Intraoperative customized double-patch device with twin sutures for multiple muscular septal defects

Interact Cardiovasc Thorac Surg. 2018 Sep 1;27(3):402-409. doi: 10.1093/icvts/ivy092.


Objectives: Closure of multiple muscular ventricular septal defects (VSDs) remains a challenge because of anatomical complexity.

Methods: We mapped all the VSDs using en face reconstruction of the right ventricular septal surface through echocardiography and then performed an 'Intraoperative Customized Double-Patch Device' technique to surgically close them in 39 patients (male:female = 25:14). The median age of the patients was 6 months (2 months-10 years), and mean weight was 5.98 ± 4.21 kg. A patch of polytetrafluoroethylene was placed on the left ventricular side of the defect and another on the right ventricular side, and they were anchored to each other using 2 polypropylene sutures. Residual shunts were evaluated using intraoperative echocardiography and measurements of right atrial-pulmonary arterial saturation were taken in all patients.

Results: The distribution of muscular VSDs was as follows: anterior muscular 12, posterior muscular 18, mid-muscular 11 and apical 9. The associated lesions included perimembranous VSD (n = 28), tetralogy of Fallot (n = 6), double-outlet right ventricle (n = 2) and supramitral membrane (n = 2). Mean clamp time and bypass time were 93 ± 19 min and 147 ± 26 min, respectively. Mean hospital stay was 11 ± 3.39 days with no in-hospital mortality. Five patients with significant residual shunts needed concomitant PA banding. All patients remained in New York Heart Association Class I. There was either no residual shunt (n = 3) or trivial shunt (n = 2) among the banded patients. All patients remained symptom-free and continued to thrive well at the most recent follow-up (3.48 ± 1.51 years).

Conclusions: Muscular VSDs can be mapped through en face reconstruction and closed using intraoperative customized double-patch device technique in a variety of situations with satisfactory immediate and short-term results.

MeSH terms

  • Cardiovascular Surgical Procedures / instrumentation*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Echocardiography
  • Female
  • Heart Septal Defects, Ventricular / surgery*
  • Humans
  • Infant
  • Male
  • Prostheses and Implants
  • Sutures*
  • Treatment Outcome