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Ann Thorac Surg 2005;79:21-28
© 2005 The Society of Thoracic Surgeons

Original article: Cardiovascular

Flap Valve Double Patch Closure of Ventricular Septal Defects in Children With Increased Pulmonary Vascular Resistance

William M. Novick, MDa,g,*, Nestor Sandoval, MDb,g, Vasiliy V. Lazorhysynets, MD, PhDc, Victor Castillo, MDd, Alexander Baskevitch, MDe, Xiomung Mo, MDf, Robert W. Reid, MDg, Branko Marinovic, MD, PhDh, Thomas G. Di Sessa, MDg,i

a Departments of Surgery and Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
b Department of Cardiac Surgery, Fundacion Abood Shaio, Bogotá, Colombia
c Department of Congenital Surgery, Amosov Institute of Cardiovascular Surgery, Kyiv, Ukraine
d Instituto del Corazon, Santander, Colombia
e Department of Cardiac Surgery, Children's Surgical Center of Minsk, Minsk, Belarus
f Department of Cardiac Surgery, Nanjing Children's Hospital, Nanjing, China
g International Children's Heart Foundation, Memphis, Tennessee, USA
h Department of Pediatrics, Clinical Hospital Center of Zagreb, Zagreb, Croatia
i Department of Pediatrics, University of Kentucky, Lexington, Kentucky, USA

Accepted for publication June 25, 2004.

* Address reprint requests to Dr Novick, 1750 Madison Ave, Suite 100, Memphis, TN 38104 (E-mail: ichfno{at}aol.com).

Presented at the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.

BACKGROUND: Closure of a large ventricular septal defect (VSD) in children with elevated pulmonary vascular resistance (PVR) is associated with significant morbidity and mortality. Sophisticated medications and circulatory assist devices may not be available to assist in the care of children with elevated PVR undergoing VSD closure. We designed a fenestrated flap valve double VSD patch to decrease the morbidity and mortality associated with the closure of a large VSD in this high-risk group.

METHODS: Ninety-one children (median age 4.0 ± 3.1 years) with a large VSD and elevated PVR (10.5 ± 4.9 Wood units) underwent double patch VSD closure. The routine VSD patch was fenestrated (4 to 8 mm), and on the left ventricular side of the patch, a second smaller patch was attached to the upper third of the fenestration before VSD patch placement.

RESULTS: Fifty-six children with a VSD as the primary lesion, 16 with complete atrioventricular canal, 10 with double outlet right ventricle/VSD, 2 with interrupted aortic arch/VSD, 2 with truncus arteriosus, and 1 each with transposition/VSD, corrected transposition/VSD, total anomalous pulmonary venous connection/VSD, VSD/left pulmonary artery atresia, and aortopulmonary window underwent operation; the overall early mortality rate was 7.7% (7 of 91). There have been 7 late deaths: 2 VSD and 5 complex defects.

CONCLUSIONS: Closure of a large VSD with elevated PVR can be performed with reasonable mortality and morbidity.




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