Double Patch Closure of VSD with Elevated Pulmonary Artery Pressure

Abstract

  Background A VSD is defined as an opening or hole in the inter vevtricular septum of the heart. Isolated VSDs occur in approximately 2 of every 1000 live births and constitute over 20 percent of all congenital heart defect ⁽¹⁾ The diagnosis and surgical treatment of children with a large VSD is frequently delayed in many countries throughout the world ⁽²⁾. Closure of a large ventricular septal defect (VSD) in children with elevated pulmonary  artery pressure is associated with significant morbidity and mortality.⁽³⁾ Pulmonary hypertensive episodes continue to be a major cause of postoperative morbidity and mortality. We designed a fenestrated flap valve double VSD patch in an effort to decrease the morbidity and mortality associated with the closure of a large VSD with elevated pulmonary arterial pressure.⁽⁴⁾                                                                                                                             Methods Twenty three patients (mean age, 6 years) with a large VSD and elevated pulmonary vascular resistance ,14 patients were male and 9 patients were female , underwent double patch VSD closure using moderately hypothermic cardiopulmonary bypass and cardioplegic arrest. The routine VSD patch was fenestrated (half of calculated aortic size) and on the left ventricular side of the patch, a second, smaller patch was attached to the fenestration along its superior margin before closure of the   VSD^{(5) .}              fig (1&2)                                                                                      .