Closure of muscular ventricular septal defects through a left ventriculotomy

Received: 29 May 1995 Accepted: 25 October 1995 G. Wollenek i . R. Wyse - 1. Sullivan - M. Elliott • M. de Leval - J. Stark (~) Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK Present address: 1Allgemeines Krankenhaus der Stadt Wien, Universit~tskhnik f/Jr Chirurgie, A-1090 Vienna, Austria Abstract Objective. To evaluate the results of closure of muscular ventri- cular septal defects through a left thoracotomy. Methods. Records of 23 children ope- rated consecutively between 1972 and 1990 were studied. Age of patients was 2_8_+3 years (2 months-10 years), weight 8.9_+5.7 kg (2.6-22 kg). Ten patients (43%) had undergone one and 4 patients (17%) two previous cardiac operations. Late follow-up was obtained from direct examination of patients or from reports of their re- ferring physicians. Bypass time was 89_+28 rain (66-167 rain). The aorta was cross-clamped for 44+15 min (21-66 rain). Until 1977 operations were performed with moderate hypo- thermia and intermittent aortic cross- clamping. After 1978 deep hypother- mia (20-25°C) and cold crystalloid cardioplegia was used. Ventricular septal defects not accessible from other approaches were closed through a small fish-mouth incision in the apex of the left ventricle. Patients' data were sampled and stored in a computerised database_ Risk factors were evaluated by stepwise logistic regression. Results. Four patients died in the hos- pital (17%); two died later_ Two re- quired reoperation for residual/recur- rent defects. All patients, except two from abroad, were available for fol- low-up, which ranged from 36 months to 18 years (mean 11.3 years). All were in NYHA class 1. Only two risk factors were identified: the number of ventricular septal defects (P<0.05) and associated atrial septal defect (P<0.02). Early echocardiographic evaluation showed good LV size and function in all except one patient, who had a perioperative septal infarc- tion. Late echocardiography per- formed in six patients demonstrated normal LV shortening without evi- dence of regional wall abnormality. Conclusions. Left ventriculotomy is a useful approach for closure of low muscular ventricular septal defects in selected patients_ [Eur J Cardio-tho- rac Surg (1996) 10: 595-598] Key words Muscular ventricular septal defects • Left ventriculotomy • Open heart surgery