Talwar Sachin, Choudhary Shiv Kumar, Garg Sanket, Saxena Anita, Ramakrishnan Sivasubramanian, Kothari Shyam Sunder, Juneja Rajnish, Airan Balram
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Interact Cardiovasc Thorac Surg. 2012 Jun;14(6):699-702. doi: 10.1093/icvts/ivs044. Epub 2012 Mar 8.
Delayed presentation of ventricular septal defect (VSD) is common in developing countries. Such patients often have severe pulmonary arterial hypertension (PAH), which increases post-operative morbidity and mortality. To address these problems, we used our technique of unidirectional valved patch (UVP) for closure of VSD. Between January 2006 and December 2010, 17 patients (age 2-23 years, median 9 years) with a large VSD and severe PAH underwent VSD closure with UVP. Pre-operative mean indexed pulmonary vascular resistance (PVRI) was 10.9 ± 2.2 Wood units and mean pre-operative systemic saturation was 93.4 ± 2.6%. Shunt was bidirectional in 15 patients and predominantly right to left in two. After VSD closure, intra-operative transoesophageal echocardiography revealed a right to left shunt across the patch in three patients 2, 7 and 9 years of age who had pre-operative PVRI of 9.5, 9.8 and 11.1 Wood units, respectively. There were no in-hospital deaths and all patients had uneventful recovery. Mean follow-up was 30 ± 14.7 months and all patients are well without cyanosis. Echocardiography showed no shunt across the patch and all have systemic saturation >95%. We conclude that UVP is a promising technique in patients with large VSD and severe PAH.
室间隔缺损（VSD）延迟就诊在发展中国家很常见。这类患者往往患有严重的肺动脉高压（PAH），这会增加术后的发病率和死亡率。为了解决这些问题，我们采用了单向带瓣补片（UVP）技术来闭合VSD。在2006年1月至2010年12月期间，17例（年龄2至23岁，中位数9岁）患有大型VSD和严重PAH的患者接受了UVP闭合VSD手术。术前平均肺血管阻力指数（PVRI）为10.9±2.2伍德单位，术前平均体循环饱和度为93.4±2.6%。15例患者存在双向分流，2例主要为右向左分流。VSD闭合后，术中经食管超声心动图显示，3例年龄分别为2岁、7岁和9岁的患者，术前PVRI分别为9.5、9.8和11.1伍德单位，补片处存在右向左分流。无院内死亡病例，所有患者恢复顺利。平均随访30±14.7个月，所有患者情况良好，无发绀。超声心动图显示补片处无分流，所有患者体循环饱和度>95%。我们得出结论，UVP对于大型VSD和严重PAH患者是一种有前景的技术。
