Ventricular septal defect surgery: Difference between revisions
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{{CMG}}, Leida Perez, M.D. ; '''Associate Editor-In-Chief:''' [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu], [[Priyamvada Singh]], [[MBBS]] | {{CMG}}, Leida Perez, M.D. ; '''Associate Editor-In-Chief:''' [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu], [[Priyamvada Singh]], [[MBBS]] | ||
==Surgery== | ==Surgery== | ||
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[[Category:Cardiology]] | |||
[[Category:Congenital heart disease]] | |||
[[Category:Pediatrics]] | |||
[[Category:Disease]] | |||
[[Category:Needs overview]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 18:17, 8 January 2013
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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
Surgery
- Muscular and membranous defects usually close spontaneously
- 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.
- Subaortic and subpulmonary defects even if small should be closed to prevent aortic regurgitation and pulmonary regurgitation.
Videos
- Shown below is a video of perimembranous VSD repair, including the operative technique, and the daily postoperative recovery.
{{#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
2008 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)[1]
Recommendations for Surgical Ventricular Septal Defect Closure (DO NOT EDIT)[1]
| Class I |
| "1. Surgeons with training and expertise in congenital heart disease (CHD) should perform VSD closure operations.(Level of Evidence: C) " |
| "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) " |
| "3. 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) " |
References
- ↑ 1.0 1.1 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.