Surgical Treatment of Muscular Ventricular Septal Defect in Infants with Multiple Ventricular Septal Defects_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GAO Botao , ZHENG Jinghao , ZHANG Haibo , CHEN Huiwen , ZHU Zhongqun , XU Zhiwei.

Department of Cardiothoracic Surgery，Shanghai Children’s Medical Center，School of Medicine，Shanghai Jiaotong University，Shanghai 200127，P. R. China;

Corresponding author：

Keywords：

Multiple ventricular septal defect; 　Muscular ventricular septal defect; 　Hybrid closure; 　Residual shunt

DOI：

10.7507/1007-4848.20130083

Video：

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　　Objective To investigate surgical strategy for the treatment of muscular ventricular septal defect （MVSD） in infants with multiple ventricular septal defects（VSD）. Methods Clinical data of 46 infants with multiple VSD who underwent surgical repair in Shanghai Children’s Medical Center from January 2010 to April 2012 were retrospectively analyzed. There were 24 males and 22 females with their age of 8±6 months and body weight of 6.1±1.9 kg. All the patients received one-stage surgical repair，among whom MVSD of 10 patients was not found and repaired during the surgery. MVSD was repaired by surgical suture in 19 patients，hybrid repair under direct vision in 12 patients，and　hybrid repair via the right ventricle in 5 patients. All the patients were regularly followed up after discharge by chest X-ray，ECG and color Doppler echocardiography to observe the closure of MVSD and the presence of residual shunt. Results　All the 46 patients with multiple VSD survived their surgery without perioperative death. Three patients undergoing hybrid repair under direct vision received delayed sternal closure. One patient undergoing hybrid repair under direct vision had postoperative cardiac dysfunction. All the 46 patients were followed up for 1-17 months. Twenty-three patients had residual shunt of varying degrees during follow-up，and most of the MVSD of patients with residual shunt were ＜4 mm，who were receiving further follow-up and evaluation. Conclusion Appropriate surgical strategies can be applied according to specific surgical views during the operation for the treatment of MVSD in infants with multiple VSD，and satisfactory clinical　outcomes can be achieved.

Citation： GAO Botao,ZHENG Jinghao,ZHANG Haibo,CHEN Huiwen,ZHU Zhongqun,XU Zhiwei.. Surgical Treatment of Muscular Ventricular Septal Defect in Infants with Multiple Ventricular Septal Defects. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(3): 260-263. doi: 10.7507/1007-4848.20130083 Copy

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2.	Wollenek G， Wyse R， Sullivan I， et a1. Closure of muscular　ventricular septal defects through a left ventriculotomy. Eur J　Cardiothorac Surg， 1996， 10 （8）：595-598.
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7.	Shin HJ， Jhang WK， Park JJ， et a1. Left ventricular function　after left ventriculotomy for surgical treatment of multiple muscular　ventricular septal defects. Ann Thorac Surg， 2011， 92 （4）： 1490-1493.
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12.	Kitagawa， T， Durham LA Ⅲ ， Mosca RS， et a1. Techniques and results in the management of multiple ventricular septal defects. J Thorac Cardiovasc Surg， 1998， 115 （5）：848-856.
13.	Serraf A， Lacour-Gayet F， Bruniaux J， et a1. Surgical management of isolated multiple ventricular septal defects. J Thorac Cardiovasc Surg， 1992， 103 （2）：437-443.
14.	Van Praagh R， Geva T， Kreutzer J. Ventricular septal defects： how shall we describe， Name and classify them ? J Am Coll Cardiol， 1989， 14 （5）： 1298-1299.
15.	Spevak PJ， Mandell VS， Colan SD， et a1. Reliability of doppler color flow mapping in the identification and localization of multiple ventricular septal defects. Echocardiography， 1993， 10 （6）： 573-581.
16.	陈会文，刘锦纷，张海波，等. 肌部室间隔缺损类型与外科纠治方法探讨. 临床儿科杂志， 2005， 23 （12）：845-847.
17.	Yoshimura N， Matsuhisa H， Otaka S， et a1. Surgical management of multiple ventricular septal defects： the role of the felt sandwich technique. J Thorac Cardiovasc Surg， 2009， 137 （4）： 924-928.
18.	Bendaly EA， Hoyer MH， Breinholt JP. Mid-term follow up of perventricular device closure of muscular ventricular septal defects. Catheter Cardiovasc Interv， 2011， 78 （4）： 577-582.
19.	Pedra CA， Pedra SR， Chaccur P， et a1. Perventricular device closure　of congenital muscular ventricular septal defects. Expert Rev Cardiovasc.
20.	Mroczek T， Kusa J， Kordon Z， et a1. Hybrid， perventricular　closure of muscular ventricular septal defects. Kardiol Pol， 2012， 70 （12）： 1280-1282.
21.	Mo XM， Zuo WS， Ma ZF， et a1. Hybrid procedure with cardiopulmonary bypass for muscular ventricular septal defects in children. Eur J Cardiothorac Surg， 2011， 40 （5）： 1203-1206.
22.	Karimi M， Hulsebus E， Murdison K， et a1. A case of hybrid closure　of a muscular ventricular septal defect： anatomical complexity and surgical management. Cardiol Young， 2012， 22 （3）： 356-359.
23.	张海波，徐志伟，刘锦纷，等. 心内直视杂交封堵肌部多发室间隔缺损. 中国微创外科杂志， 2011， 11 （5）：421-423.
24.	Gan CQ， Lin K， An Q， et a1. Perventricular device closure of　muscular ventricular septal defects on beating hearts： initial experience in eight children. J Thorac Cardiovasc Surg， 2009， 137 （4）： 929-933.
25.	高波涛，郑景浩，陈会文，等.婴幼儿室间隔缺损术后残余分流的自发愈合.中国胸心血管外科临床杂志， 2011， 18 （6）：507-509.
26.	Miglierina E， Santarone M， Corrado G， et a1. Intraventricular muscular septal defect： a possible result of spontaneous closure of interventricular communication. Echocardiography， 2011， 28 （7）： e152-e153.
27.	Asou T. Surgical management of muscular trabecular ventricular septal defects. Gen Thorac Cardiovasc Surg， 2011， 59 （11）： 723-729.

1. Ther， 2010， 8 （5）： 663-674.
2. 　Wollenek G， Wyse R， Sullivan I， et a1. Closure of muscular　ventricular septal defects through a left ventriculotomy. Eur J　Cardiothorac Surg， 1996， 10 （8）：595-598.
3. 　Stellin G， Padalino M， Milanesi O， et a1. Surgical closure of apical ventricular septal defects through a right ventricular apical infundibulotomy. Ann Thorac Surg， 2000， 69 （2）： 597-601.
4. 　García-Valentín A， Congiu S， Mayol J， et a1. Device migration in hybrid technique for apical muscular ventricular septal defects　closure. Interact Cardiovasc Thorac Surg， 2007， 6 （6）： 780-782.
5. 　Ussia GP， Scandura S， Calafiore AM， et a1. Images in cardiovascular medicine. Late device dislodgement after percutaneous closure of mitral prosthesis paravalvular leak with Amplatzer muscular ventri-　cular septal defect occluder.Circulation， 2007， 115 （8）：e208-e210.
6. 　Thakkar B， Patel N， Shah S， et a1. Perventricular device closure of isolated muscular ventricular septal defect in infants： a single centre experience. Indian Heart J， 2012， 64 （6）： 559-567.
7. 　Shin HJ， Jhang WK， Park JJ， et a1. Left ventricular function　after left ventriculotomy for surgical treatment of multiple muscular　ventricular septal defects. Ann Thorac Surg， 2011， 92 （4）： 1490-1493.
8. 　Liu JC， Zhang JZ， Li Q， et a1. Is left ventriculotomy feasible for muscular ventricular septal defects in infants ? Heart Surg Forum， 2008， 11 （2）： e78-e81.
9. 　Koneti NR. Hybrid muscular ventricular septal defect closure：Surgeon or physician. Indian Heart J， 2012， 64 （6）： 568-569.
10. 　Panduranga P， Al-Farqani A， Al-Maskari S. Early migration of an Amplatzer muscular ventricular septal defect occluder device causing severe tricuspid valve obstruction. J Cardiovasc Med （Hagerstown）， 2012， 13 （5）： 336-337.
11. 　Kirklin JK， Castaneda AR， Keane JF， et a1. Surgical management of multiple ventricular septal defects. J Thorac Cardiovasc Surg， 1980， 80 （4）：485-493.
12. 　Kitagawa， T， Durham LA Ⅲ ， Mosca RS， et a1. Techniques and results in the management of multiple ventricular septal defects. J Thorac Cardiovasc Surg， 1998， 115 （5）：848-856.
13. 　Serraf A， Lacour-Gayet F， Bruniaux J， et a1. Surgical management of isolated multiple ventricular septal defects. J Thorac Cardiovasc Surg， 1992， 103 （2）：437-443.
14. 　Van Praagh R， Geva T， Kreutzer J. Ventricular septal defects： how shall we describe， Name and classify them ? J Am Coll Cardiol， 1989， 14 （5）： 1298-1299.
15. 　Spevak PJ， Mandell VS， Colan SD， et a1. Reliability of doppler color flow mapping in the identification and localization of multiple ventricular septal defects. Echocardiography， 1993， 10 （6）： 573-581.
16. 　陈会文，刘锦纷，张海波，等. 肌部室间隔缺损类型与外科纠治方法探讨. 临床儿科杂志， 2005， 23 （12）：845-847.
17. 　Yoshimura N， Matsuhisa H， Otaka S， et a1. Surgical management of multiple ventricular septal defects： the role of the felt sandwich technique. J Thorac Cardiovasc Surg， 2009， 137 （4）： 924-928.
18. 　Bendaly EA， Hoyer MH， Breinholt JP. Mid-term follow up of perventricular device closure of muscular ventricular septal defects. Catheter Cardiovasc Interv， 2011， 78 （4）： 577-582.
19. 　Pedra CA， Pedra SR， Chaccur P， et a1. Perventricular device closure　of congenital muscular ventricular septal defects. Expert Rev Cardiovasc.
20. 　Mroczek T， Kusa J， Kordon Z， et a1. Hybrid， perventricular　closure of muscular ventricular septal defects. Kardiol Pol， 2012， 70 （12）： 1280-1282.
21. 　Mo XM， Zuo WS， Ma ZF， et a1. Hybrid procedure with cardiopulmonary bypass for muscular ventricular septal defects in children. Eur J Cardiothorac Surg， 2011， 40 （5）： 1203-1206.
22. 　Karimi M， Hulsebus E， Murdison K， et a1. A case of hybrid closure　of a muscular ventricular septal defect： anatomical complexity and surgical management. Cardiol Young， 2012， 22 （3）： 356-359.
23. 　张海波，徐志伟，刘锦纷，等. 心内直视杂交封堵肌部多发室间隔缺损. 中国微创外科杂志， 2011， 11 （5）：421-423.
24. 　Gan CQ， Lin K， An Q， et a1. Perventricular device closure of　muscular ventricular septal defects on beating hearts： initial experience in eight children. J Thorac Cardiovasc Surg， 2009， 137 （4）： 929-933.
25. 　高波涛，郑景浩，陈会文，等.婴幼儿室间隔缺损术后残余分流的自发愈合.中国胸心血管外科临床杂志， 2011， 18 （6）：507-509.
26. 　Miglierina E， Santarone M， Corrado G， et a1. Intraventricular muscular septal defect： a possible result of spontaneous closure of interventricular communication. Echocardiography， 2011， 28 （7）： e152-e153.
27. 　Asou T. Surgical management of muscular trabecular ventricular septal defects. Gen Thorac Cardiovasc Surg， 2011， 59 （11）： 723-729.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment of Muscular Ventricular Septal Defect in Infants with Multiple Ventricular Septal Defects

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