Flap valve double patch closure of ventricular septal defects in children with increased pulmonary vascular resistance

被引:64
作者
Novick, WM
Sandoval, N
Lazorhysynets, VV
Castillo, V
Baskevitch, A
Mo, XM
Reid, RW
Marinovic, B
Di Sessa, TG
机构
[1] Univ Kentucky, Dept Pediat, Lexington, KY USA
[2] Univ Zagreb, Dept Pediat, Clin Hosp Ctr, Zagreb, Croatia
[3] Int Childrens Heart Fdn, Memphis, TN USA
[4] Nanjing Childrens Hosp, Dept Cardiac Surg, Nanjing, Peoples R China
[5] Childrens Surg Ctr Minsk, Dept Cardiac Surg, Minsk, BELARUS
[6] Inst Corazon, Santander, Colombia
[7] Amosov Inst Cardiovasc Surg, Dept Congenital Surg, Kiev, Ukraine
[8] Fdn Abood Shaio, Dept Cardiac Surg, Bogota, Colombia
[9] Univ Tennessee, Ctr Hlth Sci, Dept Surg, Memphis, TN 38163 USA
[10] Univ Tennessee, Ctr Hlth Sci, Dept Pediat, Memphis, TN 38163 USA
关键词
D O I
10.1016/j.athoracsur.2004.06.107
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Closure of a large ventricular septal defect (VSD) in children with elevated pulmonary vascular resistance (PVR) is associated with significant morbidity and mortality. Sophisticated medications and circulatory assist devices may not be available to assist in the care of children with elevated PVR undergoing VSD closure. We designed a fenestrated flap valve double VSD patch to decrease the morbidity and mortality associated with the closure of a large VSD in this high-risk group. Methods. Ninety-one children (median age 4.0 +/- 3.1 years) with a large VSD and elevated PVR (10.5 +/- 4.9 Wood units) underwent double patch VSD closure. The routine VSD patch was fenestrated (4 to 8 mm), and on the left ventricular side of the patch, a second smaller patch was attached to the upper third of the fenestration before VSD patch placement. Results. Fifty-six children with a VSD as the primary lesion, 16 with complete atrioventricular canal, 10 with double outlet right ventricle/VSD, 2 with interrupted aortic arch/VSD, 2 with truncus arteriosus, and 1 each with transpositiort/VSD, corrected transposition/VSD, total anomalous pulmonary venous connection/VSD, VSD/left pulmonary artery atresia, and aortopulmonary window underwent operation; the overall early mortality rate was 7.7% (7 of 91). There have been 7 late deaths: 2 VSD and 5 complex defects. Conclusions. Closure of a large VSD with elevated PVR can be performed with reasonable mortality and morbidity.
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页码:21 / 28
页数:8
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