| Abstract: | To be correctly done, closure of a ventricular septal defect must be sound, and must also avoid damage to the conducting tissue. These two essentials are somewhat contradictory, since in order to avoid the bundle of His in its position along the postero-inferior edge of the ventricular septal defect (VSD) in the membranous septum, the sutures inserted into this region must be superficial, and therefore weak. It is for this reason that the published series continue to show evidence of a significant number of post-operative shunts and atrio-ventricular blocks, as much in the closure of isolated VSDs as in the treatment of Fallot's tetralogy. This paper compares two techniques of suturing the prosthetic material which is used to close the VSD: the classical technique, in which it is intended to avoid the bundle of His by working below it, on the right side of the interventricular septum, and a different technique in which the sutures are applied directly to the free edge of the interventricular communication. |
