A new method to close ventricular septal defect in corrected transposition of the great arteries (SLL)
Kitamura, S.; Oyama, C.; Kawachi, K.; Koh, S.; Miyagi, Y.; Morita, R.; Yamada, Y.; Taniguchi, S.
Nihon Kyobu Geka Gakkai 32(2): 209-215
1984
ISSN/ISBN: 0369-4739 PMID: 6747354 Document Number: 235185
Patch closures of an ASD , pulmonary regurgitation due to infected endocarditis, type A tricuspid valve straddling and dextrocardia. Pulmonary hypertension was also present. A new method to close a VSD without ventriculotomy was attempted. First, the right atrium was incised and through the mitral valve interrupted sutures were placed around only the lower margin of the VSD on the left ventricular side. Then, the aorta was opened and through the aortic valve, similar sutures were placed along only the upper half margin of the VSD from the right ventricular side, so that the conduction bundle in corrected TGA of SLL type was spared injury. Traumatic injury to the tricuspid and aortic valves could also be avoided because there was no need to place sutures on the deeper and lower margin of the VSD. An ellipsoid Teflon was sutured from the right ventricular side cranially to the left ventricular side caudally, passing through the VSD. Additional stitches were required at the point where the patch crossed the VSD margin. A valved conduit from the left ventricle to the pulmonary artery was created in the usual fashion. The patient is now doing well, although a minimal leakage of the patch is observed by postoperative angiocardiography. The new method to close a VSD in corrected TGA has some advantages over the previously described methods, particularly in avoidance of injuries to the conduction bundle and to the tricupsid valve and/or the aortic valve without ventriculotomy. Application of this method to the wide range of VSD in atrioventricular discordant hearts is to be further evaluated.