A right atrial approach in redo postinfarction ventricular septal defect.

Despite improvements in surgical techniques, post-infarction ventricular septal defect remains a surgical challenge that is associated with significant early and late mortality. Furthermore, the recurrence of the defect after primary correction occurs in approximately 10-25% of patients, and the operative risk increases because of a difficult dissection that is often complicated by previous patent grafts. The repair of recurrent ventricular septal defect has generally been performed by ventriculotomy in the infarcted zone. The authors propose an alternative approach that, when the rupture is posterior, allows its complete visualization, and avoids any further ventriculotomy in an already impaired ventricle.     

Coronary sinus atrial septal defect diagnosed by cyanosis after operation of ventricular septal defect

We have experienced a case of coronary sinus atrial septal defect (ASD) with ventricular septal defect (VSD). Cardiac catheterization revealed a step-up of oxygen saturation in right ventricle, L-R shunt 70.3%, R-L shunt 6.9% and pulmonary hypertension (PH). Since diagnosis of coronary sinus ASD was difficult, the operation was performed under diagnosis of VSD. Although the operation was success, cyanosis appeared after the operation. Contrast echocardiography using subcostal 4 chamber view showed coronary sinus ASD with a large Thebesian valve and the right-to-left shunt of the ASD. The Thebesian valve seemed to lead the venous return flow to the left atrium. Coronary sinus ASD was closed using a Xenomedica patch.     

Combined perventricular closure of ventricular septal defect and atrial septal defect via lower ministernotomy

Background

Minimally invasive approaches such as perventricular closure of ventricular septal defects (VSD) have been applied for the surgical correction of congenital heart defects in order to avoid disadvantages related to median sternotomy with a cardiopulmonary bypass (CPB). However, reports remain scarce regarding combined perventricular closure of VSD and atrial septal defects (ASD) via minimally invasive approaches, such as lower ministernotomy.

Results

The authors have operated on 5 patients who were diagnosed with VSD in association with ASD, successfully realizing perventricular closure via lower ministernotomy.

Conclusion

The proposed technique proved to be safe and effective.

     

Double-outlet right ventricle with non-committed ventricular septal defect

Objective: The term non-committed was used to define hearts in which the VSD was anatomically related to, or was close to, neither great vessel, being separated from both by considerable muscle. We report our experience of the surgical management of this subset, considered being of particular surgical relevance. Methods: Between January 1987 and December 1997, 23 patients having double-outlet right ventricle (DORV) with non-committed VSD underwent biventricular repair. Nine (39%) had undergone previous palliation. The median age was 20 months and the median weight was 8.5 kg. Two main types of repair were used: intraventricular baffle repair (n=21) and arterial switch operation with VSD to pulmonary artery baffle (n=2). At repair, 12 (52%) patients required concomitant VSD enlargement. In two other patients presenting with restrictive inlet VSD associated with tricuspid attachments, crossing the subaortic pathway biventricular repair was abandoned at operation. Results: There were two hospital deaths (9%, 70% CL: 3–19%). Eight patients (35%, 70% CL: 23–48%) underwent nine reoperations, six for subaortic stenosis. No late death occurred. At last visit, all patients were asymptomatic and only two had cardiac medication. Conclusions: The biventricular repair of DORV with non-committed VSD is feasible in the vast majority of cases with comparable results to other subsets of DORV. After repair, the subaortic region is at risk for development of subaortic stenosis.     

Reoperation for prosthetic ventricular septal defect patch endocarditis: long-term results with an autologous atrial septal patch

Treatment of prosthetic patch endocarditis after closure of a ventricular septal defect is challenging. It is essential to reduce inflammation and prevent recurrence of endocarditis. We report a successful case of reclosure of a ventricular septal defect using an autologous atrial septal patch taken from the fossa ovalis. There were no complications, and the long-term results were satisfactory. The autologous septal patch might be a promising material for prosthetic patch endocarditis.     

Delayed repair of an acquired posterior septal defect through a right atrial approach

A patient with chronic postinfarction ventricular septal defect located posteriorly is described. The right atrial approach is suggested for these defects and the operative differences between chronic and acute defects are discussed.     

Right ventricular size and ventricular septal motion after repair of atrial septal defect in children

An enlarged right ventricle and abnormal ventricular septal motion are characteristic echocardiographic features of atrial septal defect and often persist after the defect has been completely closed, even when the operation clinically is judged to be successful. These features were examined retrospectively 15 to 21 months after operation in a group of children whose atrial septal defect had been closed between January 1976 and July 1979. Despite satisfactory postoperative results in all, about two thirds had an enlarged right ventricular dimension and about the same number had abnormal septal motion when examined echocardiographically an average of 18 months after operation. The best operative strategy seems to be to operate while the right ventricular end-diastolic dimension is still relatively small in echocardiographic terms.     

Surgery for ventricular septal defect

Of 255 patients undergoing closure of ventricular septal defect (VSD), 48% were younger than 2 years, 59% had associated cardiac and 26% non-cardiac abnormality, 13% had multiple, and only 29% isolated VSD. VSD was closed via the left ventricular apex in seven cases, without increased morbidity or mortality. The three early and six late deaths occurred in patients with complicated defects. Pulmonary vascular occlusive disease caused four deaths (1 early, 3 late). At follow-up (mean c. 3, range 1-11 years), 79% of the patients were well, 10% had cardiac symptoms and 7.5% had symptoms from associated noncardiac anomalies. Reoperation for significant residual VSD was required in 12 cases (4 single and 8 multiple VSD). Complete, pacemaker-requiring A-V block was found in four patients (none with simple VSD closure). It is concluded that 1) concomitant cardiac and non-cardiac lesions are common in VSD, 2) mortality is closely related to such lesions and to pulmonary vascular occlusive disease, 3) the latter is a rare, but real cause of death, 4) left ventricular approach need not increase mortality or morbidity, 5) significant residual VSD is rare after single, but common in multiple VSD, and 6) risk of complete A-V block after simple VSD closure is very low.     

Noonan syndrome associated with atrial septal defect, ventricular septal defect and pulmonary stenosis--a case report

A 10 year old girl with diagnosis of Noonan syndrome was admitted to our hospital because of easy fatiguability and cardiac murmur. She had a peculiar face with hypertelorism, saddle nose, webbed neck and kyphosis. Chromosomal analysis demonstrated normal 46 XX pattern. Associated cardiac anomalies in this case were atrial septal defect, ventricular septal defect and pulmonary stenosis caused by pulmonary valvular dysplasia. The cardiac anomalies were corrected successfully and postoperative clinical course was uneventful.     

A case report: successful direct closure of atrial septal defect in isolated right ventricular hypoplasia]

We experienced a surgery for an isolated right ventricular hypoplasia with atrial septal defect (ASD). The patient, 3 1/2-year-old girl, underwent direct closure of ASD. Preoperatively right ventricular end diastolic volume was 18 ml or 22 ml including trabecular portion by angiocardiographic examination. It was almost a half of normal. We performed intraoperative ASD occlusion test using a Foley 12 F balloon catheter before surgical closure of ASD. Postoperatively, mild right pleural effusion was found, but it disappeared soon with a use of diuretics. ASD occlusion test was safe and useful for estimating surgical closure of ASD. Postoperative cardiac catheterization revealed slight increase of right atrial pressure. It is necessary to follow up her condition carefully.     

Congenital pericardial defect associated with atrial and ventricular septal defects

Congenital pericardial defects are rare anomalies but in recent years improved diagnostic techniques have often led to a pre-operative diagnosis. The present communication describes a case of a partial pericardial defect with herniation of the lung into the pericardium associated with a lung cyst which is extremely rare. The sternum showed some deficiency in its lower portion. Atrial and ventricular septal defects with a small pericardio-peritoneal foramen were also present.