation of the left PA. The patient presented with a fistula between the ascending aorta and the left branch PA, confirmed by echocardiography and cardiac catheterization. She underwent repair of the APF with a homograft patch reconstruction of the ascending aorta.

Transcatheter Closure of Perimembranous Ventricular Septal Defect Using the Lifetech Konar-Multi Functional Occluder: Early to Midterm Results of the Indonesian Multicenter Study.

Background:The alternative device to close perimembranous ventricular septal defect (pmVSD) has been searched for better result, less complications and applicable for infants. However, the ideal device is still unavailable. We aimed to evaluate the effectiveness and outcome of transcatheter pmVSD closure using the KONAR-multi functional occluder (MFO).Methods:Clinical, procedural, follow-up data of pmVSD patients with symptom of heart failure or evidence of significant left to right shunt, growth failure, recurrent respiratory tract infection, and history of endocarditis who underwent transcatheter closure using the MFO were prospectively evaluated.Results:Between January 2016 and December 2017, there were complete records of 132 pmVSD children closed using MFO from eleven centers in Indonesia. The median of age was 4.5 (0.3–17.4) years; weight 14.8 (3.5–57) kg, defect size at the smallest part 3.4 (1.0–8.1) mm, flow ratio 1.6 (1.3–4.9), mean pulmonary artery pressure 18 (7–79) mmHg, fluoroscopy time 18 (3.8–91) and procedural time 75 (26–290) minutes. A retrograde approach was done in 41 (31%) patients. Procedures succeeded in first attempt in 126 (95.4%), failed in three and migration in three patients. Six of eight infants with congestive heart failure were closed successfully. Of 126 patients with successful VSD closure, 12 months follow-up were completed in all patients. The rate of complete occlusion at 1 month, 3 months, 6 months and 12 months after intervention were 95.2%, 97.6%, 99.2%, and 99.2%, respectively. New-onset aortic regurgitation and moderate tricuspid regurgitation developed only in five and three patients. Neither complete atrioventricular block, nor other complications occurred.Conclusion:Transcatheter closure of pmVSD using the MFO is safe, effective, and feasible in infants and children.

Value of transesophageal echocardiography in device closure of perimembranous ventricular septal defects in children via ultra-minimal trans intercostal incision.

To investigate the value of transesophageal echocardiography (TEE) in perimembranous ventricular septal defect (PmVSD) closure via a left parasternal ultra-minimal trans intercostal incision in children. From January 2015 to December 2020, 212 children with PmVSDs underwent device occlusion via an ultra-minimal trans intercostal incision. TEE was used throughout the perioperative period, including TEE assessment, TEE-guided localization of the puncture site, and TEE guidance. All patients were followed up using transthoracic echocardiography for more than 6 months. A total of 207 cases were successfully occluded, and the success rate was 97.64%. One hundred forty-five patients had a single orifice, and 62 patients had multiple orifices in the aneurysm of the membranous septum (AMS). During the operation, the surgeon readjusted the device or replaced it with a larger device in 17 cases. After the operation, 19 cases of a slight residual shunt, 13 cases of pericardial effusion, and 4 cases of pleural effusion were noted. All patients returned to normal during the 4-month follow-up period. Mild mitral regurgitation was present in one patient and remained the same during the follow-up period. No other complications were found. Under TEE guidance, PmVSDs were closed successfully using a concentric occluder via an ultra-minimal trans intercostal incision. TEE, which was used to assess defects and postoperative effect, effectively guide PmVSDs closure, is of great value.

Long-Term Outcomes of Surgical Repair for Ventricular Septal Defect in Adults.

Data of the outcomes of ventricular septal defect (VSD) closure in adults are limited to establish recommendations. Therefore, we reviewed our experience with surgical VSD closure in adult patients. We retrospectively reviewed 152 patients who underwent surgical VSD closure between January 1996 and April 2020. The median age of the patients was 30.5 [interquartile range (IQR) 23.1-42.7] years. The median follow-up duration was 10.9 (IQR 4.8-16.1) years. VSDs were classified according to the Society of Thoracic Surgeons classification as type 2 (n = 66, 43.4%), type 1 (n = 59, 38.8%), and type 4 (n = 27, 17.8%). Aortic cusp prolapse (n = 86, 56.6%) and aortic valve regurgitation (AR, n = 75, 49.3%) were the most common indications for surgical closure. Four patients underwent late reoperation (2.6%) due to AR, infective endocarditis and residual VSD. In the log-rank test, preoperative trivial or more degree of AR (P = 0.004) and coronary cusp deformity (P = 0.031) was associated with late moderate or greater degree of AR. Preoperative moderate or greater AR was associated with reoperation (P = 0.047). Only concomitant aortic valve (AV) repair at the time of VSD closure was a significant risk factor for late significant AR progression in the multivariable analysis. VSD closure in adults can be performed with low mortality and morbidity rates. AR can progress after VSD closure because the aortic cusp may have irreversible damage from long-standing shunt flow exposure. We conclude that VSD with AV deformity or AR in adults should be treated aggressively before disease progression with irreversible damage occurs.

The role of transesophageal echocardiography in device closure of perimembranous ventricular septal defects with the hybrid approach.

The role of transesophageal echocardiography in device closure of perimembranous ventricular septal defects with the hybrid approach.

Staged correction of pulmonary atresia, ventricular septal defect, and collateral arteries.

ObjectivesPulmonary atresia (PA) with ventricular septal defect (VSD) and systemic‐pulmonary collateral arteries (SPCAs) presents with variable anatomy with regard to the pulmonary vasculature, requiring personalized surgical treatment. A protocol consisting of staged unifocalization and correction was employed.MethodsSince 1989, 39 consecutive patients were included (median age at first operation 13 months). In selected cases, a central aorto‐pulmonary shunt was performed as the first procedure. Unifocalization procedures were performed through a lateral thoracotomy. Correction consisted of shunt takedown, VSD closure, and interposition of an allograft between the right ventricle and the reconstructed pulmonary artery. Echocardiographic data were obtained postoperatively and at interval follow‐up.ResultsIn 39 patients 66 unifocalization procedures were performed. Early mortality was 5%. Seven patients were considered not suitable for correction, of which four have since died. One patient is awaiting further correction. A correction was performed successfully in 28 patients. Operative mortality was 3% and late mortality was 11%. Median follow‐up after the correction was 19 years. Eleven patients required homograft replacement. Freedom from conduit replacement was 88%, 73%, and 60% at 5, 10, and 15 years respectively. Right ventricular function was reasonable or good in 75% of patients. All but one patient were in NYHA Class I or II.ConclusionsAfter complete unifocalization 30/37 patients (81%) were considered correctable. The staged approach of PA, VSD, and SPCAs results in adequate correction and good functional capacity. RV function after correction remains reasonable or good in the majority of patients.

Perimembranous ventricular septal defect closure in infants with KONAR-MF occluder

BackgroundVentricular septal defect (VSD) with significant left to right shunt requires closure. Device closure in Infants with perimembranous VSD and moderate left to right shunt is emerging as an indication in selective cases. ObjectiveAnalysis of infants with moderate perimembranous VSD closed with new KONAR MF occluder. MethodsInfants with perimembranous VSD and moderate left to right shunt who underwent device closure with KONAR MF device (Lifetech Inc., Shenzhen, China) in a tertiary care setup were analyzed retrospectively. ResultsFive infants had perimembranous VSD with moderate left to right shunt. They underwent device closure with a KONAF MF device. The mean age was 7.8 months and the mean defect size was 4.3 mm. The VSD was crossed antegradely in two patients and retrogradely in three patients. All but one patient had an antegrade deployment. The KONAR MF device size ranged from 6–4 mm to 10–8 mm. The device was deployed with either Launcher guiding catheter (Medtronic AVE, Santa Rosa, CA) 5F and 6F or 5F Lifetech delivery system. Successful deployment was possible in all patients. One patient had tilting of the device 3 h after the procedure with significant residual flow. The patient was sent for surgery after combined cardiology and surgical discussion. All other infants had stable device positions. There was no residual flow and no significant aortic regurgitation or any hemolysis. In the mean follow up of 15 months, they were all doing well, had good device performance with no evidence of heart block. ConclusionsDevice closure of moderate sized perimembranous VSD in infants with KONAR MF occluder appeared to be safe and effective in short term follow up. Larger studies with long term data will help with future recommendations.

A comparison of autologous pericardium with Dacron™ for closure of ventricular septal defect in infants.

Glutaraldehyde-treated autologous pericardium (GtAP) and Dacron™ are 2 patch materials commonly used to repair ventricular septal defects (VSDs) in children. The primary objective of this study was to test the hypothesis that GtAP is as effective as Dacron for the repair of isolated VSD in infants. Data were collected retrospectively from all infants who underwent repair of isolated VSD at our institution between January 2009 and April 2017. A total of 156 patients were divided into 2 groups: 99 underwent repair with Dacron patch and 57 with GtAP. The primary end point was the need for reintervention for significant residual VSD. Adjusted hospital charges were also compared. The 2 groups were comparable in their baseline characteristics. There was no significant difference in postoperative morbidity indicators. One patient in each group underwent reintervention for the closure of residual VSD. The GtAP group had a higher incidence trivial and small residual VSD at discharge than the Dacron group (65% vs 39%, P = 0.007). The median duration of follow-up was 37 (15-75) months with no difference between the 2 groups. Forty-five percentage of the residual VSDs in the Dacron group (19/42) and 54%in the GtAP group (21/39) had closed. There was no difference in hospital charges and clinical outcomes. GtAP for the closure of isolated VSD in infants is comparable to Dacron. Although the incidence of trivial or small residual VSD is higher with the use of pericardium immediately after surgery, this difference disappears over time.

Results of the arterial switch operation for Taussig-Bing variants in the setting of a lower-middle income country: A single-institution experience.

This study was conducted to evaluate the surgical results of the arterial switch operation for Taussig-Bing variants, at a single institution in a lower-middle income country. Between June 2010 and December 2018, all consecutive patients diagnosed with Taussig-Bing variants who underwent the arterial switch operation and ventricular septal defect closure were included in the study. A total of 72 patients of Taussig-Bing variants underwent arterial switch operation and ventricular septal defect closure. There were 10 early deaths (13.9%) and 2 late deaths (2.8%). Intraoperative ventricular septal defect enlargement (hazard ratio [HR] 7.23, 95% confidence interval [CI] 3.1294-16.7167; p < .001), secondary aortic cross-clamping (HR 28.38, 95% CI 4.8427-166.3484; p < .001), postoperative pneumonia (HR 5.64, 95% CI 1.2724-24.9917; p = .023), and postoperative sepsis (HR 5.28, 95% CI 1.3512-20.6553; p = .017) were risk factors for overall mortality by competing risk analysis. Sixty patients (83.3%) required septoparietal trabeculation division/resection during the arterial switch operation in an attempt to avoid right ventricular outflow tract obstruction. The reoperation rate for right ventricular outflow tract obstruction at last follow up was 6% (three patients). The estimated freedom from reoperation for right ventricular outflow tract obstruction at 1, 5, and 9 years was 98.3%, 91.9%, and 91.9%, respectively. The results of arterial switch operation for Taussig-Bing variants were satisfactory in the operative setting of a lower-middle income country, and performing extensive septoparietal trabeculation division might reduce the reintervention rate for right ventricular outflow tract obstruction in these patients.