Ann Thorac Surg 2004;77:2259-2260
© 2004 The Society of Thoracic Surgeons
Correspondence
Shallow stitch close to the rim of the ventricular septal defect after pulmonary artery banding
Takaaki Sugita, MD,
Masahiko Matsumoto, MD,
Jyunichirou Nishizawa, MD,
Katsuhiko Matsuyama, MD,
Yujirou Kawanishi, MD,
Kyoukun Uehara, MD
Department of Cardiovascular Surgery, Tenri Hospital, 200 Mishima, Tenri, Nara, 632-8552 Japan
e-mail: taandsa{at}maple.ocn.ne.jp
To the Editor:
We read with great interest the article by Fukuda and colleagues [1] who reported that a shallow stitch close to the rim of a ventricular septal defect (VSD) eliminated injury to the right bundle branch. Based on their presentation in Japan, we used the technique for closure of a VSD without malalignment in a series of 23 patients, 2 of whom had previously undergone extended aortic arch anastomosis and pulmonary artery banding (PAB). No early or late operative deaths occurred, and reoperation for a residual defect was not required. Patient age at operation was 10 to 24 months, with a median age of 12 months.
Postoperative Doppler echocardiography revealed a small, hemodynamically insignificant residual shunt in 5 patients. However, the residual shunt disappeared spontaneously in 4 of the 5 patients and decreased to trivial in the remaining patient at 6 to 12 
postoperatively.
Preoperatively, all patients showed regular sinus rhythm and normal duration of the QRS complex. Postoperatively, none of the patients developed complete atrioventricular block. Complete right bundle branch block without left axis deviation occurred in the 2 patients who underwent PAB previously, and in no patients who did not have previous PAB.
Thus, the novel suturing method reported by Fukuda and colleagues is extremely effective for the closure of an ordinary VSD, but is less effective for the closure of a VSD after PAB. We suspect that septal hypertrophy following PAB poses technical obstacles to this suturing method (Fig 1).
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Fig 1. A schematic drawing of the inferior rim of the perimembranous ventricular septal defect viewed from the posterior right ventricular cavity. The septum is divided at the level where the right bundle branch arises from the His bundle. Two stitches are shown on each side of the figure, with the left side indicating novel suturing method for ordinary ventricular septal defect and the right side for ventricular septal defect with hypertrophy following pulmonary artery banding.
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References
- Fukuda T., Suzuki T., Kashima I., Sato M., Morikawa Y. Shallow stitching close to the rim of the ventricular septal defect eliminates injury to the right bundle branch. Ann Thorac Surg 2002;74:550-555.[Abstract/Free Full Text]
