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Surgery for doubly committed ventricular septal defects

Lookup NU author(s): Professor Bob Anderson


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OBJECTIVES: Doubly committed ventricular septal defects (VSDs) account for up to almost one-third of isolated ventricular septal defects in Asian countries, compared with only 1/20th in western populations. In our surgical experience, this type of defect accounted for almost three-quarters of our practice. To date, patch closure has been considered the gold standard for surgical treatment of these lesions. Our objectives are to evaluate the indications and examine the outcomes of surgery for doubly committed VSDs.METHODS: Between October 2013, when our service of paediatric cardiac surgery was opened, and December 2014, 24 patients were referred for surgical closure of VSDs. Among them, 17 patients (71%), with the median age of 6 years, ranging from 2 to 9 years, and with a median body weight of 19 kg, ranging from 11 to 56 kg, underwent surgical repair for doubly committed defects. In terms of size, the defect was considered moderate in 4 and large in 13. Aortic valvular regurgitation (AoVR) was present in 11 patients (65%) preoperatively, with associated malformations found in 14 (82%), with 5 patients (29%) having two or more associated defects.RESULTS: After surgery, there was trivial residual shunting in 2 patients (12%). AoVR persisted in 6 (35%), reducing to trivial in 5 (29%) and mild in 1 (6%). Mean stays in the intensive care unit and hospital were 2.6 +/- 1.2 days, ranging from 2 to 7 days, and 6.8 +/- 0.8 days, ranging from 6 to 9 days, respectively. The mean follow-up was 14 +/- 4 months, ranging from 6 to 20 months, with no early or late deaths and without clinical deterioration.CONCLUSIONS: The incidence of doubly committed lesions is high in our experience, frequently associated with AoVR and other associated malformation. Early detection is crucial to prevent further progression of the disease. Patch closure remains the gold standard in management, not least since it allows simultaneous repair of associated intracardiac defects.

Publication metadata

Author(s): Shamsuddin AM, Chen YC, Wong AR, Le TP, Anderson RH, Corno AF

Publication type: Article

Publication status: Published

Journal: Interactive Cardiovascular and Thoracic Surgery

Year: 2016

Volume: 23

Issue: 2

Pages: 231-234

Print publication date: 01/08/2016

Online publication date: 11/05/2016

Acceptance date: 09/04/2016

ISSN (print): 1569-9293

ISSN (electronic): 1569-9285

Publisher: Oxford University Press


DOI: 10.1093/icvts/ivw129


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