A simple surgical technique for closure of apical muscular ventricular septal defect

The morphometric study of the moderator band in Thais

A moderator band, also known as the septomarginal trabecula, is a group of muscle bundles located in the ventricle of almost all human hearts. The morphology of the moderator band has various forms and several studies have focused mostly on its structure. Thus, in the present study, we sought to study the morphology and morphometry of the moderator band and tried to rearrange the criteria based on the previous studies to classify the moderator band in Thais. The study investigated 67 formalin-fixed human hearts of both sexes obtained from Thai donors aged 24-101 years with mean age at death 69.92 years. The moderator band was evident in 66 of the 67 specimens (98.51%). The moderator band had the mean or median of overall length, thickness, distance to the base of the tricuspid valve, distance to the base of the pulmonary valve, distance to the apex of the right ventricle, the angle at the septal connection, and angle of the papillary, which were 18.9 ± 6.4 mm, 3.17 (2.04-4.55) mm, 33.0 ± 7.97 mm, 38.8 ± 9.62 mm, 56.4 ± 8.09 mm, 50 (30-105)°, 73.9 ± 30.1°, respectively. The mean distance originating point from the supraventricular crest to the anterior papillary muscle was 0.396 ± 0.07 of the distance from the base of the tricuspid valve to the apex of the right ventricle. Our present classification found that crest-like and thick moderator band with complex secondary branching at high origin (type IVc), and low origin (type IVd) were the most common subtypes. This study provided both anatomical and clinical information that should be useful in cardiac surgery, radiology, and cardiac electrophysiological interventions.

A novel surgical technique to address post septal myectomy ventricular septal defect

Iatrogenic ventricular septal defect is a rare complication in patients undergoing septal myectomy for hypertrophic obstructive cardiomyopathy and it necessitates closure in the post-operative period. We describe a novel surgical technique for closure of the ventricular septal defect using a biventricular approach with a custom made Polytetrafluoroethylene device. Our method is easily reproducible.

Surgical closure of multiple large apical ventricular septal defects: how we do it

The management of apical ventricular septal defects continues to be challenging because of the difficulty in achieving a complete closure without a left apical ventriculotomy. In this study, we present our innovative technique of closing multiple and/or large muscular apical ventricular septal defects through a right atriotomy. We operated three patients with multiple apical muscular trabecular ventricular septal defects ("Swiss cheese") using a technique that involved exclusion of the right ventricular apex. Their ages ranged between 2 months and 13 years. The VSDs were approached through right atriotomy. The trans right atrial approach using a 5-0 polypropylene purse-string suture or a two-patch procedure is a novel method of closing large apical ventricular septal defects. It was found to be effective with no persistent residual defects and did not have the disadvantages of a ventriculotomy.

A Simple Technique for Closing Multiple Muscular and Apical Ventricular Septal Defects

BACKGROUND

Multiple ventricular septal defects (VSDs) are difficult to close. In this report, we describe a simple and safe technique of closing multiple muscular and apical VSDs.

METHODS

Between January 2010 and December 2013, 52 patients with a muscular VSD either in isolation or in association with other congenital heart disease underwent surgery using this technique in which a black silk thread was passed through the suspected VSD opening into the left ventricle and brought out through the mitral valve and the interatrial septum. Sutures were placed around the silk thread to close the VSD.

RESULTS

Out of 52 patients, 34 were male; age ranged from 45 days to 5.5 years. In addition to the large subaortic/lage muscular VSD, three additional VSDs were present in 34 patients, two additional VSDs were present in 13 patients, and five patients had "Swiss Cheese septum." The VSDs were mid-muscular in 35 patients and were apical in 17 patients. Eleven patients had associated complex lesions. Intraoperative transesophageal echocardiograms did not reveal any significant residual shunt in any of these patients. There was no step-up on oximetry. There was one hospital death due to sepsis. Follow-up was available in 48 patients; three patients were lost to follow-up. At follow-up, no patient had a residual VSD.

CONCLUSION

The biventricular approach through trans-right atrial, trans-interatrial septum using a thread through the hole method for closing multiple muscular VSD is effective with no persistent residual defects.