Ventricular septal defect surgery: Difference between revisions
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* Suture techniques include horizontal pledgeted mattress sutures, and running polypropylene suture. | * Suture techniques include horizontal pledgeted mattress sutures, and running polypropylene suture. | ||
* Critical attention is necessary to avoid injury to the conduction system located on the left ventricular side of the | * Critical attention is necessary to avoid injury to the conduction system located on the left ventricular side of the interventricular septum near the [[papillary muscle]] of the conus. | ||
* Care is taken to avoid injury to the [[aortic valve]] with sutures. | * Care is taken to avoid injury to the [[aortic valve]] with sutures. | ||
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AMPLATZER Muscular Occluder VSD is delivered through a catheter. The physician deploys the occluder discs on either side of the defect, closing off the hole | AMPLATZER Muscular Occluder VSD is delivered through a catheter. The physician deploys the occluder discs on either side of the defect, closing off the hole | ||
== ACC/AHA Guideline:Recommendations for Surgical Ventricular Septal Defect Closure(DO NOT EDIT) == | |||
{| class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''Surgeons with training and expertise in congenital heart disease (CHD) should perform VSD closure operations.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''Closure of a VSD is indicated when there is a Qp/Qs (pulmonary–to–systemic blood flow ratio) of 2.0 or more and clinical evidence of left ventricular (LV) volume overload. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''Closure of a VSD is indicated when the patient has a history of infective endocarditis (IE). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki> | |||
|} | |||
{| class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] | |||
|- | |||
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' VSD closure is not recommended in patients with severe irreversible PAH.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki> | |||
|} | |||
{| class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''Closure of a VSD is reasonable when net left-to-right shunting is present at a pulmonary blood flow/systemic blood flow (Qp/Qs) greater than 1.5 with pulmonary artery pressure less than two thirds of systemic pressure and PVR less than two thirds of systemic vascular resistance.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Closure of a VSD is reasonable when net left-to-right shunting is present at a Qp/Qs greater than 1.5 in the presence of LV systolic or diastolic failure.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki> | |||
|} | |||
==References== | ==References== | ||
Revision as of 19:46, 4 October 2012
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Ventricular septal defect Microchapters | |
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Differentiating Ventricular Septal Defect from other Diseases | |
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Diagnosis | |
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ACC/AHA Guidelines for Surgical and Catheter Intervention Follow-Up | |
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Case Studies | |
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Ventricular septal defect surgery On the Web | |
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American Roentgen Ray Society Images of Ventricular septal defect surgery | |
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Risk calculators and risk factors for Ventricular septal defect surgery | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Leida Perez, M.D. ; Associate Editor-In-Chief: Keri Shafer, M.D. [2], Priyamvada Singh, MBBS
Overview
Surgical technique for Repair of Perimembranous VSD
- Perimembranous VSD is repaired on cardiopulmonary bypass with ischemic arrest. Device closure is rarely used in the United States because of the reported incidence of early and late onset complete heart block after device closure, presumably secondary to device trauma to the AV node.
- Surgical exposure is achieved through the right atrium. The tricuspid valve septal leaflet is retracted or incised to expose the defect margins.
- Several patch materials are available, including native pericardium, bovine pericardium, PTFE (Goretex(tm) or Impra(tm), or dacron.
- Suture techniques include horizontal pledgeted mattress sutures, and running polypropylene suture.
- Critical attention is necessary to avoid injury to the conduction system located on the left ventricular side of the interventricular septum near the papillary muscle of the conus.
- Care is taken to avoid injury to the aortic valve with sutures.
- The heart is extensively deaired by venting blood through the aortic cardioplegia site, and by infusing Carbon Dioxide into the operative field to displace air.
- Intraoperative transesophageal echocardiography is used to confirm secure closure of the VSD, function of the aortic valve, ventricular function, and the elimination of all air from the left side of the heart.
- The sternum is closed, with potential placement of a local anesthetic infusion catheter under the fascia, to stabilize postoperative pain control.
Videos
- A video of Perimembranous VSD repair, including the operative technique, and the daily postoperative recovery, can be seen here:
{{#ev:youtube|Uf_tRlG1nMc}}
{{#ev:youtube|I5sRAcOVGiU}}
AMPLATZER Muscular Occluder VSD is delivered through a catheter. The physician deploys the occluder discs on either side of the defect, closing off the hole
ACC/AHA Guideline:Recommendations for Surgical Ventricular Septal Defect Closure(DO NOT EDIT)
| Class I |
| "1.Surgeons with training and expertise in congenital heart disease (CHD) should perform VSD closure operations.(Level of Evidence: B) " |
| "2.Closure of a VSD is indicated when there is a Qp/Qs (pulmonary–to–systemic blood flow ratio) of 2.0 or more and clinical evidence of left ventricular (LV) volume overload. (Level of Evidence: B) " |
| "1.Closure of a VSD is indicated when the patient has a history of infective endocarditis (IE). (Level of Evidence: C) " |
| Class III |
| "1. VSD closure is not recommended in patients with severe irreversible PAH.(Level of Evidence: B) " |
| Class IIa |
| "1.Closure of a VSD is reasonable when net left-to-right shunting is present at a pulmonary blood flow/systemic blood flow (Qp/Qs) greater than 1.5 with pulmonary artery pressure less than two thirds of systemic pressure and PVR less than two thirds of systemic vascular resistance.(Level of Evidence: B) |
| "2. Closure of a VSD is reasonable when net left-to-right shunting is present at a Qp/Qs greater than 1.5 in the presence of LV systolic or diastolic failure.(Level of Evidence: B) " |