Unidirectional valved patch closure of ventricular septal defects with severe pulmonary arterial hypertension

作者：Talwar Sachin^*; Choudhary Shiv Kumar; Garg Sanket; Saxena Anita; Ramakrishnan Sivasubramanian; Kothari Shyam Sunder; Juneja Rajnish; Airan Balram

来源：Interactive Cardiovascular and Thoracic Surgery, 2012, 14(6): 699-702.

DOI：10.1093/icvts/ivs044

• Ventricular septal defect
• Pulmonary hypertension
• Pulmonary vascular resistance

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.

• 出版日期2012-6
• 单位河北医科大学