Ann Thorac Surg 2000;70:274-275
© 2000 The Society of Thoracic Surgeons
Invited commentary
Invited commentary
Willard M. Daggett, MDa
a Department of Surgery, Massachusetts General Hospital, Bulfinch 119, Boston, MA 02114, USA
e-mail: dailey.stephanie{at}mgh.harvard.edu
This case report of a technique for ventricular septal rupture repair by Ito and colleagues is not entirely new in terms of a large patch covering the entire septum, that aspect of the technique having been first reported by Iben and coworkers from Stanford many years ago. What is new about this technique are the through-and-through sutures used to fix the septal patch, the sutures being brought through the ventricle on the side opposite the infarct. This method overcomes a weakness in the David technique, which is an application of the Vincent Dorr principle of infarct exclusion, wherein the weak point is along the base of the septum, an area in which sutures may tear out. We have modified David’s technique, as suggested by Cooley, by bringing sutures through theventricular septal defect from right to left using pledgets on the right ventricular side of the septum posteriorly. The through-and-through ventricular suture technique proposed by Ito and colleagues is interesting and may well have merit, although clearly the experience with this technique needs verification. The authors do accurately identify a point of vulnerability in Tirone David’s repair and have proposed a potentially practical solution to that problem.
Related Article
-
Entire septal patch technique for postinfarction ventricular septal rupture
- Toshiaki lto, Hiroaki Hagiwara, and Atsuo Maekawa
Ann. Thorac. Surg. 2000 70: 273-274.
[Abstract]
[Full Text]
[PDF]
