Paediatric Heart Centre, Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Chin Med J (Engl). 2013;126(15):2866-70.
Multiple apical muscular ventricular septal defects (VSDs) remain a challenge for surgeons because of their anatomical features. We used single patch with intermediate fixations to repair multiple apical muscular VSDs through right ventriculotomy.
We analysed the data of 16 children (median age 8 months, range 2 months to 144 months) with multiple apical muscular VSDs who underwent a single patch technique via apical right ventriculotomy. Perioperative data were collected and analysed, and the patients were followed up for three months to 66 months (median, 46 months) to investigate the outcomes.
All patients recovered from cardiopulmonary bypass easily with median of cardiopulmonary bypass time 87 minutes and of aortic crossclamp time 53 minutes. No surgically related death occurred and no patient required reoperation. One patient died of pseudomonas pyocyanea infection on day 11 postoperatively. Residual shunt happened in one patient with a diameter of 2 mm and spontaneously closed in 12 months after operation. Two patients presented slightly reduced right ventricular volume and apical hypokinesia postoperatively and recovered 24 and 36 months later respectively. No other complication was found during the three months to 66 months follow-up.
Our experiences using a single patch technique with intermediate fixations via right ventriculotomy in the management of multiple muscular VSDs had favourable outcomes.
由于解剖学特征，多个心尖部肌性室间隔缺损（VSD）仍然是外科医生面临的挑战。我们采用中间固定的单补丁技术通过右心室切开术修复多个心尖部肌性 VSD。
我们分析了 16 例通过心尖部右心室切开术采用单补丁技术治疗的多个心尖部肌性 VSD 患儿（中位年龄 8 个月，范围 2 个月至 144 个月）的数据。收集并分析围手术期数据，并对患者进行 3 个月至 66 个月（中位 46 个月）的随访，以调查结果。
所有患者均顺利脱离体外循环，体外循环时间中位数为 87 分钟，主动脉阻断时间中位数为 53 分钟。无手术相关死亡，无患者需要再次手术。1 例术后第 11 天发生假单胞菌感染死亡。1 例患者存在 2mm 残余分流，术后 12 个月自行闭合。2 例患者术后右心室容积稍小，心尖部运动减弱，分别在 24 个月和 36 个月后恢复。在 3 个月至 66 个月的随访期间未发现其他并发症。
我们采用右心室切开术中间固定的单补丁技术治疗多个肌性 VSD 的经验取得了良好的效果。
