DEPARTMENT OF CARDIOTHORACIC SURGERY, SHAHEED MADANI HEART HOSPITAL, TABRIZ, IRAN
Objective- Decision making for closure of large ventricular septal defect (VSD) with increased pulmonary vascular resistance (PVR) sometimes is difficult. In this prospective study, we report our experience in patients undergoing closure of large VSD with a valve-patch.
Methods- Between March 1998 and December 2004, acyanotic patients with large VSD and pulmonary artery hypertension were selected for surgery. In all the patients, Cortex patch material was used, and a longitudinal slit (5-8 mm) was made in the middle part of it. A pericardial piece was sewn around the slit on one side of the Cortex patch except in the upper part. Usually via the right atrial approach, the VSD was closed with trimmed Cortex patch with the pericardial valve-patch located on the left ventricular side, allowing it to open for probable right to left shunt.
Results- Sixteen patients with a mean age of 7±5.7 years and PVR of 9.6±3.8 Wood units underwent operation. All the patients were weaned off cardiopulmonary bypass successfully and sedated for at least 18-24 hours. Echocardiography on the same day of operation revealed right to left shunt in 6 cases. Two patients died in the early postoperative period. One child died due to frequent episodes of pulmonary hypertensive crisis and the other with persistent severe pulmonary hypertension and systemic low oxygen saturation. In three years' follow-up, PVR gradually regressed except in one case, in which PVR increased with right-to-left shunt and cyanosis.
Conclusion- Valve patch technique in severe pulmonary artery hypertensive cases is a promising technique to decrease morbidity and mortality; however, in sustained or elevated PVR it may have deleterious effects in the early and late postoperative periods.