Minimally Invasive Cardiac Surgery Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy.
Multimed Man Cardiothorac Surg. 2021 Nov 4;2021. doi: 10.1510/mmcts.2021.072.
After a median full sternotomy, cardiopulmonary bypass is installed in the usual manner. Apical ventriculotomy is performed through the infarcted myocardium. Polypropylene pledgeted mattress sutures are passed from the right to the left ventricular side through the ventricular septal defect, with the pledgets remaining on the right ventricle. Great care must be taken to place the suture on healthy myocardium and away from the edge of the ventricular septal defect; otherwise the chances of a recurrent postoperative ventricular septal defect would increase. The sutures are subsequently positioned through a heterologous patch, previously prepared to be appropriate for the ventricular septal defect closure. A collar of 3 to 4 cm is left on the external side of the patch. A 4-0 polypropylene running suture is placed through this collar and the left ventricle to further reinforce the ventricular septal defect closure. The left ventricular incision is closed with polypropylene 3-0 continuous sutures. For each ventricular edge, the running suture is passed through 2 polytetrafluoroethylene felts: one on the endoventricular side and the other on the epicardial side. Finally, the suture line is reinforced with a continuous 2-0 polypropylene suture, which is passed through the polytetrafluoroethylene felts, the ventricular wall, and the heterologous patch used to close the ventricular septal defect.
经正中胸骨切开后，以常规方式安装体外循环。通过梗死心肌进行心尖室壁切开术。通过室间隔缺损从右心室向左侧传递带垫片的聚丙烯褥式缝线，垫片保留在右心室。必须小心将缝线置于健康心肌上并远离室间隔缺损边缘，否则会增加术后室间隔缺损复发的几率。随后，缝线穿过先前准备好的合适的异种补片穿过，以适当闭合室间隔缺损。在补片的外侧留下 3 到 4 厘米的领状结构。通过此领状结构和左心室放置 4-0 聚丙烯连续缝线，进一步加强室间隔缺损闭合。用聚丙烯 3-0 连续缝线关闭左心室切口。对于每个心室边缘，连续缝线穿过两个聚四氟乙烯毡片：一个在内室面，另一个在心外膜面。最后，缝线用连续 2-0 聚丙烯缝线加强，缝线穿过聚四氟乙烯毡片、心室壁和用于闭合室间隔缺损的异种补片。
