Department of Cardiovascular Surgery, Konkuk University Medical Center, Seoul, Republic of Korea.
Ann Thorac Surg. 2011 Oct;92(4):1490-3. doi: 10.1016/j.athoracsur.2011.04.026. Epub 2011 Aug 12.
Optimal management of muscular ventricular septal defects (MVSD) is still not determined in the current era. Moreover, long-term left ventricular function after closure of MVSD is not well known. Thus, we investigated surgical outcomes including long-term left ventricular function after closure of MVSD through left ventriculotomy.
We conducted a retrospective review of medical records of 20 children who underwent MVSD closure between March 1993 and August 2010. There were 10 boys (50%) and 10 girls (50%). Patient age ranged from 1.6 to 103.4 months (median, 26.4 months), and body weight from 2.8 to 31.5 kg (median, 11.9 kg). Electrocardiogram results were normal sinus rhythm in all except 1 patient with congenital complete atrioventricular block. There were 16 patients who previously had palliative pulmonary artery banding procedures before closure of MVSD. There were 13 patients (65%) with Swiss-cheese type VSD.
There was 1 hospital death of a patient with congenital complete atrioventricular block with pacemaker malfunction (5%). There was 1 late death of a patient with del 22q with adenoviral pneumonia. There was no reoperation. Median follow-up duration was 85.9 months (range, 4.7 to 166.7). The location of MVSD was apical portion in 10 patients (50%) and midtrabecular portion in 9 patients (45%). There were 6 Dacron patch closures and 13 direct closures of MVSD through left ventriculotomy. There was no complete atrioventricular block. Last follow-up echocardiographic data showed normal ejection fraction with 65.2% ± 8.2% after closure of MVSDs. There was no leakage in 8 patients; 11 patients had insignificant leakage, which disappeared spontaneously in 4 patients 17.9 months (median value) after operation.
Our acceptable long-term results of left ventricular function after left ventriculotomy proved that this technique might be a viable option in the management of MVSD.
在当前时代，MVSD 的最佳治疗方法仍未确定。此外，MVSD 闭合后左心室功能的长期预后尚不清楚。因此，我们通过左心室切开术研究了 MVSD 闭合的手术结果，包括长期左心室功能。
我们对 1993 年 3 月至 2010 年 8 月期间接受 MVSD 闭合治疗的 20 名儿童的病历进行了回顾性分析。其中男 10 例（50%），女 10 例（50%）。患者年龄 1.6 至 103.4 个月（中位数 26.4 个月），体重 2.8 至 31.5kg（中位数 11.9kg）。除 1 例先天性完全性房室传导阻滞患者外，其余患者心电图均为窦性心律。16 例患者在 MVSD 闭合前曾行姑息性肺动脉带术。13 例（65%）患者为瑞士奶酪型 VSD。
1 例合并起搏器功能障碍的先天性完全性房室传导阻滞患者在院死亡（5%）。1 例因腺病毒肺炎导致 del 22q 的患者死亡。无再次手术。中位随访时间为 85.9 个月（范围 4.7 至 166.7）。MVSD 的位置 10 例（50%）位于心尖部，9 例（45%）位于间隔部。6 例行涤纶片修补，13 例行左心室切开直接修补 MVSD。无完全性房室传导阻滞。末次随访时超声心动图显示左心室射血分数正常，MVSD 闭合后为 65.2%±8.2%。8 例无残余分流，11 例残余分流较小，4 例患者于术后 17.9 个月（中位数）自然消失。
我们的左心室功能长期结果可接受，证明了左心室切开术在 MVSD 治疗中的可行性。
