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]]


==Overview==
==Surgery==
==Surgery==


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[[Category:Cardiology]]
[[Category:Congenital heart disease]]
[[Category:Pediatrics]]
[[Category:Disease]]
[[Category:Needs overview]]


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Revision as of 18:17, 8 January 2013

Ventricular septal defect Microchapters

Home

Patient Information

Overview

Classification

Pathophysiology

Causes

Differentiating Ventricular Septal Defect from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography

Cardiac Catheterization

Treatment

Medical Therapy

Surgery

Ventricular septal defect post-surgical prognosis

ACC/AHA Guidelines for Surgical and Catheter Intervention Follow-Up

Prevention

ACC/AHA Guidelines for Reproduction

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Ventricular septal defect surgery On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Ventricular septal defect surgery

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Ventricular septal defect surgery

CDC on Ventricular septal defect surgery

Ventricular septal defect surgery in the news

Blogs on Ventricular septal defect surgery

Directions to Hospitals Treating Ventricular septal defect

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.

Videos

  • Shown below is a video of perimembranous VSD repair, including the operative technique, and the daily postoperative recovery.

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{{#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. 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.

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